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Limited evidence for a moderating effect of HIV status on brain age in heavy episodic drinkers

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We set out to test the hypothesis that greater brain ageing will be observed in people with HIV (PWH) and those who engage in heavy episodic drinking (HED), with their combined effects being especially detrimental in cognitive control brain networks. We correlated measures of “brain age gap” (BAG) and neurocognitive impairment in participants with and without HIV and HED. Sixty-nine participants were recruited from a community health centre in Cape Town: HIV − /HED − (N = 17), HIV + /HED − (N = 14), HIV − /HED + (N = 21), and HIV + /HED + (N = 17). Brain age was modelled using structural MRI features from the whole brain or one of six brain regions. Linear regression models were employed to identify differences in BAG between patient groups and controls. Associations between BAG and clinical data were tested using bivariate statistical methods. Compared to controls, greater global BAG was observed in heavy drinkers, both with (Cohen’s d = 1.52) and without (d = 1.61) HIV. Differences in BAG between HED participants and controls were observed for the cingulate and parietal cortex, as well as subcortically. A larger BAG was associated with higher total drinking scores but not nadir CD4 count or current HIV viral load. The association between heavy episodic drinking and BAG, independent of HIV status, points to the importance of screening for alcohol use disorders in primary care. The relatively large contribution of cognitive control brain regions to BAG highlights the utility of assessing the contribution of different brain regions to brain age.

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Heavy episodic drinking


Brain age gap


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Thanks go to Teboho Linda, who conducted all neurocognitive assessments for this study, Ntombekhaya Queen Maswana and Sheila Mdlakoma, who assisted with recruitment and participant screening, the Cape Universities Body Imaging Centre (CUBIC) at Groote Schuur Hospital in Cape Town, where all the MRI scans were performed, and the study participants who gave so willingly of their time. Steve Shoptaw received support from the Centre for HIV Identification, Prevention, and Treatment Services (CHIPTS; Grant number: P30MH058107). Freesurfer 5.3 segmentation of the test dataset was performed using facilities provided by the University of Cape Town’s ICTS High Performance Computing team (


This work was supported by funding awarded to JI from the National Research Foundation (NRF) of South Africa (Grant #: 91466), and through a self-initiated grant from the South African Medical Research Centre. The NRF and MRC was not involved in any aspect of study conceptualisation and implementation, including, but not limited to, study design, data collection, analysis and interpretation of data; writing of the report; and submission of the article for publication.

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JI: Conceptualization, methodology, formal analysis, writing—original draft, visualization, project administration, and funding acquisition. JJ: Conceptualization, methodology, and writing—review and editing. TS: Writing—review and editing. HG: Methodology, investigation, and writing—review and editing. CF: Investigation and writing—review and editing. TK: Software and writing—review and editing. OAA: Writing—review and editing. SS: Supervision and writing—review and editing. DJS: Supervision and writing—review and editing.

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Correspondence to Jonathan C. Ipser.

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Ipser, J.C., Joska, J., Sevenoaks, T. et al. Limited evidence for a moderating effect of HIV status on brain age in heavy episodic drinkers. J. Neurovirol. 28, 383–391 (2022).

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