Neurological Management of Persons Living with HIV*

Date/Time: Sunday, September 10, 2023 - 11:45 AM – 12:45 PM
Track: Interactive Lunch Workshop
Room: Franklin Hall 4 (4th Floor)
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Chair: Beau Ances, MD, PhD, MSc, FANA

Co-Chair: Felicia Chow, MD, MAS

HIV is a leading cause of cognitive impairment worldwide in persons less than 50 years old. This session will focus on three common co-morbidities that are typically seen in persons living with HIV (PLWH) in the modern combination anti-retroviral therapy (CART) era. Talks will focus on diagnosis of epilepsy in PLWH especially in low and middle income countries, the relationship between stroke (ischemic and hemorrhagic) in PLWH with a concentration on gender differences, and aging with HIV, especially the potential role of Alzheimer disease in this population.

Learning Objectives:

  • How to take care of PLWH who have epilepsy 
  • How to take care of PLWH who have cerebrovascular disease 
  • How to take care of PLWH who are aging

Epilepsy in People Living with HIV (PLWH)

Speaker: Gretchen L. Birbeck, MD, MPH, DTMH, FANA

HIV infection places people at risk of central nervous system (CNS) opportunistic infections which may result in epileptic foci. Long term survival with well-treated HIV entails exposure to a chronic, low grade inflammatory state that may also take its toll on the CNS. And regions of the world with endemic HIV are also regions heavily impacted by high epilepsy prevalence with a large treatment gap. These converging influences mean that for many PLWH, epilepsy is a comorbid, chronic condition. This session will address issues of clinical management for PLWH who experience new onset seizure, the chronic care for their seizure disorder, and the management of acute seizures including status epilepticus in this potentially fragile population. Medication interactions will be reviewed. Critical social aspects, including comorbid stigma burdens will be addressed as well.  

HIV and Alzheimer's Disease

Speaker: Beau Ances, MD, PhD, MSc, FANA

Due to combination antiretroviral therapy, persons with HIV (PWH) are living longer with the average life expectancy approaching the general population. The effects of HIV and aging with regards to the brain are only more recently being investigated. HIV may accelerate brain aging. Various factors may contribute to the brain age being greater than the chronological age including prevalent cerebrovascular comorbidities (e.g., hypertension, dyslipidemia), immunodeficiency, co- infections, chronic inflammation and immune activation, and social determinants of health. This session will highlight studies that have used biofluids, imaging, and cognitive testing to evaluate potential contributors to developing neurodegenerative diseases (e.g. Alzheimer disease) in PWH in the US. Results will be discussed in the context of future clinical trials to improve cognitive performance in older PWH.

Strokes and HIV

Speaker: Felicia Chow, MD, MAS

PLWH are at elevated risk of cerebrovascular disease. Various factors contribute to higher stroke risk associated with HIV infection, including prevalent cardiometabolic comorbidities (e.g., hypertension, dyslipidemia), immunodeficiency, chronic inflammation and immune activation, and health-related behaviors such as smoking and substance use. This session will highlight some of the contributors to cerebrovascular risk in PLWH in the US and LMICs, and how these may differ between men and women, along with recent data on cerebrovascular risk reduction and how cardiometabolic and cerebrovascular disease is linked to cognitive health in PLWH.