Risk factors for cognitive and functional decline in older people living with HIV and other infectious diseases ; Facteurs de risque de déclin cognitif et fonctionnel chez les personnes âgées vivant avec le VIH et autres maladies infectieuses

Generalized access to combined antiretroviral therapy significantly impacted on the health status and life expectancy of people living with HIV. However, even with effective treatment, there are interactions between the aging process and HIV that promote an early development of age-related diseases, including geriatric syndromes such as functional decline and cognitive impairment. On the other hand, an older person may be exposed to multiple infectious diseases throughout their life, and HIV is not the only infection potentially associated with functional decline, or particularly, with cognitive impairment. Considering these elements, this thesis was not only interested in cognitive disorders and functional decline in older people living with HIV, but also in other infections to which older people may have been exposed. In this context, the objectives of this thesis were to produce a state-of-the-art description of the knowledge on infectious diseases and their impact on cognition; to study trajectories of functional decline in older people living with HIV, and to identify potential risk factors; as well as to provide complementary data on the role of Helicobacter pylori infection on cognitive aging. For those objectives, we initially conducted a literature review on infectious diseases for which there is convincing evidence of their impact on cognition in older people. Indeed, several longitudinal studies show how various severe acute infections and chronic infections, besides HIV, such as herpes simplex virus, hepatitis C virus, H. pylori infection, chronic periodontitis, as well as emerging diseases, can have an impact on cognition and increase the risk of cognitive decline or dementia (articles 1 et 2). Then, relying on the older adults living with HIV cohort from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico, we addressed specific risk factors for functional decline in this population, assessing it through two dimensions. First, we showed that lower values of the ...