Episodic memory trajectories of older adults with and without HIV: A longitudinal population-based study in rural South Africa
Year: 2026
Type: article
Study design: Observational Study
Abstract: With the introduction of antiretroviral treatment (ART), life expectancy among people with HIV in South Africa has increased substantially. This ageing population faces age-related challenges, including cognitive decline. Yet, differences in cognitive trends between people with and without HIV remain poorly understood. We analyzed longitudinal data on 3,066 adults aged 40 + years in rural South Africa from the "Health and Aging in Africa: Longitudinal Studies in South Africa" (HAALSA) cohort. Using generalized estimating equations, we compared episodic memory trajectories over seven years (2014 - 2022) across three groups: (1) people without HIV, (2) people with HIV and suppressed viral load, and (3) people with HIV and unsuppressed viral load. Furthermore, we predicted episodic memory scores at yearly intervals. On average, the trend in episodic memory decline did not differ between people without HIV and people with HIV with suppressed or unsuppressed viral load. However, looking individually at yearly intervals revealed that participants without HIV experienced significantly steeper episodic memory decline compared to participants with HIV with suppressed viral load when controlling for individual-level characteristics. Consequently, over the seven-year period, participants without HIV progressed from having episodic memory comparable to those with suppressed viral load to levels similar to those with unsuppressed viral load. The slower episodic memory decline among virally suppressed people with HIV compared to those without HIV may reflect benefits from regular healthcare engagement or may also be a result of selective mortality. Our findings suggest that policymakers should: (1) intensify efforts to increase ART coverage and adherence among unsuppressed people with HIV; (2) implement targeted cognitive screening for at-risk individuals regardless of HIV status; (3) expand screening and treatment for conditions that contribute to cognitive decline; and (4) promote behaviors that may preserve cognitive function, particularly in resource-constrained settings. Further research on potential underlying mechanisms should be conducted.
Source: PLOS Global Public Health
Authors: Michaela Theilmann, Sarah Gao, Darina T. Bassil, Ryan G. Wagner, Xuexin Yu, Eric Tchetgen Tchetgen, Molly Rosenberg, Carla Roberts-Toler, Brendan Maughan-Brown, Lindsay Kobayashi, Charlotte Kelham, Kathleen Kahn, John Joska, Guy Harling, Jose Gutierrez, Chido Chinogurei, Julia K. Rohr, Jennifer Manne-Goehler
Institutions: Brigham and Women's Hospital, Harvard University, Massachusetts General Hospital, University of Southern California, South African Medical Research Council, Barrow Neurological Institute, University of the Witwatersrand, Agincourt Health and Socio-Demographic Surveillance System, Columbia University, University of Pennsylvania, Indiana University Bloomington, Indiana University, University of Cape Town, University of Michigan, University College London, Africa Health Research Institute, University of KwaZulu-Natal, University of Miami, Heidelberg University, Heidelberg Institute of Global Health
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,496
Awards: Strengthening and stabilising a demographic and health surveillance in Agincourt: foundation for a health and population research programme in South Africa's rural northeast, G1112674395, G1119205115, G2563538044, Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions., G337067848, Preventing cardiometabolic diseases in Africa: life-course and multi-sector approaches., G4061508305, Using social networks to understand and intervene on HIV epidemic spread, G4469057728, G4570411886, Investigating and responding to health, population and social transitions in rural Southern Africa., G493219187, Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions., G7299740096, G775404406, G7923275117, G8186070293, G8276714428, Using social networks to understand and intervene on HIV epidemic spread, G9000035790, G9000091477
OpenAlex ID: W7166036116