Recent research published in the Journal of NeuroVirology has suggested that the speed at which people with HIV walk could provide important clues about their brain health.
The University of Cape Town study by the Department of Psychiatry and Mental Health’s Neuroscience Institute linked slower walking speeds to poorer cognitive performance and identified changes in brain connectivity that may help explain the relationship.
The research found that among people with HIV, slower walking speed was significantly associated with poorer overall cognitive performance and functioning, particularly in memory and motor skills. This relationship was linked to changes in the brain’s frontoparietal network (FPN), a key network involved in executive functioning, attention and cognitive control.
HIV+ people who walked more slowly tended to have altered connectivity within this network, and these connectivity patterns were also associated with poorer executive function, the researchers wrote.
“Based on our analyses, we found that slower walking speed was associated with poorer global neurocognitive function in this cohort.”
Globally, a large proportion of the roughly 40m people with HIV experience some degree of cognitive impairment, which is often linked to greater ageing in this clinical population.
“A substantial body of evidence also suggests that walking speed may serve as an informative and potentially clinically useful index of cognitive function in both the elderly and psychiatric patients,” said Dr Jonathan Ipser from the Neuroscience Institute.
He said the research sought to test the hypothesis that gait speed is associated with cognitive function among middle-aged people with HIV in a low- to middle-income (LMIC) setting, and that this association is comparable to what is seen in much older healthy adults from the Global North.
“Finally, we sought to determine whether functional connectivity at rest for the frontoparietal cognitive control network has an impact on the relationship between walking speed and cognitive function in PLWH,” he added.
For the study, 39 participants were recruited from a community health centre in Cape Town. The researchers used statistical methods to compare those with HIV in this sample with those without HIV.
They examined how walking speed was linked to performance across different areas of thinking and memory, and how these links related to communication within and between seven brain networks while participants were at rest.
To better understand why slower walking speed is linked to poorer cognitive functioning in people with HIV, they used resting-state functional magnetic resonance imaging (rs-fMRI). This brain imaging technique measures spontaneous fluctuations in blood oxygen levels, known as blood-oxygen-level-dependent (BOLD) signals, which reflect underlying neural activity.
Unlike task-based scans, rs-fMRI records brain activity while participants are at rest, allowing researchers to examine how different brain regions communicate naturally.
By analysing these connectivity patterns, the study identified changes in the brain’s frontoparietal network. These connectivity differences were associated with slower gait speed and poorer cognitive performance, suggesting that altered brain network functioning may help explain the relationship between physical mobility and cognition in this population.
The findings suggest that HIV-related brain changes may contribute to both cognitive difficulties and reduced mobility, potentially reflecting accelerated ageing in this population.
The authors concluded that a simple gait-speed test could serve as a practical, low-cost screening tool for identifying possible HIV-associated brain injury and neurocognitive impairment, especially in resource-limited settings.
“We also observed that connectivity within the FPN, and of the right inferior frontal cortex in particular, showed a HIV-specific relationship with both walking speed and executive function. Our findings indicate that a brief gait test may have potential as an early, low-resource indicator of HIV-associated brain injury in HIV+ people,” said Ipser.
Study details
Evidence that intrinsic brain connectivity moderates the association between gait and neurocognitive function in people living with HIV
Jonathan Ipser, Samantha Smuts, Hetta Gouse, Carla Freeman, Dan Stein & John Joska.
Published in Journal of NeuroVirology on 13 October 2026
Abstract
Globally, a substantial proportion of the approximately 40 million people living with HIV (PLWH) experience some degree of HIV-associated brain injury (HABI), which is often linked to accentuated or accelerated aging in this clinical population. We set out to test the hypothesis that gait speed is associated with cognitive deficits in middle-aged PLWH in a low-middle income (LMIC) setting, and that this is comparable to what is seen in much older healthy adults. In addition, we sought to identify, as a potential marker of HABI, intrinsic functional brain connectivity abnormalities that moderate the association between gait and cognitive function in PLWH. Thirty-nine participants (17 HIV + and 22 HIV-, mean age = 39 +-8.99 years) were recruited from a community health centre in Cape Town. Bivariate and multiple linear regression models compared PLWH and controls with respect to associations between gait speed and neurocognitive domain scores, with relations between these factors and functional connectivity of seven resting state networks assessed within a multivariate regression modelling framework. We found that slower gait speed in PLWH was associated with lower global neurocognitive scores (t = -3.12; p < 0.008), and that this association was replicated in a large public domain cohort of healthy older adults. Moreover, intrinsic connectivity of the frontoparietal network in PLWH was a significant predictor of both gait speed and executive function, a finding that may implicate impaired compensatory mechanisms in this patient population. Our findings underscore the potential utility of gait tests in screening for HABI in PLWH in low resourced settings.
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