Comment on “Neuropathologic findings in a community-based autopsy cohort of older, virally suppressed, people with HIV”

To the Editor: We have read with great interest the work “Neuropathologic findings in a community-based autopsy cohort of older, virally suppressed, people with HIV”, recently published in the Journal of Neuropathology & Experimental Neurology by Zaikos et al.1 This study provides a novel and systematic evaluation of neuropathological lesions in older, virally suppressed people living with HIV (PWH). Because widely available combination antiretroviral therapy (cART) now extends the lifespan of PWH, the majority of this population may now reach over 50 years of age, shifting the clinical focus from acute viral replication to age-related comorbidities and neuropathology from HIV-related encephalopathy within the HAND (HIV-associated neurocognitive disorder) spectrum, vascular and neurodegenerative lesions.2,3 A central question raised by the authors’ findings is the extent to which these neurodegenerative lesions are clinically meaningful in the context of viral suppression; that is, if chronic inflammation or “inflammaging” may also interact negatively in the development of dementia-associated neuropathology.