About The Study

Study investigators aimed to understand the biological, psychological, and social factors that affect brain health, the impact of cognitive symptoms on function and quality of life, and their evolution over time. Researchers were also focused on developing tools that could be applied in the clinic setting. Measurement of cognition remains a major stumbling block to effective brain health management. To address this unmet need, the researchers had developed a brief computerized test (B-CAM, for Brief Cognitive Ability Measure) that applies cutting-edge statistical methods to assess cognition over time. Once optimized as a result of the study, this web-based open-access (meaning, free!) tool could be used in the clinic setting to measure cognitive abilities in a few minutes. Pilot interventional sub-studies aimed at improving brain health were also conducted.

About The Disease

As life expectancy for people living with HIV increases, it is becoming clear that HIV affects both cognition and mental health, even with excellent systemic viral control. Emerging research suggests that there are multiple interacting processes impacting the brain. Factors such as aging, chronic inflammation, depression, cerebrovascular disease, substance use and hepatitis C infection may impact brain health. The experience of living with chronic infection and stigma can also threaten brain health by affecting stress levels and physical health.

Study Approach

This was a prospective cohort study that recruited 856 participants. Participants were assessed and followed at 9–12 month intervals over up to 10 years. Clinical assessments included the measurement of blood pressure, waist and hip circumference, weight, and height as well as the documentation of medical history. Participants were also asked to complete questionnaires and undergo tests using the B-CAM measurement tool. The researchers hoped to further the development of the B-CAM as a free and accessible cognitive assessment tool for routine clinical monitoring of brain health, and develop subsequent interventions and mechanism-based studies involving research participants, community members, and those involved in the front-line care of people with HIV. This work will provide needed insight into the underlying compromised brain health issues in HIV.


Researchers found that stigma had a direct effect on cognitive performance and anxiety, including negative effects on daily engagement in meaningful activities. They also found that HIV symptoms, pain, fatigue, low motivation, stigma, and unemployment were related to loneliness. Loneliness increased the odds of cognitive impairment, low mood, stress, and poor physical health. Those who were “quite often” lonely were over 4 times more likely to report poor or very poor quality of life than those who were “almost never” lonely.

The team developed the Communicating Cognitive Concerns Questionnaire (C3Q), which is the first questionnaire specifically developed for use among people with HIV. While not strongly associated with cognitive test performance, it reflects real-life concerns of people and is associated with mood, work, and work productivity. It is a needed step in assessing cognition in this population.

The team also developed the “My Personal Brain Health Dashboard”. A health outcome profile was computer generated from the outcomes measures of each person enrolled and single actionable items with evidence of life impact were chosen. Users could compare their results to an optimal target and 80% found the dashboard useful for setting health-related goals.


The results provide evidence that HIV-related stigma is a threat to cognitive as well as mental health, with a negative impact on everyday function in men aging with HIV. This argues for direct links between the psychosocial and biological impacts of HIV at the level of the brain. Stigma reduction may be a novel route to addressing cognitive impairment.