Complementary dose of COVID-19 vaccination may prevent SARS-CoV-2 breakthrough infection among previously vaccinated HIV positive persons.

People living with HIV (PLWH) are a heterogeneous group of immunocompromised persons. Detectable HIV viral load and chronic comorbidities are independently increasing the risk of severe outcomes from COVID-19 among PLWH. We aimed to assess the efficacy and safety of the COVID-19 vaccines in PLWH. A significant increase in S-RBD antibody titers >100 AU/mL was observed when compared the titers measured one week after the 1st dose to titers performed after the 2nd vaccine dose.

Daily emotional inertia and long-term subjective well-being among people living with HIV.

OBJECTIVE: The aim of this study was to verify if subjective well-being (SWB) modifies the autoregressive effect of daily emotions and if this emotional inertia predicts long-term changes in SWB among people living with HIV (PLWH). METHODS: The 131 participants had medically confirmed diagnoses of HIV and were undergoing antiretroviral therapy. They assessed their SWB (satisfaction with life, negative affect, positive affect) twice with an interval of one year. They also took part in a five-day online diary study six months from their baseline SWB assessment and reported their daily negative and positive emotions. RESULTS: Results showed that baseline SWB did not modify the emotional carryover effect from one to another. Additionally, after control for baseline SWB, emotional inertia did not predict SWB one year later. However, such an effect was noted for the mean values of daily reported emotions, indicating their unique predictive power over SWB itself. CONCLUSIONS: This may suggest that emotional inertia does not necessarily provide better information than more straightforward measures of affective functioning.

Risk factors for kidney disease among HIV-1 positive persons in the methadone program.

BACKGROUND: Kidney injury is a serious comorbidity among HIV-infected patients. Intravenous drug use is listed as one of the risk factors for impaired renal function; however, this group is rarely assessed for specific renal-related risks. METHODS: Patients attending methadone program from 1994 to 2015 were included in the study. Data collected included demographic data, laboratory tests, antiretroviral treatment history, methadone dosing and drug abstinence. Patients' drug abstinence was checked monthly on personnel demand. We have evaluated two study outcomes: (1) having at least one or (2) three eGFR < 60 ml/min (MDRD formula). RESULTS: In total, 267 persons, with 2593 person-years of follow-up were included into analyses. At the time of analyses, 251 (94%) were on antiretroviral therapy (ARV). Fifty-two (19.5%) patients had 1eGFR and 20 (7.5%) 3eGFR < 60. In univariate analysis, factors significantly increasing the odds of impaired renal function were: female gender, detectable HIV RNA on ART, age at registration per 5 years older, atazanavir use and time on antiretroviral treatment per 1 year longer. In the multivariate model, only female gender (OR 4.7; p = 0.002), time on cART (OR 1.11; p = 0.01) and baseline eGFR (OR 0.71; p = 0.001) were statistically significant. CONCLUSIONS: We have demonstrated a high rate of kidney function impairment among HIV-1 positive patients in the methadone program. All risk factors for decreased eGFR in this subpopulation of patients were similar to those described for general HIV population with very high prevalence in women. These findings imply the need for more frequent kidney function monitoring in this subgroup of patients.

Discontinuation of tenofovir due to nephrotoxicity: insight into 12 years of clinical practice

INTRODUCTION: Chronic kidney disease is a significant cause of morbidity and mortality among patients infected with human immunodeficiency virus (HIV). Tenofovir disoproxil fumarate (TDF) is widely used as the part of combination antiretroviral therapy (cART) and may cause renal function impairment. AIM: The primary objective of this analysis was to determine the rate of reversibility of kidney dysfunction and factors correlated with eGFR improvement in patients treated with TDF. MATERIALS AND METHODS: All patients who discontinued TDF between 2003 and 2015 were screened and included in the study if the reason for withdrawal was nephrotoxicity. Kidney function (eGFR, proteinuria, haematuria) was assessed on treatment and one year after discontinuation. Factors associated with not achieving eGFR recovery one year after discontinuing TDF were assessed. RESULTS: A total of 69 patients out of 1625 screened discontinued TDF due to nephrotoxicity and were included in the analysis. At the end of the study period eGFR (CKD-EPI) improved in 52 (75,4%) patients. The eGFR difference was 11,7 ml/min/1,73m2 (95% CI: 6,0 ­ 14,5). Two factors were associated with kidney function improvement: the length of TDF treatment and baseline eGFR. Better recovery was observed in patients treated with shorter (difference: 15,6 ml/min/1,73m2, 95% CI: 5,99 ­ 23,0) and in those with impaired renal function at baseline (difference: 21 ml/min/1,73m2, 95% CI: 11,0 ­ 27,99). CONCLUSIONS: In majority of patients who discontinue TDF therapy, kidney function improves during oneyear period. The drug withdrawal in case of eGFR deterioration should not be postponed.

Religious Fundamentalism, Satisfaction with Life and Posttraumatic Stress Symptoms Intensity in a Polish Sample of People Living with HIV/AIDS.

We investigated the relationship between religious fundamentalism, satisfaction with life and the intensity of posttraumatic stress symptoms in people living with HIV/AIDS. The study was conducted on 283 adults, including 242 HIV-positive patients and 41 individuals with AIDS, aged from 20 to 74. Religious fundamentalism was positively correlated with age and posttraumatic stress symptoms intensity. Negative correlation between satisfaction with life and posttraumatic stress intensity was also found. Religious fundamentalism and satisfaction with life accounted for 34% of the variance in posttraumatic stress symptoms intensity. The level of patients' education mediated the relationship between religious fundamentalism and the posttraumatic stress symptoms intensity.

Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland.

OBJECTIVES: HIV-positive women are at increased risk of HPV infection and cervical cancer. European and national guidelines advise yearly screening for cervical cancer, however due to the lack of a central registration of HIV infected persons there is a gap in offering such care through general healthcare services in many countries, including Poland. MATERIAL AND METHODS: In response to the above limitations, integrated gynaecological care (IGC) was established at the HIV Out-Patient Clinic in Warsaw. We analysed data from January 2007 to May 2014. Logistic regression models were used to identify factors associated with not using IGC by patients. RESULTS: Two hundred and forty women were registered in the observation period:59.6% infected through sexual contact, 18.7% through IDUs, 19.2 % through unknown causes and 2.5% by other (two were vertically infected). The median follow-up time was 2.35 (IQR 0.9-4.5) years and 78.3% were on combination antiretroviral therapy (cART). In total 145 of the women (60.4%) used IGC, from 72.1% of those registered in 2007 to 27.3% registered in 2014. There were in total 1075 gynaeco-logical visits and 254 cervical cytology tests performed. Seventy-five (51.7%) women were tested for HPV infection. Fac-tors decreasing the odds of not using IGC identified by multivariate regression models were being on cART (OR 0.25 [IQR: 0.10-0.59]; p = 0.003) and longer time of observation (0.69 [0.58-0.83]; p = 0.0001). CONCLUSIONS: The utilisation of IGC was very high, but with a delay in commencing the IGC. Women on cART and with longer periods of follow-up had lower odds of not using IGC. A screening approach for women not yet on cART, or newly registered in the clinics, needs special attention.

Nephrology consultations incorporated into HIV care - non-compliance is an important issue.

Although infrequent, kidney disease is a potentially serious co-morbidity among human immunodeficiency virus (HIV)-infected patients. The spectrum of renal impairment is very wide from clinically insignificant to end stage renal disease and often requires nephrologist's consultation. Therefore, we established combined renal and HIV care in the HIV Out-Patient Clinic in Warsaw. Medical records of patients consulted by nephrologist from March 2014 to March 2015 were included in analyses. Patients changing medication without consulting the physician or persistently not coming for follow-up visits were defined as non-compliant. In statistical analyses, non-parametric tests and logistic regression models were used as appropriate. In total, 100 patients were consulted by a nephrologist during the study period. All patients were white Europeans, 88 (88%) male, 42 (42%) infected through men having sex with men and 16 (16%) through intravenous drug users. Fifteen (15%) patients had hepatitis C virus (HCV) infections and 11 (11%) confirmed with positive HCV RNA. The most common reasons for referral were proteinuria and increased serum creatinine. In 6 out of 31 patients (19.3% of those referred for increased creatinine level) elevated serum creatinine was due to illegal substances or diet supplements use. Fifty-seven (57%) of patients were non-compliant. In univariate logistic regression models, all tested factors were non-significant. In most cases, patients were referred to nephrologist due to possible link between laboratory abnormalities and antiretroviral treatment. In one out of five cases, elevated creatinine level was linked with substance/dietary abuse. Poor compliance is an important problem in integrated nephrological care, however we were not able to identify any factors associated with non-compliance.

Coping profiles and subjective well-being among people living with HIV: less intensive coping corresponds with better well-being.

PURPOSE: The aim of this study was to investigate the relationship between coping strategies and subjective well-being (SWB) among people living with HIV (PLWH) using the latent profile analysis (LPA) with control for socio-medical covariates. METHODS: The sample comprised five hundred and thirty people (N = 530) with a confirmed diagnosis of HIV+. The study was cross-sectional with SWB operationalized by satisfaction with life (Satisfaction with Life Scale) and positive and negative affect (PANAS-X). Coping with stress was measured by the Brief COPE Inventory, enriched by several items that assessed rumination and enhancement of positive emotional states. Additionally, the relevant socio-medical variables were collected. RESULTS: The one-step model of LPA revealed the following: (1) a solution with five different coping profiles suited the data best; (2) socio-medical covariates, except for education, were not related to the profiles' membership. Further analysis with SWB as a distal outcome showed that higher intensity coping profiles have significantly worse SWB when compared with lower intensity coping profiles. However, the lowest SWB was noted for mixed intensity coping profile (high adaptive/low maladaptive). CONCLUSIONS: The person-centered approach adopted in this study informs about the heterogeneity of disease-related coping among PLWH and its possible reactive character, as the highest SWB was observed among participants with the lowest intensity of coping.

Social support, stress coping strategies, resilience and posttraumatic growth in a Polish sample of HIV-infected individuals: results of a 1 year longitudinal study.

This study investigated the level of posttraumatic growth (PTG) and its association with the level of social support, stress coping strategies and resilience among a people living with HIV (PLWH) in a 1 year longitudinal study. We also controlled for age, HIV infection duration and the presence of posttraumatic stress symptoms (PTSS). From the 290 participants, initially eligible for the study, 110 patients were recruited for the first assessment and 73 patients participated in a follow-up assessment. Participants filled out following psychometric tools: the Posttraumatic Growth Inventory (PTGI), the Berlin Social Support Scales (BSSS), the Mini-COPE Inventory, the Resiliency Assessment Scale (SPP-25) and the PTSD-F questionnaire. Received support and resilience were positively, whereas return to religion as coping strategy was negatively related to the PTG. Clinicians and researchers need to focus on potentially positive consequences of HIV infection, i.e. PTG, and factors that might promote it among PLWH.

Gender differences in posttraumatic stress symptoms and social support in a sample of HIV-positive individuals.

The aim of the authors of the present study was to investigate gender differences in the levels of posttraumatic stress symptoms (PTSS) and social support in a Polish sample of HIV+ men (n = 613) and women (n = 230). This was an anonymous cross-sectional study, and participation was voluntary. The research questionnaires were distributed in paper form among patients of Warsaw's Hospital for Infectious Diseases from January to October 2015. The level of PTSS was assessed using the PTSD Factorial Version Inventory. Social support was assessed using the Berlin Social Support Scales. HIV+ women scored higher on all PTSS dimensions compared to HIV+ men. HIV+ women were characterized by a higher need for support and more support actually received compared to HIV+ men. We observed a positive association between HIV infection duration and AIDS phase and the global trauma score only among HIV+ men. The moderation analysis also revealed a positive relationship between actual received support and the global trauma score among HIV+ women only. Increased clinician awareness is needed about the role of PTSS and social support among people living with HIV, especially taking gender differences into account.

Gender differences in posttraumatic stress symptoms and the level of posttraumatic growth among a Polish sample of HIV-positive individuals.

The main goal of the current study was to investigate gender differences in the relationship between the level of posttraumatic stress symptoms (PTSSs) and the intensity of posttraumatic growth (PTG), treated as the explained variable, among a Polish sample of HIV-positive individuals (n = 250) while controlling for participants' ages and time since HIV diagnosis. The level of PTG was measured using the Polish adaptation of the Posttraumatic Growth Inventory. The level of PTSSs was assessed using the PTSD Factorial Version Inventory. HIV-positive women scored higher for some PTSSs (intrusion/arousal) and for a particular PTG dimension (spiritual change). In addition, the PTSSs that occurred were negatively related to the PTG level but only among HIV-positive women. Given the important health-related benefits associated with PTG among HIV-positive people, it is vital to shape competencies for effective growth promotion among these individuals, taking into account gender differences within this phenomenon.

Factors associated with the first antiretroviral therapy modification in older HIV-1 positive patients.

BACKGROUND: Rates of first antiretroviral therapy (cART) modifications are high in most observational studies. The age-related differences in treatment duration and characteristics of first cART modifications remain underinvestigated. With increasing proportion of older patients in HIV population it is important to better understand age-related treatment effects. METHODS: Patients were included into this analysis, if being cART naïve at the first visit at the clinic. Follow-up time was measured from the first visit date until first cART modification or 28 February 2013. First cART modification was defined as any change in the third drug component i.e. protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), integrase inhibitor or fusion inhibitor. Cox proportional hazard models were used to identify factors related to first cART modification in three age groups: <30, 30-50 and >50. RESULTS: In total 2027 patients with 14,965 person-years of follow-up (PYFU) were included. The oldest group included 136 patients with 1901, middle group 1202 with 8416 PYFU and youngest group consisted of 689 patients with 4648 PYFU. Median follow-up time was 5.8 (IQR 3.4-9.4) years, median time on first cART was 4.4 (IQR 2.1-8.5) years. 72.4 % of patients started PI-based and 26.1 % NNRTI-based regimen. In total 1268 (62.5 %) patients had cART modification (non-adherence 30.8 %, toxicity 29.6 %). Durability of first cART was the best in patients over 50 y.o. (log-rank test, p = 0.001). Factors associated with discontinuation in this group were late presentation (HR 0.45, [95 % CI 0.23-0.90], p = 0.02) and PI use (HR 2.17, [95 % CI 1.18-4.0], p = 0.01). CONCLUSIONS: Rates of first cART modifications or discontinuation were comparable in all groups; however older patients were significantly longer on first cART regimen.

HIV infection duration, social support and the level of trauma symptoms in a sample of HIV-positive Polish individuals.

The aim of this study was to investigate the relationship between the average HIV infection duration and the level of quantitatively rated post-traumatic stress disorder (PTSD) symptoms and social support dimensions in a sample of 562 Polish HIV+ adults. Possible moderating effects of social support on the relationship between the average HIV infection duration and the level of PTSD symptoms were also analysed. The results of this study suggest that the average HIV infection duration may intensify PTSD symptoms and deteriorate the perceived availability of social support in HIV+ individuals. However, a positive relationship between HIV infection duration and the level of trauma symptoms was observed only in the group of HIV+ individuals with low perceived available social support, but not in the group of HIV-infected individuals with high perceived available social support. This research provided some new insight into the psychological and social aspects of living with HIV. In particular, our results suggest that although HIV infection duration may intensify trauma symptoms and deteriorate social support, perceived available social support may act as a buffer against HIV-related trauma symptoms.

The Spectrum of Malignancies among Adult HIV Cohort in Poland between 1995 and 2012: A Retrospective Analysis of 288 Cases.

THE AIM OF THE STUDY: The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland. MATERIAL AND METHODS: A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test. RESULTS: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm(3) (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. The most frequent malignancies were: NHL (n = 76; 26.39%), KS (n = 49; 17.01%), ICC (n = 34; 11.81%), HD (n = 23; 7.99%), lung cancer (n = 18; 6.25%) and HCC (n = 14; 4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender (OR = 1.889; 95% CI: 1.104-3.233; p = 0.024), advanced age: 50-60 years (OR = 3.022; 95% CI: 1.359-6.720; p = 0.01) and ≥ 60 years (OR = 15.111; 95% CI: 3.122-73.151; p < 0.001), longer duration of HIV-infection and successful HAART (OR = 2.769; 95% CI: 1.675-4.577; p = 0) were independent predictors of NADMs overall, respectively. CONCLUSIONS: In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations.

The Clinical Effectiveness and Safety of Vaccinations against COVID-19 in HIV-Positive Patients: Data from Observational Study in Poland.

People living with HIV (PLWH) are a heterogeneous group of immunocompromised persons, yet underrepresented in randomized clinical trials leading to vaccination registration. Detectable HIV viral load and having chronic comorbidities may increase the risk of severe COVID-19 outcomes in this group of patients. We aimed to assess the efficacy and safety of vaccinations against COVID-19 in PLWH. MATERIALS AND METHODS: We performed a retrospective analysis of medical records of HIV-positive individuals routinely followed up between 1 January 2021 and 30 April 2022 that were at the HIV Outpatient Clinic in Warsaw. The analysis included data on the type and date of administration of subsequent doses of COVID-19 vaccination, adverse vaccine reactions, and the history of SARS-CoV-2 infection. RESULTS: In total, 217 patients were included in the analysis, with a median age of 43 years (IQR: 35.5-51.5 years) and median CD4+ count of 591 cells/uL (IQR: 459.5-745.0 cells/uL). Most of the patients were male (191/217, 88.0%) and were vaccinated with the BNT162b2 vaccine (143/217, 65.9%). None of the patients diagnosed with COVID-19 required hospitalization. Vaccine adverse events (VAE) mostly occurred after the 1st dose (in 33/217 (15.2%)), and none of them were severe or required medical care. CONCLUSIONS: In our cohort of patients, vaccination against COVID-19 proved to be safe and effective against a severe course of the disease among people living with HIV. However, vaccination, to a lesser degree, protects against mild SARS-CoV-2 infection. Longer observations are required in order to assess the sustainability of protection against severe COVID-19 in this group of patients.

Temperament traits, coping style and trauma symptoms in HIV+ men and women.

This article presents a study of relations between temperament traits and coping style, and intensity of trauma symptoms in HIV+ men and women. The study was run on 310 HIV + individuals (157 men and 153 women) in or not in the AIDS phase. Temperament traits were assessed with the Formal characteristics of behaviour - temperament inventory. Coping styles were assessed with the Coping inventory for stressful situations. Intensity of trauma symptoms was assessed with the Factorial version of the post-traumatic stress disorder inventory. Coping style had the greatest effect on intensity of trauma symptoms. Emotion-focused coping accounted for 13% of the variance of trauma symptom intensity in HIV + participants. Together, sensory sensibility, emotional reactivity and emotion-focused coping accounted for 26% of the variance of trauma intensity symptoms. Emotion-focused coping and emotional reactivity were conducive to increased trauma symptom intensity in HIV+ participants whereas sensory sensibility tended to reduce symptom intensity.

Inflammatory Bowel Disease in Adult HIV-Infected Patients-Is Sexually Transmitted Infections Misdiagnosis Possible?

BACKGROUND: The aim of our study was to describe 50 cases of inflammatory bowel disease (IBD) and HIV co-existence that are under medical supervision in Warsaw. METHODS: This was a retrospective descriptive study. Fifty HIV-infected patients, diagnosed with IBD during the years 2001-2019, were identified. IBD was diagnosed endoscopically and then confirmed by biopsy. All data was obtained from medical records. RESULTS: All studied patients were male with a median age of 33 years old (range 20-58 years). All, except one, were men who have sex with men (MSM). The median CD4 cell count was 482 cells/µL (range 165-1073 cells/µL). Crohn's disease (CD) was diagnosed in 7 patients (14%), ulcerative colitis (UC) in 41 patients (82%), and 2 patients (4%) had indeterminate colitis. Forty-nine patients (98%) reported a history of unprotected receptive anal intercourse and different sexual transmitted infections (STIs). Only in 10 patients (20%) were one or more IBD relapses observed. CONCLUSIONS: We recommend HIV testing for every MSM with IBD suspicion. Moreover, STIs testing should be performed in every IBD patient with colorectal inflammation, using molecular and serological methods. Persons who reported unprotected receptive anal intercourse seem to have the biggest risk of STI-associated proctitis or proctocolitis mimicking IBD.

Evolving patterns of HIV-1 transmitted drug resistance in Poland in the years 2000-2008.

The aim of the study was to determine the rate of transmission of drug resistant human immunodeficiency virus-1 (HIV-1) variants among therapy-naïve HIV positive patients in Poland in the year 2008, to compare the data with the results from the years 2000 to 2007 and to monitor patterns of HIV-1 subtypes present in Polish population and their evolution. Complete protease and part of reverse transcriptase regions were sequenced from the sera of patients directed to the laboratory for drug resistance testing. The Stanford's HIVdb program was used for the interpretation of results and subtyping. The variants scoring at least "intermediate resistance" for at least one drug were considered as resistant. The results obtained were compared to those obtained in the years 2000-2007. A total of 95 patients were enrolled in the 2008 study. Homosexual transmission of infection was documented in more than 55% of all cases. The overall prevalence of transmitted drug resistance (TDR) was 5.3% (3.9% in 2007, 5.8% in 2006, and 14.1% in the years 2002-2005). The study from the years 2000 to 2001 revealed 28.7% prevalence. Preliminary analysis of the first half of 2009 shows the ratio of 7.8%. In four (4.2%) cases drug resistance was associated with protease inhibitors class, in one case (1.1%) with resistance to non-nucleoside reverse transcriptase inhibitors class. In four cases (4.2%) non-B subtype was identified (C, G, CRF01_AE, CRF02_AG). An increase of percentage of drug resistant mutants-from 3.9% (2007) to 5.3% (2008)-was recognized. In this study, TDR was limited to single classes of antiretroviral drugs. HIV-1 subtype B prevails in Poland.

HIV and age underlie specific patterns of brain abnormalities and cognitive changes in high functioning patients.

OBJECTIVE: Findings on the influence of age and HIV on brain and cognition remain equivocal, particularly in aviremic subjects without other age or HIV-related comorbidities. We aimed to (a) examine the effect of HIV status and age on structural brain measurements and cognition, and (b) apply the machine learning technique to identify brain morphometric and cognitive features that are most discriminative between aviremic subjects with HIV on stable combination antiretroviral therapy (cART) and healthy controls. METHOD: Fifty-three HIV-seropositive patients and 62 healthy controls underwent neuropsychological testing (executive functions, attention, memory, learning, psychomotor speed, fluency) and volumetric MRI scans. Voxel-based morphometry, ANCOVAs, machine learning, and multivariate regression were conducted to determine the between group differences in terms of relationship of HIV status, age, and their interaction on neurocognitive and structural brain measures. RESULTS: Volume and gray matter (GM) thickness of the caudate, parahippocampus, insula, and inferior frontal gyrus were smaller in seropositive subjects in comparison with healthy controls (HC). They also performed worse in complex attention and cognitive fluency tasks. Support vector machine (SVM) analysis revealed that the best between-groups classification accuracy was obtained based on cognitive scores encompassing complex attention and psychomotor speed, as well as volumetric measures of white matter and total gray matter; third, fourth, and lateral ventricles; amygdala; caudate; and putamen. Both voxel-based morphometry (VBM) and regression analysis yielded that HIV and aging independently increase brain vulnerability and cognitive worsening. CONCLUSION: Patients with HIV on effective cART demonstrate smaller volumetric measures and worse cognitive functioning relative to seronegative individuals. There is no interaction between HIV infection and aging. (PsycINFO Database Record (c) 2019 APA, all rights reserved).