Imperial College London

Dr Jonathan Underwood

Faculty of MedicineDepartment of Infectious Disease

Honorary Clinical Research Fellow



+44 (0)20 3312 1466jonathan.underwood Website CV




Winston Churchill WingSt Mary's Campus






BibTex format

author = {Cole, JH and caan, M and Underwood, J and de, Francesco D and van, Zoest R and Wit, F and Mutsaerts, H and Leech, R and Geurtsen, G and Portigies, P and Majoie, C and Schim, van der Loeff M and Sabin, C and Reiss, P and Winston, A and Sharp, D},
doi = {cid/cix1124},
journal = {Clinical Infectious Diseases},
pages = {1899--1909},
title = {No evidence for accelerated ageing-related brain pathology in treated HIV: longitudinal neuroimaging results from the Comorbidity in Relation to AIDS (COBRA) project},
url = {},
volume = {66},
year = {2018}

RIS format (EndNote, RefMan)

AB - BackgroundDespite successful antiretroviral therapy people living with HIV (PLWH) experience higher rates of age-related morbidity, including abnormal brain structure, brain function and cognitive impairment. This has raised concerns that PLWH may experience accelerated ageing-related brain pathology.MethodsWe performed a multi-centre longitudinal study of 134 virologically-suppressed PLWH (median age = 56.0 years) and 79 demographically-similar HIV-negative controls (median age = 57.2 years). To measure cognitive performance and brain pathology, we conducted detailed neuropsychological assessments and multi-modality neuroimaging (T1-weighted, T2-weighted, diffusion-MRI, resting-state functional-MRI, spectroscopy, arterial spin labelling) at baseline and after two-year follow-up. Group differences in rates of change were assessed using linear mixed effects models.Results123 PLWH and 78 HIV-negative controls completed longitudinal assessments (median interval = 1.97 years). There were no differences between PLWH and HIV-negative controls in age, sex, years of education, smoking, alcohol use, recreational drug use, blood pressure, body-mass index or cholesterol levels.At baseline, PLWH had poorer global cognitive performance (P<0.01), lower grey matter volume (P=0.04), higher white matter hyperintensity load (P=0.02), abnormal white-matter microstructure (P<0.005) and greater ‘brain-predicted age difference’ (P=0.01). Longitudinally, there were no significant differences in rates of change in any neuroimaging measure between PLWH and HIV-negative controls (P>0.1). Cognitive performance was stable across the study period in both groups.ConclusionsOur finding indicate that when receiving successful treatment, middle-aged PLWH are not at increased risk of accelerated ageing-related brain changes or cognitive decline over two years, when compared to closely-matched HIV-negative controls.
AU - Cole,JH
AU - caan,M
AU - Underwood,J
AU - de,Francesco D
AU - van,Zoest R
AU - Wit,F
AU - Mutsaerts,H
AU - Leech,R
AU - Geurtsen,G
AU - Portigies,P
AU - Majoie,C
AU - Schim,van der Loeff M
AU - Sabin,C
AU - Reiss,P
AU - Winston,A
AU - Sharp,D
DO - cid/cix1124
EP - 1909
PY - 2018///
SN - 1058-4838
SP - 1899
TI - No evidence for accelerated ageing-related brain pathology in treated HIV: longitudinal neuroimaging results from the Comorbidity in Relation to AIDS (COBRA) project
T2 - Clinical Infectious Diseases
UR -
UR -
VL - 66
ER -