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Petro NM, Rempe MP, Schantell M, Ku V, Srinivas AN, O’Neill J, Kubat ME, Bares SH, May-Weeks PE, Wilson TW. Spontaneous cortical activity is altered in persons with HIV and related to domain-specific cognitive function. Brain Commun 2024; 6:fcae228. [PMID: 39035415 PMCID: PMC11258575 DOI: 10.1093/braincomms/fcae228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/23/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024] Open
Abstract
Whilst the average lifespan of persons with HIV now approximates that of the general population, these individuals are at a much higher risk of developing cognitive impairment with ∼35-70% experiencing at least subtle cognitive deficits. Previous works suggest that HIV impacts both low-level primary sensory regions and higher-level association cortices. Notably, multiple neuroHIV studies have reported elevated levels of spontaneous cortical activity during the pre-stimulus baseline period of task-based experiments, but only a few have examined such activity during resting-state conditions. In the current study, we examined such spontaneous cortical activity using magnetoencephalography in 79 persons with HIV and 83 demographically matched seronegative controls and related this neural activity to performance on neuropsychological assessments of cognitive function. Consistent with previous works, persons with HIV exhibited stronger spontaneous gamma activity, particularly in inferior parietal, prefrontal and superior temporal cortices. In addition, serostatus moderated the relationship between spontaneous beta activity and attention, motor and processing speed scores, with controls but not persons with HIV showing stronger beta activity with better performance. The current results suggest that HIV predominantly impacts spontaneous activity in association cortices, consistent with alterations in higher-order brain function, and may be attributable to deficient GABAergic signalling, given its known role in the generation of gamma and beta oscillations. Overall, these effects align with previous studies showing aberrant spontaneous activity in persons with HIV and provide a critical new linkage to domain-specific cognitive dysfunction.
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Affiliation(s)
- Nathan M Petro
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Maggie P Rempe
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
- College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA
| | - Mikki Schantell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
- College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA
| | - Vivian Ku
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Advika N Srinivas
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Jennifer O’Neill
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE 68198, USA
| | - Maureen E Kubat
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE 68198, USA
| | - Sara H Bares
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE 68198, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE 68178, USA
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Oomen PGA, Hakkers CS, Arends JE, van der Berk GEL, Pas P, Hoepelman AIM, van Welzen BJ, du Plessis S. Underlying Neural Mechanisms of Cognitive Improvement in Fronto-striatal Response Inhibition in People Living with HIV Switching Off Efavirenz: A Randomized Controlled BOLD fMRI Trial. Infect Dis Ther 2024; 13:1067-1082. [PMID: 38642238 PMCID: PMC11098980 DOI: 10.1007/s40121-024-00966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION It is unclear whether neurotoxicity due to the antiretroviral drug efavirenz (EFV) results in neurocognitive impairment in people living with HIV (PLWH). Previously, we found that discontinuing EFV was associated with improved processing speed and attention on neuropsychological assessment. In this imaging study, we investigate potential neural mechanisms underlying this cognitive improvement using a BOLD fMRI task assessing cortical and subcortical functioning. METHODS Asymptomatic adult PLWH stable on emtricitabine/tenofovirdisoproxil/efavirenz were randomly (1:2) assigned to continue their regimen (n = 12) or to switch to emtricitabine/tenofovirdisoproxil/rilpivirine (n = 28). At baseline and after 12 weeks, both groups performed the Stop-Signal Anticipation Task, which tests reactive and proactive inhibition (indicative of subcortical and cortical functioning, respectively), involving executive functioning, working memory, and attention. Behavior and BOLD fMRI activation levels related to processing speed and attention Z-scores were assessed in 17 pre-defined brain regions. RESULTS Both groups had comparable patient and clinical characteristics. Reactive inhibition behavioral responses improved for both groups on week 12, with other responses unchanged. Between-group activation did not differ significantly. For reactive inhibition, positive Pearson coefficients were observed for the change in BOLD fMRI activation levels and change in processing speed and attention Z-scores in all 17 regions in participants switched to emtricitabine/tenofovir disoproxil/rilpivirine, whereas in the control group, negative correlation coefficients were observed in 10/17 and 13/17 regions, respectively. No differential pattern was observed for proactive inhibition. CONCLUSION Potential neural mechanisms underlying cognitive improvement after discontinuing EFV in PLWH were found in subcortical functioning, with our findings suggesting that EFV's effect on attention and processing speed is, at least partially, mediated by reactive inhibition. TRIAL REGISTRATION Clinicaltrials.gov identifier [NCT02308332].
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Affiliation(s)
- Patrick G A Oomen
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Charlotte S Hakkers
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Guido E L van der Berk
- Department of Internal Medicine and Infectious Diseases, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Pascal Pas
- Department of Psychiatry, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Berend J van Welzen
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Stefan du Plessis
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
- SAMRC Genomics and Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parow, Cape Town, 7505, South Africa
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3
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Chaganti J, Gates TM, Brew BJ. Reversible large-scale network disruption correlates with neurocognitive improvement in HIV-associated minor neurocognitive disorder with combined anti-retroviral therapy intensification: a prospective longitudinal resting-state functional magnetic resonance imaging study. Neurol Sci 2023; 44:3261-3269. [PMID: 37052787 DOI: 10.1007/s10072-023-06783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/23/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE HIV-associated neurocognitive disorder (HAND) affects multiple cognitive domains and currently, the neuropsychological testing is the gold standard to identify these deficits. The aim of this longitudinal 12-month pilot study is to determine the effect of intensified combination antiretroviral therapy (cART) on rs-fMRI in virally suppressed (both in CSF and blood) patients with active HAND (those who have progressive neurocognitive impairment) and correlated with neurocognitive function tests. METHODS In this pilot study, we have evaluated sixteen patients with active HAND with viral suppression in both blood and CSF to study the effect of cART on functional connectivity. Participants underwent rs-fMRI at the baseline (time point-1 (TP-1) and 12-month visits (time point-2 (TP-2)). Connectivity in the five major networks was measured at TP-1 and TP-2 using the seed-based approach. All the participants underwent a five-domain neuropsychological battery at TP-1 and TP-2. Neurocognitive scores (NC) as well as blood and CSF markers were correlated with functional connectivity (FC). RESULTS There was a significant increase in the FC between the two time points within the executive, salience, default mode, dorsal attention, and visual networks at voxel level threshold of p < 0.001 and cluster level threshold of p < 0.05 and corrected for false detection rate (FDR). The neurocognitive scores were positively correlated with all the networks at similar cluster and voxel level thresholds. CONCLUSIONS These results indicate that rs-fMRI can be potentially used as one of the biomarkers for treatment efficacy in HAND.
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Affiliation(s)
- Joga Chaganti
- Department of Medical Imaging, St Vincent's Hospital, Sydney, Australia.
| | - Thomas M Gates
- Center for Applied Medical Research Program, St Vincent's Hospital, Sydney, Australia
| | - Bruce J Brew
- Department of Neurology, Head Neuroscience Program and Peter Duncan Neuroscience Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Sydney, Australia
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Lew BJ, McCusker MC, O'Neill J, Bares SH, Wilson TW, Doucet GE. Resting state network connectivity alterations in HIV: Parallels with aging. Hum Brain Mapp 2023; 44:4679-4691. [PMID: 37417797 PMCID: PMC10400792 DOI: 10.1002/hbm.26409] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
The increasing incidence of age-related comorbidities in people with HIV (PWH) has led to accelerated aging theories. Functional neuroimaging research, including functional connectivity (FC) using resting-state functional magnetic resonance imaging (rs-fMRI), has identified neural aberrations related to HIV infection. Yet little is known about the relationship between aging and resting-state FC in PWH. This study included 86 virally suppressed PWH and 99 demographically matched controls spanning 22-72 years old who underwent rs-fMRI. The independent and interactive effects of HIV and aging on FC were investigated both within- and between-network using a 7-network atlas. The relationship between HIV-related cognitive deficits and FC was also examined. We also conducted network-based statistical analyses using a brain anatomical atlas (n = 512 regions) to ensure similar results across independent approaches. We found independent effects of age and HIV in between-network FC. The age-related increases in FC were widespread, while PWH displayed further increases above and beyond aging, particularly between-network FC of the default-mode and executive control networks. The results were overall similar using the regional approach. Since both HIV infection and aging are associated with independent increases in between-network FC, HIV infection may be associated with a reorganization of the major brain networks and their functional interactions in a manner similar to aging.
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Affiliation(s)
- Brandon J. Lew
- Institute for Human NeuroscienceBoys Town National Research HospitalOmahaNebraskaUSA
- College of MedicineUniversity of Nebraska Medical Center (UNMC)OmahaNebraskaUSA
| | - Marie C. McCusker
- Institute for Human NeuroscienceBoys Town National Research HospitalOmahaNebraskaUSA
- Interdepartmental Neuroscience ProgramYale University School of MedicineNew HavenConnecticutUSA
| | - Jennifer O'Neill
- Department of Internal Medicine, Division of Infectious DiseasesUNMCOmahaNebraskaUSA
| | - Sara H. Bares
- Department of Internal Medicine, Division of Infectious DiseasesUNMCOmahaNebraskaUSA
| | - Tony W. Wilson
- Institute for Human NeuroscienceBoys Town National Research HospitalOmahaNebraskaUSA
- College of MedicineUniversity of Nebraska Medical Center (UNMC)OmahaNebraskaUSA
- Department of Pharmacology & NeuroscienceCreighton UniversityOmahaNebraskaUSA
| | - Gaelle E. Doucet
- Institute for Human NeuroscienceBoys Town National Research HospitalOmahaNebraskaUSA
- Department of Pharmacology & NeuroscienceCreighton UniversityOmahaNebraskaUSA
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5
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Son JJ, Arif Y, Schantell M, Willett MP, Johnson HJ, Okelberry HJ, Embury CM, Wilson TW. Oscillatory dynamics serving visual selective attention during a Simon task. Brain Commun 2023; 5:fcad131. [PMID: 37151223 PMCID: PMC10162684 DOI: 10.1093/braincomms/fcad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/08/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023] Open
Abstract
Selective attention is an important component of cognitive control and is essential for day-to-day functioning. The Simon task is a common test of visual selective attention that has been widely used to probe response selection, inhibition and cognitive control. However, to date, there is a dearth of literature that has focused on the oscillatory dynamics serving task performance in the selective attention component of this task. In this study, 32 healthy adults (mean age: 33.09 years, SD: 7.27 years) successfully completed a modified version of the Simon task during magnetoencephalography. All magnetoencephalographic data were pre-processed and transformed into the time-frequency domain. Significant oscillatory brain responses were imaged using a beamforming approach, and peak task-related neural activity was extracted to examine the temporal dynamics. Across both congruent and Simon conditions, our results indicated robust decreases in alpha (8-12 Hz) activity in the bilateral occipital regions and cuneus during task performance, while increases in theta (3-6 Hz) oscillatory activity were detected in regions of the dorsal frontoparietal attention network, including the dorsolateral prefrontal cortex, frontal eye fields and insula. Lastly, whole-brain condition-wise analyses showed Simon interference effects in the theta range in the superior parietal region and the alpha range in the posterior cingulate and inferior frontal cortices. These findings provide network-specific insights into the oscillatory dynamics serving visual selective attention.
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Affiliation(s)
- Jake J Son
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
- Interdisciplinary Graduate Program in Biomedical Sciences (IGPBS), College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA
| | - Yasra Arif
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Mikki Schantell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
- Interdisciplinary Graduate Program in Biomedical Sciences (IGPBS), College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA
| | - Madelyn P Willett
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Hallie J Johnson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Hannah J Okelberry
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Christine M Embury
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
- Interdisciplinary Graduate Program in Biomedical Sciences (IGPBS), College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE 68178, USA
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Oomen PGA, Hakkers CS, Arends JE, van der Berk GEL, Pas P, Hoepelman AIM, van Welzen BJ, du Plessis S. The Effect of Efavirenz on Reward Processing in Asymptomatic People Living with HIV: A Randomized Controlled Trial. AIDS Res Hum Retroviruses 2023. [PMID: 36734413 DOI: 10.1089/aid.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) studies have demonstrated that HIV-infection affects the fronto-striatal network. It has not been examined what impact efavirenz (EFV), an antiretroviral drug notorious for its neurocognitive effects, has on the reward system: a key subcomponent involved in depressive and apathy symptoms. Therefore, this study aims to investigate the effect of EFV on reward processing using a monetary incentive delay (MID) task. In this multicenter randomized controlled trial, asymptomatic adult participants stable on emtricitabine/tenofovirdisoproxil fumarate (FTC/TDF)/EFV were randomly assigned in a 2:1 ratio to switch to FTC/TDF/rilpivirine (RPV) (n = 30) or continue taking FTC/TDF/EFV (n = 13). At baseline and 12 weeks after therapy switch, both groups performed an MID task. Behavior and functional brain activity related to reward anticipation and reward outcome were assessed with blood-oxygen-level-dependent fMRI. Both groups were matched for age, education level, and time since HIV diagnosis and on EFV. At the behavioral level, both groups had faster response times and better response accuracy during rewarding versus nonrewarding trials, with no improvement resulting from switching FTC/TDF/EFV to FTC/TDF/RPV. No significant change in activation related to reward anticipation in the ventral striatum was found after switching therapy. Both groups had significantly higher activation levels over time, consistent with a potential learning effect. Similar activity related to reward outcome in the orbitofrontal cortex was found. Discontinuing FTC/TDF/EFV was not found to improve activity related to reward anticipation in asymptomatic people living with HIV, with similar cortical functioning during reward outcome processing. It is therefore likely that EFV does not affect motivational control. Further research is needed to determine whether EFV affects motivational control in HIV populations with different characteristics.
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Affiliation(s)
- Patrick G A Oomen
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Charlotte S Hakkers
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Guido E L van der Berk
- Department of Internal Medicine and Infectious Diseases, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Pascal Pas
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Berend J van Welzen
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stefan du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.,SAMRC Genomics and Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Spooner RK, Taylor BK, Ahmad IM, Dyball K, Emanuel K, O'Neill J, Kubat M, Swindells S, Fox HS, Bares SH, Stauch KL, Zimmerman MC, Wilson TW. Mitochondrial redox environments predict sensorimotor brain-behavior dynamics in adults with HIV. Brain Behav Immun 2023; 107:265-275. [PMID: 36272499 PMCID: PMC10590193 DOI: 10.1016/j.bbi.2022.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/23/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Despite virologic suppression, people living with HIV (PLWH) remain at risk for developing cognitive impairment, with aberrations in motor control being a predominant symptom leading to functional dependencies in later life. While the neuroanatomical bases of motor dysfunction have recently been illuminated, the underlying molecular processes remain poorly understood. Herein, we evaluate the predictive capacity of the mitochondrial redox environment on sensorimotor brain-behavior dynamics in 40 virally-suppressed PLWH and 40 demographically-matched controls using structural equation modeling. We used state-of-the-art approaches, including Seahorse Analyzer of mitochondrial function, electron paramagnetic resonance spectroscopy to measure superoxide levels, antioxidant activity assays and dynamic magnetoencephalographic imaging to quantify sensorimotor oscillatory dynamics. We observed differential modulation of sensorimotor brain-behavior relationships by superoxide and hydrogen peroxide-sensitive features of the redox environment in PLWH, while only superoxide-sensitive features were related to optimal oscillatory response profiles and better motor performance in controls. Moreover, these divergent pathways may be attributable to immediate, separable mechanisms of action within the redox environment seen in PLWH, as evidenced by mediation analyses. These findings suggest that mitochondrial redox parameters are important modulators of healthy and pathological oscillations in motor systems and behavior, serving as potential targets for remedying HIV-related cognitive-motor dysfunction in the future.
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Affiliation(s)
- Rachel K Spooner
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Düsseldorf, Germany.
| | - Brittany K Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, USA
| | - Iman M Ahmad
- College of Allied Health Professions, UNMC, Omaha, NE, USA
| | - Kelsey Dyball
- Department of Neurological Sciences, UNMC, Omaha, NE, USA
| | - Katy Emanuel
- Department of Neurological Sciences, UNMC, Omaha, NE, USA
| | - Jennifer O'Neill
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE, USA
| | - Maureen Kubat
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE, USA
| | - Susan Swindells
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE, USA
| | - Howard S Fox
- Department of Neurological Sciences, UNMC, Omaha, NE, USA
| | - Sara H Bares
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE, USA
| | - Kelly L Stauch
- Department of Neurological Sciences, UNMC, Omaha, NE, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, USA
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8
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Li R, Gao Y, Wang W, Jiao Z, Rao B, Liu G, Li H. Altered gray matter structural covariance networks in drug-naïve and treated early HIV-infected individuals. Front Neurol 2022; 13:869871. [PMID: 36203980 PMCID: PMC9530039 DOI: 10.3389/fneur.2022.869871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWhile regional brain structure and function alterations in HIV-infected individuals have been reported, knowledge about the topological organization in gray matter networks is limited. This research aims to investigate the effects of early HIV infection and combination antiretroviral therapy (cART) on gray matter structural covariance networks (SCNs) by employing graph theoretical analysis.MethodsSixty-five adult HIV+ individuals (25–50 years old), including 34 with cART (HIV+/cART+) and 31 medication-naïve (HIV+/cART–), and 35 demographically matched healthy controls (HCs) underwent high-resolution T1-weighted images. A sliding-window method was employed to create “age bins,” and SCNs (based on cortical thickness) were constructed for each bin by calculating Pearson's correlation coefficients. The group differences of network indices, including the mean nodal path length (Nlp), betweenness centrality (Bc), number of modules, modularity, global efficiency, local efficiency, and small-worldness, were evaluated by ANOVA and post-hoc tests employing the network-based statistics method.ResultsRelative to HCs, less efficiency in terms of information transfer in the parietal and occipital lobe (decreased Bc) and a compensated increase in the frontal lobe (decreased Nlp) were exhibited in both HIV+/cART+ and HIV+/cART– individuals (P < 0.05, FDR-corrected). Compared with HIV+/cART– and HCs, less specialized function segregation (decreased modularity and small-worldness property) and stronger integration in the network (increased Eglob and little changed path length) were found in HIV+/cART+ group (P < 0.05, FDR-corrected).ConclusionEarly HIV+ individuals exhibited a decrease in the efficiency of information transmission in sensory regions and a compensatory increase in the frontal lobe. HIV+/cART+ showed a less specialized regional segregation function, but a stronger global integration function in the network.
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Affiliation(s)
- Ruili Li
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yuxun Gao
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zengxin Jiao
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Bo Rao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- *Correspondence: Bo Rao
| | - Guangxue Liu
- Department of Natural Medicines, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Guangxue Liu
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Hongjun Li
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9
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High-content analysis and Kinetic Image Cytometry identify toxicity and epigenetic effects of HIV antiretrovirals on human iPSC-neurons and primary neural precursor cells. J Pharmacol Toxicol Methods 2022; 114:107157. [PMID: 35143957 PMCID: PMC9103414 DOI: 10.1016/j.vascn.2022.107157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Despite viral suppression due to combination antiretroviral therapy (cART), HIV-associated neurocognitive disorders (HAND) continue to affect half of people with HIV, suggesting that certain antiretrovirals (ARVs) may contribute to HAND. METHODS We examined the effects of nucleoside/nucleotide reverse transcriptase inhibitors tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) and the integrase inhibitors dolutegravir (DTG) and elvitegravir (EVG) on viability, structure, and function of glutamatergic neurons (a subtype of CNS neuron involved in cognition) derived from human induced pluripotent stem cells (hiPSC-neurons), and primary human neural precursor cells (hNPCs), which are responsible for neurogenesis. RESULTS Using automated digital microscopy and image analysis (high content analysis, HCA), we found that DTG, EVG, and TDF decreased hiPSC-neuron viability, neurites, and synapses after 7 days of treatment. Analysis of hiPSC-neuron calcium activity using Kinetic Image Cytometry (KIC) demonstrated that DTG and EVG also decreased the frequency and magnitude of intracellular calcium transients. Longer ARV exposures and simultaneous exposure to multiple ARVs increased the magnitude of these neurotoxic effects. Using the Microscopic Imaging of Epigenetic Landscapes (MIEL) assay, we found that TDF decreased hNPC viability and changed the distribution of histone modifications that regulate chromatin packing, suggesting that TDF may reduce neuroprogenitor pools important for CNS development and maintenance of cognition in adults. CONCLUSION This study establishes human preclinical assays that can screen potential ARVs for CNS toxicity to develop safer cART regimens and HAND therapeutics.
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10
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Christopher-Hayes NJ, Lew BJ, Wiesman AI, Schantell M, O'Neill J, May PE, Swindells S, Wilson TW. Cannabis use impacts pre-stimulus neural activity in the visual cortices of people with HIV. Hum Brain Mapp 2021; 42:5446-5457. [PMID: 34464488 PMCID: PMC8519863 DOI: 10.1002/hbm.25634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 12/04/2022] Open
Abstract
People with HIV (PWH) use cannabis at a higher rate than the general population, but the influence on neural activity is not well characterized. Cannabis use among PWH may have a beneficial effect, as neuroinflammation is known to be a critical problem in PWH and cannabis use has been associated with a reduction in proinflammatory markers. Thus, it is important to understand the net impact of cannabis use on brain and cognitive function in PWH. In this study, we collected magnetoencephalographic (MEG) brain imaging data on 81 participants split across four demographically matched groups (i.e., PWH using cannabis, controls using cannabis, non‐using PWH, and non‐using controls). Participants completed a visuospatial processing task during MEG. Time–frequency resolved voxel time series were extracted to identify the dynamics of oscillatory and pre‐stimulus baseline neural activity. Our results indicated strong theta (4–8 Hz), alpha (10–16 Hz), and gamma (62–72 Hz) visual oscillations in parietal–occipital brain regions across all participants. PWH exhibited significant behavioral deficits in visuospatial processing, as well as reduced theta oscillations and elevated pre‐stimulus gamma activity in visual cortices, all of which replicate prior work. Strikingly, chronic cannabis use was associated with a significant reduction in pre‐stimulus gamma activity in the visual cortices, such that PWH no longer statistically differed from controls. These results provide initial evidence that cannabis use may normalize some neural aberrations in PWH. This study fills an important gap in understanding the impact of cannabis use on brain and cognitive function in PWH.
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Affiliation(s)
| | - Brandon J Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, Nebraska, USA.,College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
| | - Alex I Wiesman
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, Nebraska, USA.,College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Mikki Schantell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, Nebraska, USA.,College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
| | - Jennifer O'Neill
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, Nebraska, USA
| | - Pamela E May
- Department of Neurological Sciences, UNMC, Omaha, Nebraska, USA
| | - Susan Swindells
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, Nebraska, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, Nebraska, USA.,College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
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11
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Ripamonti E, Clerici M. Living With Chronic HIV Disease in the Antiretroviral Era: The Impact of Neurocognitive Impairment on Everyday Life Functions. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:386-396. [PMID: 34370420 PMCID: PMC8384087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Although there is extensive literature around the biologic correlations of neurocognitive function in HIV/AIDS, less is known about the impact in everyday living. We conducted a systematic review of the association of neurocognitive impairment with everyday life functions in people with HIV on antiretroviral therapy. We specifically focused on attention, executive function, processing speed, and the central executive component of the working memory. We considered 3 domains of everyday functions: (1) autonomy, (2) decision making and adherence to treatment, and (3) quality of life and psychologic wellbeing. The relationship between neurocognitive impairment and mental health was examined, given its correlation with everyday life functions. Results indicate that people with HIV do experience problems with autonomy of daily living (especially if aged older than 50 years) and with decision making, and neurocognitive impairment plays a role in this regard. Psychologic wellbeing is associated with executive function and processing speed. These patients may also have a reduced quality of life, but the relationship between quality of life and cognition is uncertain or could be mediated by other factors. Neurocognitive impairment correlates with depression and anxiety; however, the relationship of cognitive performance with apathy is still controversial.
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Affiliation(s)
- Enrico Ripamonti
- Send correspondence to Enrico Ripamonti, Milan Center for Neuroscience NeuroMI, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy, or email
| | - Mario Clerici
- Head of the Department of Pathophysiology and Transplantation at the University of Milan in Italy
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12
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Casagrande CC, Lew BJ, Taylor BK, Schantell M, O'Neill J, May PE, Swindells S, Wilson TW. Impact of HIV-infection on human somatosensory processing, spontaneous cortical activity, and cortical thickness: A multimodal neuroimaging approach. Hum Brain Mapp 2021; 42:2851-2861. [PMID: 33738895 PMCID: PMC8127147 DOI: 10.1002/hbm.25408] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 12/22/2022] Open
Abstract
HIV-infection has been associated with widespread alterations in brain structure and function, although few studies have examined whether such aberrations are co-localized and the degree to which clinical and cognitive metrics are related. We examine this question in the somatosensory system using high-resolution structural MRI (sMRI) and magnetoencephalographic (MEG) imaging of neural oscillatory activity. Forty-four participants with HIV (PWH) and 55 demographically-matched uninfected controls completed a paired-pulse somatosensory stimulation paradigm during MEG and underwent 3T sMRI. MEG data were transformed into the time-frequency domain; significant sensor level responses were imaged using a beamformer. Virtual sensor time series were derived from the peak responses. These data were used to compute response amplitude, sensory gating metrics, and spontaneous cortical activity power. The T1-weighted sMRI data were processed using morphological methods to derive cortical thickness values across the brain. From these, the cortical thickness of the tissue coinciding with the peak response was estimated. Our findings indicated both PWH and control exhibit somatosensory gating, and that spontaneous cortical activity was significantly stronger in PWH within the left postcentral gyrus. Interestingly, within the same tissue, PWH also had significantly reduced cortical thickness relative to controls. Follow-up analyses indicated that the reduction in cortical thickness was significantly correlated with CD4 nadir and mediated the relationship between HIV and spontaneous cortical activity within the left postcentral gyrus. These data indicate that PWH have abnormally strong spontaneous cortical activity in the left postcentral gyrus and such elevated activity is driven by locally reduced cortical gray matter thickness.
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Affiliation(s)
- Chloe C Casagrande
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska, USA
| | - Brandon J Lew
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska, USA.,College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
| | - Brittany K Taylor
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska, USA
| | - Mikki Schantell
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska, USA.,College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
| | - Jennifer O'Neill
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
| | - Pamela E May
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
| | - Susan Swindells
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
| | - Tony W Wilson
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska, USA.,College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
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13
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Toniolo S, Cercignani M, Mora-Peris B, Underwood J, Alagaratnam J, Bozzali M, Boffito M, Nelson M, Winston A, Vera JH. Changes in functional connectivity in people with HIV switching antiretroviral therapy. J Neurovirol 2020; 26:754-763. [PMID: 32500477 PMCID: PMC7532134 DOI: 10.1007/s13365-020-00853-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022]
Abstract
We assessed changes in functional connectivity by fMRI (functional magnetic resonance imaging) and cognitive measures in otherwise neurologically asymptomatic people with HIV (PWH) switching combination antiretroviral therapy (cART). In a prospective study (baseline and follow-up after at least 4 months), virologically suppressed PWH switched non-nuclease reverse-transcriptase inhibitors (NNRTI; tenofovir-DF/emtricitabine with efavirenz to rilpivirine) and integrase-strand-transfer inhibitors (INSTI; tenofovir-DF/emtricitabine with raltegravir to dolutegravir). PWH were assessed by resting-state fMRI and stop-signal reaction time (SSRT) task fMRI as well as with a cognitive battery (CogState™) at baseline and follow-up. Switching from efavirenz to rilpivirine (n = 10) was associated with increased functional connectivity in the dorsal attention network (DAN) and a reduction in SSRTs (p = 0.025) that positively correlated with the time previously on efavirenz (mean = 4.8 years, p = 0.02). Switching from raltegravir to dolutegravir (n = 12) was associated with increased connectivity in the left DAN and bilateral sensory-motor and associative visual networks. In the NNRTI study, significant improvements in the cognitive domains of executive function, working memory and speed of visual processing were observed, whereas no significant changes in cognitive function were observed in the INSTI study. Changes in fMRI are evident in PWH without perceived neuropsychiatric complaints switching cART. fMRI may be a useful tool in assisting to elucidate the underlying pathogenic mechanisms of cART-related neuropsychiatric effects.
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Affiliation(s)
- Sofia Toniolo
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Knightsgate Road, Falmer Campus, Brighton, BN1 9RR, UK. .,Nuffield Department of Clinical Neurosciences, University of Oxford, New Radcliffe House, Walton St., Oxford, OX2 6BW, UK.
| | - Mara Cercignani
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Knightsgate Road, Falmer Campus, Brighton, BN1 9RR, UK
| | - Borja Mora-Peris
- Department of Infectious Disease, Faculty of Medicine, St Mary's Campus, Imperial College London, Praed Street, London, W2 1NY, UK.,Division of Infection and Immunity, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK
| | - Jonathan Underwood
- Department of Infectious Disease, Faculty of Medicine, St Mary's Campus, Imperial College London, Praed Street, London, W2 1NY, UK
| | - Jasmini Alagaratnam
- Department of Infectious Disease, Faculty of Medicine, St Mary's Campus, Imperial College London, Praed Street, London, W2 1NY, UK
| | - Marco Bozzali
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Knightsgate Road, Falmer Campus, Brighton, BN1 9RR, UK
| | - Marta Boffito
- Department of Infectious Disease, Faculty of Medicine, St Mary's Campus, Imperial College London, Praed Street, London, W2 1NY, UK.,Department of HIV Medicine, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Mark Nelson
- Department of HIV Medicine, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, St Mary's Campus, Imperial College London, Praed Street, London, W2 1NY, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
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14
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Lew BJ, O'Neill J, Rezich MT, May PE, Fox HS, Swindells S, Wilson TW. Interactive effects of HIV and ageing on neural oscillations: independence from neuropsychological performance. Brain Commun 2020; 2:fcaa015. [PMID: 32322820 PMCID: PMC7158235 DOI: 10.1093/braincomms/fcaa015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/23/2019] [Accepted: 01/17/2020] [Indexed: 01/24/2023] Open
Abstract
HIV infection is associated with increased age-related co-morbidities including cognitive deficits, leading to hypotheses of HIV-related premature or accelerated ageing. Impairments in selective attention and the underlying neural dynamics have been linked to HIV-associated neurocognitive disorder; however, the effect of ageing in this context is not yet understood. Thus, the current study aimed to identify the interactive effects of ageing and HIV on selective attention processing. A total of 165 participants (92 controls, 73 participants with HIV) performed a visual selective attention task while undergoing magnetoencephalography and were compared cross-sectionally. Spectrally specific oscillatory neural responses during task performance were imaged and linked with selective attention function. Reaction time on the task and regional neural activity were analysed with analysis of covariance (ANCOVA) models aimed at examining the age-by-HIV interaction term. Finally, these metrics were evaluated with respect to clinical measures such as global neuropsychological performance, duration of HIV infection and medication regimen. Reaction time analyses showed a significant HIV-by-age interaction, such that in controls older age was associated with greater susceptibility to attentional interference, while in participants with HIV, such susceptibility was uniformly high regardless of age. In regard to neural activity, theta-specific age-by-HIV interaction effects were found in the prefrontal and posterior parietal cortices. In participants with HIV, neuropsychological performance was associated with susceptibility to attentional interference, while time since HIV diagnosis was associated with parietal activity above and beyond global neuropsychological performance. Finally, current efavirenz therapy was also related to increased parietal interference activity. In conclusion, susceptibility to attentional interference in younger participants with HIV approximated that of older controls, suggesting evidence of HIV-related premature ageing. Neural activity serving attention processing indicated compensatory recruitment of posterior parietal cortex as participants with HIV infection age, which was related to the duration of HIV infection and was independent of neuropsychological performance, suggesting an altered trajectory of neural function.
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Affiliation(s)
- Brandon J Lew
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jennifer O'Neill
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael T Rezich
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Pamela E May
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Howard S Fox
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Susan Swindells
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W Wilson
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
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15
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Brain microstructural changes support cognitive deficits in HIV uninfected children born to HIV infected mothers. Brain Behav Immun Health 2020; 2:100039. [PMID: 34589830 PMCID: PMC8474176 DOI: 10.1016/j.bbih.2020.100039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Antiretroviral therapy (ART) is considered the most effective way to prevent perinatal transmission of human immunodeficiency virus (HIV). However, there is little knowledge about the effect of ART on the brain of HIV uninfected children born to HIV infected mothers (HUC). The current study evaluated the brain's microstructural integrity, and cognitive function in HUC compared to healthy children born to normal mothers (CHNM) and HIV infected children born to HIV infected mothers (HIC) to investigate the effect of in-utero exposure of ART on cerebral gray and white matter. Materials and methods Forty nine HIC, 12 HUC and 18 CHNM underwent neuropsychological (NP) assessment and a brain MRI. Diffusion tensor imaging (DTI) data was used to generate fractional anisotropy (FA) and mean diffusivity (MD) maps. Voxel wise comparison for FA and MD was performed between three groups using an analysis of covariance (ANCOVA) including age and sex as covariates, and correction for multiple comparisons (false discovery rate (FDR), p < 0.05 with minimum extended cluster size, 150 voxels). NP test scores were also compared between three groups using ANOVA with Post Hoc Bonferroni multiple comparison corrections (p < 0.05). Significantly changed FA and MD values in different brain regions in HIC and HUC compared to CHNM were used for correlation analysis with NP test scores using Pearson's correlation. Results HIC and HUC groups showed significantly decreased NP test scores in various domain compared to CHNM. Significantly lower NP test scores was observed in HIC than those of HUC. HIC showed decreased FA and increased MD in multiple brain sites as compared to both CHNM and HUC. Decreased FA along with both increased and decreased MD in different brain regions was present in HUC compared to CHNM. Both positive and negative correlation of altered FA and MD values from different brain regions in HIC and HUC with NP test scores was observed. Conclusion The presence of brain tissue changes and neurocognitive function deficit in absence of HIV infection in HUC indicates that ART may have a detrimental impact on the developing brain. The findings of the current study underscore the need for screening of ART exposed children for neurodevelopment and cognitive abnormalities at an early stage and call for access to early interventions, and nutritional and care programs.
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16
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Du Plessis S, Perez A, Fouche JP, Phillips N, Joska JA, Vink M, Myer L, Zar HJ, Stein DJ, Hoare J. Efavirenz is associated with altered fronto-striatal function in HIV+ adolescents. J Neurovirol 2019; 25:783-791. [PMID: 31165369 DOI: 10.1007/s13365-019-00764-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 04/24/2019] [Accepted: 05/15/2019] [Indexed: 01/11/2023]
Abstract
Neurotoxicity associated with the antiretroviral efavirenz (EFV) has been documented in HIV-infected adults, but there are no data on the impact of EFV on brain function in adolescents. We investigated potential alterations in fronto-striatal function associated with EFV use in adolescents. A total of 86 adolescents underwent a Stop Signal Anticipation Task (SSAT) during functional MRI (fMRI), 39 HIV+ adolescents receiving EFV, 27 HIV+ adolescents on antiretroviral therapy without EFV (matched on age, gender, education, CD4 cell count and HIV viral load) and 20 HIV- matched controls (matched on age and gender). The task required participants to give timed GO responses with occasional STOP signals at fixed probabilities. Reactive inhibition was modelled as a correct STOP response and proactive inhibition was modelled after response slowing as the STOP probability increases. A priori mask-based regions associated with reactive and proactive inhibition were entered into two respective multivariate ANOVAs. The EFV treatment group showed significantly blunted proactive inhibitory behavioural responses compared to HIV+ adolescents not receiving EFV. There was no difference in reactive inhibition between treatment groups. We also demonstrated a significant effect of EFV treatment on BOLD signal in proactive inhibition regions. There was no difference in regions involved in reactive inhibition. We found no differences between adolescents not receiving EFV and HIV- controls, showing that functional and behavioural differences were unique to the EFV group. Here, we demonstrate for the first time a potential adverse impact of EFV on higher cortical function in young HIV+ adolescents.
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Affiliation(s)
- Stéfan Du Plessis
- Department of Psychiatry, Faculty of Heath Sciences, Stellenbosch University, Francie van Zijl Avenue, Tygerberg, Cape Town, South Africa.
| | - Alexander Perez
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nicole Phillips
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Matthijs Vink
- Departments of Experimental and Developmental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, UCT, Cape Town, South Africa
- SA Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- SA Medical Research Council Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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17
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Wilson TW, Lew BJ, Spooner RK, Rezich MT, Wiesman AI. Aberrant brain dynamics in neuroHIV: Evidence from magnetoencephalographic (MEG) imaging. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:285-320. [PMID: 31481167 DOI: 10.1016/bs.pmbts.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetoencephalography (MEG) is a noninvasive, silent, and totally passive neurophysiological imaging method with excellent temporal resolution (~1ms) and good spatial precision (~3-5mm). While MEG studies of neuroHIV remain relatively rare, the number of studies per year has sharply increased recently and this trend will likely continue into the foreseeable future. The current in-depth review focuses on the studies that have been conducted to date, which include investigations of somatosensory and visual modalities, resting-state, as well as motor control and higher-level functions such as working memory and visual attention. The review begins with an introduction to the principles and methods of MEG, and then transitions to a review of each of the empirical studies that have been conducted to date, separated by sensory modality for the basic studies and cognitive domain for the higher-level investigations. As such, this review attempts to be exhaustive in its coverage of empirical MEG studies of neuroHIV. Across studies major themes emerge including aberrant neural oscillatory activity in HIV-infected adults, both in primary sensory regions of the brain and higher-order executive regions. Many studies have also connected the amplitude of neural oscillations to behavioral and/or neuropsychological function in the study population, making a vital connection to performance and improving the veracity of the findings. One conspicuous emerging area is the use of MEG to distinguish cognitively-impaired from unimpaired HIV-infected adults, with major success reported and future studies sure to come. The review concludes with a summary of findings and suggested focus areas for future studies.
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Affiliation(s)
- Tony W Wilson
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; Center for Magnetoencephalography, UNMC, Omaha, NE, United States.
| | - Brandon J Lew
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; Center for Magnetoencephalography, UNMC, Omaha, NE, United States
| | - Rachel K Spooner
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; Center for Magnetoencephalography, UNMC, Omaha, NE, United States
| | - Michael T Rezich
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; Center for Magnetoencephalography, UNMC, Omaha, NE, United States
| | - Alex I Wiesman
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; Center for Magnetoencephalography, UNMC, Omaha, NE, United States
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18
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Lew BJ, McDermott TJ, Wiesman AI, O'Neill J, Mills MS, Robertson KR, Fox HS, Swindells S, Wilson TW. Neural dynamics of selective attention deficits in HIV-associated neurocognitive disorder. Neurology 2018; 91:e1860-e1869. [PMID: 30333162 PMCID: PMC6260195 DOI: 10.1212/wnl.0000000000006504] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To identify the neural markers of attention dysfunction in patients with HIV-associated neurocognitive disorder (HAND). Methods Sixty participants, including 40 HIV-infected adults (half with HAND) and 20 demographically matched controls performed a visual selective attention task while undergoing high-density magnetoencephalography. Neuronal activity related to selective attention processing was quantified and compared across the 3 groups, and correlated with neuropsychological measures of attention and executive function. Spontaneous neural activity was also extracted from these attention-related cortical areas and examined with respect to HAND status. Results HIV-infected participants with and without HAND exhibited behavioral selective attention deficits on the magnetoencephalography task, as indicated by an increased flanker effect. Neuronal measures of flanker interference activity in the alpha and theta range revealed differential dynamics in attention-related brain areas across the 3 groups, especially in those with HAND. In addition, theta range flanker interference activity in the left inferior frontal and dorsolateral prefrontal cortex was associated with executive function and attention composite scores, respectively. Progressively stronger spontaneous alpha and theta activity was also found in unimpaired HIV-infected and HAND participants relative to controls across brain regions implicated in different components of attention processing. Conclusions Behavioral and neuronal metrics of selective attention performance distinguish participants with HAND from controls and unimpaired HIV-infected participants. These metrics, along with measures of local spontaneous neural activity, may hold promise as early markers of cognitive decline in participants with HIV infection and be useful prognostic indicators for HAND.
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Affiliation(s)
- Brandon J Lew
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Timothy J McDermott
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Alex I Wiesman
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Jennifer O'Neill
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Mackenzie S Mills
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Kevin R Robertson
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Howard S Fox
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Susan Swindells
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill
| | - Tony W Wilson
- From the Departments of Neurological Sciences (B.J.L., T.J.M., A.I.W., M.S.M., T.W.W.), Internal Medicine (J.O., S.S.), and Pharmacology and Experimental Neuroscience (H.S.F.), University of Nebraska Medical Center, Omaha; and Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill.
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Spooner RK, Wiesman AI, Mills MS, O'Neill J, Robertson KR, Fox HS, Swindells S, Wilson TW. Aberrant oscillatory dynamics during somatosensory processing in HIV-infected adults. Neuroimage Clin 2018; 20:85-91. [PMID: 30094159 PMCID: PMC6070689 DOI: 10.1016/j.nicl.2018.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/27/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
While the arrival of combination antiretroviral therapy significantly decreased the prevalence of HIV-associated dementia, between 35 and 70% of all infected adults continue to develop some form of cognitive impairment. These deficits appears to affect multiple neural subsystems, but the mechanisms and extent of damage are not fully understood. In the current study, we utilized magnetoencephalography (MEG), advanced oscillatory analysis methods, and a paired-pulse somatosensory stimulation paradigm to interrogate pre-attentive inhibitory processing in 43 HIV-infected adults and 28 demographically-matched uninfected controls. MEG responses were imaged using a beamformer, and time series data were extracted from the peak voxel in grand-averaged functional brain images to quantify the dynamics of sensory gating, oscillatory power, spontaneous power, and other neural indices. We found a significantly weakened response to the second stimulation compared to the first across groups, indicating significant sensory gating irrespective of HIV-infection. Interestingly, HIV-infected participants exhibited reduced neural responses in the 20-75 Hz gamma range to each somatosensory stimulation compared to uninfected controls, and exhibited significant alterations in peak gamma frequency in response to the second stimulation. Finally, HIV-infected participants also had significantly stronger spontaneous activity in the gamma range (i.e., 20-75 Hz) during the baseline period before stimulation onset. In conclusion, while HIV-infected participants had the capacity to efficiently gate somatosensory input, their overall oscillatory responses were weaker, spontaneous baseline activity was stronger, and their response to the second stimulation had an altered peak gamma frequency. We propose that this pattern of deficits suggests dysfunction in the somatosensory cortices, which is potentially secondary to accelerated aging.
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Affiliation(s)
- Rachel K Spooner
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Center for Magnetoencephalography, UNMC, Omaha, NE, USA
| | - Alex I Wiesman
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Center for Magnetoencephalography, UNMC, Omaha, NE, USA
| | - Mackenzie S Mills
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Center for Magnetoencephalography, UNMC, Omaha, NE, USA
| | - Jennifer O'Neill
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE, USA
| | - Kevin R Robertson
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Howard S Fox
- Department of Pharmacology and Experimental Neuroscience, UNMC, Omaha, NE, USA
| | - Susan Swindells
- Department of Internal Medicine, Division of Infectious Diseases, UNMC, Omaha, NE, USA
| | - Tony W Wilson
- Department of Neurological Sciences, University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Center for Magnetoencephalography, UNMC, Omaha, NE, USA.
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Abstract
Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or without a contrast agent). In addition, single-photon emission computed tomography with various tracers (e.g., thallium-201, Tc99-HMPAO) and positron emission tomography with various agents (e.g., [18F]-dexoyglucose, [11C]-PiB, and [11C]-TSPO tracers), were applied to study opportunistic infections or HIV-associated neurocognitive disorders. Neuroimaging provides diagnoses and biomarkers to quantitate the severity of brain injury or to monitor treatment effects, and may yield insights into the pathophysiology of HIV infection. As the majority of antiretroviral-stable HIV+ patients are living longer, age-related comorbid disorders (e.g., additional neuroinflammation, cerebrovascular disorders, or other dementias) will need to be considered. Other highly prevalent conditions, such as substance use disorders, psychiatric illnesses, and the long-term effects of combined antiretroviral therapy, all may lead to additional brain injury. Neuroimaging studies could provide knowledge regarding how these comorbid conditions impact the HIV-infected brain. Lastly, specific molecular imaging agents may be needed to assess the central nervous system viral reservoir.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Medicine and Department of Neurology, John A. Burns School of Medicine, University of Hawaii, Manoa, United States.
| | - Dinesh K Shukla
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Neural response to working memory demand predicts neurocognitive deficits in HIV. J Neurovirol 2017; 24:291-304. [PMID: 29280107 DOI: 10.1007/s13365-017-0607-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/31/2017] [Accepted: 11/20/2017] [Indexed: 01/14/2023]
Abstract
Human immunodeficiency virus (HIV) continues to have adverse effects on cognition and the brain in many infected people, despite a reduced incidence of HIV-associated dementia with combined antiretroviral therapy (cART). Working memory is often affected, along with attention, executive control, and cognitive processing speed. Verbal working memory (VWM) requires the interaction of each of the cognitive component processes along with a phonological loop for verbal repetition and rehearsal. HIV-related functional brain response abnormalities during VWM are evident in functional MRI (fMRI), though the neural substrate underlying these neurocognitive deficits is not well understood. The current study addressed this by comparing 24 HIV+ to 27 demographically matched HIV-seronegative (HIV-) adults with respect to fMRI activation on a VWM paradigm (n-back) relative to performance on two standardized tests of executive control, attention and processing speed (Stroop and Trail Making A-B). As expected, the HIV+ group had deficits on these neurocognitive tests compared to HIV- controls, and also differed in neural response on fMRI relative to neuropsychological performance. Reduced activation in VWM task-related brain regions on the 2-back was associated with Stroop interference deficits in HIV+ but not with either Trail Making A or B performance. Activation of the posterior cingulate cortex (PCC) of the default mode network during rest was associated with Hopkins Verbal Learning Test-2 (HVLT-2) learning in HIV+. These effects were not observed in the HIV- controls. Reduced dynamic range of neural response was also evident in HIV+ adults when activation on the 2-back condition was compared to the extent of activation of the default mode network during periods of rest. Neural dynamic range was associated with both Stroop and HVLT-2 performance. These findings provide evidence that HIV-associated alterations in neural activation induced by VWM demands and during rest differentially predict executive-attention and verbal learning deficits. That the Stroop, but not Trail Making was associated with VWM activation suggests that attentional regulation difficulties in suppressing interference and/or conflict regulation are a component of working memory deficits in HIV+ adults. Alterations in neural dynamic range may be a useful index of the impact of HIV on functional brain response and as a fMRI metric in predicting cognitive outcomes.
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Randall SR, Warton CMR, Holmes MJ, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM. Larger Subcortical Gray Matter Structures and Smaller Corpora Callosa at Age 5 Years in HIV Infected Children on Early ART. Front Neuroanat 2017; 11:95. [PMID: 29163068 PMCID: PMC5673662 DOI: 10.3389/fnana.2017.00095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Sub-Saharan Africa is home to 90% of HIV infected (HIV+) children. Since the advent of antiretroviral therapy (ART), HIV/AIDS has transitioned to a chronic condition where central nervous system (CNS) damage may be ongoing. Although, most guidelines recommend early ART to reduce CNS viral reservoirs, the brain may be more vulnerable to potential neurotoxic effects of ART during the rapid development phase in the first years of life. Here we investigate differences in subcortical volumes between 5-year-old HIV+ children who received early ART (before age 18 months) and uninfected children using manual tracing of Magnetic Resonance Images. Participants included 61 Xhosa children (43 HIV+/18 uninfected, mean age = 5.4 ± 0.3 years, 25 male) from the children with HIV early antiretroviral (CHER) trial; 27 children initiated ART before 12 weeks of age (ART-Before12Wks) and 16 after 12 weeks (ART-After12Wks). Structural images were acquired on a 3T Allegra MRI in Cape Town and manually traced using MultiTracer. Volumetric group differences (HIV+ vs. uninfected; ART-Before12Wks vs. ART-After12Wks) were examined for the caudate, nucleus accumbens (NA), putamen (Pu), globus pallidus (GP), and corpus callosum (CC), as well as associations within infected children of structure volumes with age at ART initiation and CD4/CD8 as a proxy for immune health. HIV+ children had significantly larger NA and Pu volumes bilaterally and left GP volumes than controls, whilst CC was smaller. Bilateral Pu was larger in both treatment groups compared to controls, while left GP and bilateral NA were enlarged only in ART-After12Wks children. CC was smaller in both treatment groups compared to controls, and smaller in ART-After12Wks compared to ART-Before12Wks. Within infected children, delayed ART initiation was associated with larger Pu volumes, effects that remained significant when controlling for sex and duration of treatment interruption (left β = 0.447, p = 0.005; right β = 0.325, p = 0.051), and lower CD4/CD8 with larger caudates controlling for sex (left β = -0.471, p = 0.002; right β = -0.440, p = 0.003). Volumetric differences were greater in children who initiated ART after 12 weeks. Results suggest damage is ongoing despite early ART and viral load suppression; however, earlier treatment is neuroprotective.
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Affiliation(s)
- Steven R. Randall
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher M. R. Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark F. Cotton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre J. W. van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ernesta M. Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Corrêa DG, Zimmermann N, Ventura N, Tukamoto G, Doring T, Leite SC, Fonseca RP, Bahia PR, Lopes FC, Gasparetto EL. Longitudinal evaluation of resting-state connectivity, white matter integrity and cortical thickness in stable HIV infection: Preliminary results. Neuroradiol J 2017; 30:535-545. [PMID: 29068256 DOI: 10.1177/1971400917739273] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose The objectives of this study were to determine if HIV-infected patients treated with highly active antiretroviral therapy (HAART), without dementia, suffer from longitudinal gray matter (GM) volume loss, changes in white matter (WM) integrity and deterioration in functional connectivity at rest, in an average interval of 30 months. Methods Clinically stable HIV-positive patients (on HAART, CD4 + T lymphocyte > 200 cells/μl, and viral loads <50 copies/μl) were recruited. None of them had HIV-associated dementia. Each patient underwent two scans, performed in a 1.5-T magnetic resonance imaging (MRI) scanner. FreeSurfer was used to perform cortical volumetric reconstruction and segmentation of GM structures. WM integrity was assessed using tract-based spatial statistics to post-process diffusion tensor imaging data, and FMRIB's Software Library tools were used to post-process resting-state functional magnetic resonance imaging (RS-fMRI). Results There were no significant differences in cortical thickness, deep GM volumes, or diffusivity parameters between the scans at the two time points. Five resting-state networks were identified in our patients. In the second MRI, HIV-positive patients presented increased areas of functional connectivity in visual pathways, frontoparietal and cerebellar networks, compared with the first MRI (considering p < 0.05). Conclusions RS-fMRI revealed potentially compensatory longitudinal alterations in the brains of HIV-positive patients, attempting to compensate for brain damage related to the infection.
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Affiliation(s)
- Diogo G Corrêa
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, 28125 Federal University of Rio de Janeiro , Brazil
- 2 499470 Clínica de Diagnóstico por Imagem (CDPI) , Brazil
| | - Nicolle Zimmermann
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, 28125 Federal University of Rio de Janeiro , Brazil
- 3 Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Nina Ventura
- 2 499470 Clínica de Diagnóstico por Imagem (CDPI) , Brazil
- 4 Department of Radiology, Hospital Universitário Antônio Pedro, Federal Fluminense University, Brazil
| | | | - Thomas Doring
- 2 499470 Clínica de Diagnóstico por Imagem (CDPI) , Brazil
| | - Sarah Cb Leite
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, 28125 Federal University of Rio de Janeiro , Brazil
| | - Rochele P Fonseca
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, 28125 Federal University of Rio de Janeiro , Brazil
- 3 Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Paulo Rv Bahia
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, 28125 Federal University of Rio de Janeiro , Brazil
| | - Fernanda Cr Lopes
- 2 499470 Clínica de Diagnóstico por Imagem (CDPI) , Brazil
- 4 Department of Radiology, Hospital Universitário Antônio Pedro, Federal Fluminense University, Brazil
| | - Emerson L Gasparetto
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, 28125 Federal University of Rio de Janeiro , Brazil
- 2 499470 Clínica de Diagnóstico por Imagem (CDPI) , Brazil
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24
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Motor-related brain abnormalities in HIV-infected patients: a multimodal MRI study. Neuroradiology 2017; 59:1133-1142. [PMID: 28889255 DOI: 10.1007/s00234-017-1912-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/22/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE It is generally believed that HIV infection could cause HIV-associated neurocognitive disorders (HAND) across a broad range of functional domains. Some of the most common findings are deficits in motor control. However, to date no neuroimaging studies have evaluated basic motor control in HIV-infected patients using a multimodal approach. METHODS In this study, we utilized high-resolution structural imaging and task-state functional magnetic resonance imaging (fMRI) to assess brain structure and motor function in a homogeneous cohort of HIV-infected patients. RESULTS We found that HIV-infected patients had significantly reduced gray matter (GM) volume in cortical regions, which are involved in motor control, including the bilateral posterior insula cortex, premotor cortex, and supramarginal gyrus. Increased activation in bilateral posterior insula cortices was also demonstrated by patients during hand movement tasks compared with healthy controls. More importantly, the reduced GM in bilateral posterior insula cortices was spatially coincident with abnormal brain activation in HIV-infected patients. In addition, the results of partial correlation analysis indicated that GM reduction in bilateral posterior insula cortices and premotor cortices was significantly correlated with immune system deterioration. CONCLUSION This study is the first to demonstrate spatially coincident GM reduction and abnormal activation during motor performance in HIV-infected patients. Although it remains unknown whether the brain deficits can be recovered, our findings may yield new insights into neurologic injury underlying motor dysfunction in HAND.
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25
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Zhuang Y, Qiu X, Wang L, Ma Q, Mapstone M, Luque A, Weber M, Tivarus M, Miller E, Arduino RC, Zhong J, Schifitto G. Combination antiretroviral therapy improves cognitive performance and functional connectivity in treatment-naïve HIV-infected individuals. J Neurovirol 2017; 23:704-712. [PMID: 28791662 PMCID: PMC5655604 DOI: 10.1007/s13365-017-0553-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/20/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
Our study aimed to investigate the short-term effect of combination antiretroviral therapy (cART) on cognitive performance and functional and structural connectivity and their relationship to plasma levels of antiretroviral (ARV) drugs. Seventeen ARV treatment-naïve HIV-infected individuals (baseline mean CD4 cell count, 479 ± 48 cells/mm3) were age matched with 17 HIV-uninfected individuals. All subjects underwent a detailed neurocognitive and functional assessment and magnetic resonance imaging. HIV-infected subjects were scanned before starting cART and 12 weeks after initiation of treatment. Uninfected subjects were assessed once at baseline. Functional connectivity (FC) was assessed within the default mode network while structural connectivity was assessed by voxel-wise analysis using tract-based spatial statistics (TBSS) and probabilistic tractography within the DMN. Tenofovir and emtricitabine blood concentration were measured at week 12 of cART. Prior to cART, HIV-infected individuals had significantly lower cognitive performance than control subjects as measured by the total Z-score from the neuropsychological tests assessing six cognitive domains (p = 0.020). After 12 weeks of cART treatment, there remained only a weak cognitive difference between HIV-infected and HIV-uninfected subjects (p = 0.057). Mean FC was lower in HIV-infected individuals compared with those uninfected (p = 0.008), but FC differences became non-significant after treatment (p = 0.197). There were no differences in DTI metrics between HIV-infected and HIV-uninfected individuals using the TBSS approach and limited evidence of decreased structural connectivity within the DMN in HIV-infected individuals. Tenofovir and emtricitabine plasma concentrations did not correlate with either cognitive performance or imaging metrics. CONCLUSIONS Twelve weeks of cART improves cognitive performance and functional connectivity in ARV treatment-naïve HIV-infected individuals with relatively preserved immune function. Longer periods of observation are necessary to assess whether this effect is maintained.
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Affiliation(s)
- Yuchuan Zhuang
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Lu Wang
- Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Qing Ma
- Department of Pharmacy Practice, University at Buffalo, Buffalo, NY, USA
| | - Mark Mapstone
- Department of Neurology, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Amneris Luque
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Miriam Weber
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Madalina Tivarus
- Department of Imaging Sciences, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY, 14642, USA
| | - Eric Miller
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, CA, USA
| | - Roberto C Arduino
- Division of Infectious Diseases, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jianhui Zhong
- Department of Imaging Sciences, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY, 14642, USA
| | - Giovanni Schifitto
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA. .,Department of Imaging Sciences, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY, 14642, USA.
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Chaganti JR, Heinecke A, Gates TM, Moffat KJ, Brew BJ. Functional Connectivity in Virally Suppressed Patients with HIV-Associated Neurocognitive Disorder: A Resting-State Analysis. AJNR Am J Neuroradiol 2017; 38:1623-1629. [PMID: 28596187 DOI: 10.3174/ajnr.a5246] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 03/29/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE HIV-associated neurocognitive disorder still occurs despite virally suppressive combination antiretroviral therapy. In the pre-combination antiretroviral era and in patients without HIV suppression, HIV-associated neurocognitive disorder was caused by synaptodendritic injury resulting in impairment of neural networks, characterized by decreased attention, psychomotor slowing, and working memory deficits. Whether similar pathogenesis is true for HIV-associated neurocognitive disorder in the context of viral suppression is not clear. Resting-state fMRI has been shown to be efficient in detecting impaired neural networks in various neurologic illnesses. This pilot study aimed to assess resting-state functional connectivity of the brain in patients with active HIV-associated neurocognitive disorder in the context of HIV viral suppression in both blood and CSF. MATERIALS AND METHODS Eighteen patients with active HIV-associated neurocognitive disorder (recent diagnosis with progressing symptoms) on combination antiretroviral therapy with viral suppression in both blood and CSF and 9 demographically matched control subjects underwent resting-state functional MR imaging. The connectivity in the 6 known neural networks was assessed. To localize significant ROIs within the HIV and control group, we performed a seed-based correlation for each known resting-state network. RESULTS There were significant group differences between the control and HIV-associated neurocognitive disorder groups in the salience (0.26 versus 0.14, t = 2.6978, df = 25, P = .0123) and executive networks (0.52 versus 0.32, t = 2.2372, df = 25, P = .034). The covariate analysis with neuropsychological scores yielded statistically significant correlations in all 6 studied functional networks, with the most conspicuous correlation in salience networks. CONCLUSIONS Active HIV-associated neurocognitive disorder in virally suppressed patients is associated with significantly decreased connectivity in the salience and executive networks, thereby making it potentially useful as a biomarker.
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Affiliation(s)
- J R Chaganti
- From the Departments of Radiology (J.R.C., K.J.M.)
| | - A Heinecke
- Brain Innovation B.V. (A.H.), Maastricht, the Netherlands
| | - T M Gates
- Department of Neurology, Clinical Research Program (T.M.J.)
| | - K J Moffat
- From the Departments of Radiology (J.R.C., K.J.M.)
| | - B J Brew
- Neurology (B.J.B.), St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia.,Neurosciences Program, Peter Duncan Neurosciences Unit (B.J.B.), St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
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Aberrant Neuronal Dynamics during Working Memory Operations in the Aging HIV-Infected Brain. Sci Rep 2017; 7:41568. [PMID: 28155864 PMCID: PMC5290733 DOI: 10.1038/srep41568] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/20/2016] [Indexed: 11/08/2022] Open
Abstract
Impairments in working memory are among the most prevalent features of HIV-associated neurocognitive disorders (HAND), yet their origins are unknown, with some studies arguing that encoding operations are disturbed and others supporting deficits in memory maintenance. The current investigation directly addresses this issue by using a dynamic mapping approach to identify when and where processing in working memory circuits degrades. HIV-infected older adults and a demographically-matched group of uninfected controls performed a verbal working memory task during magnetoencephalography (MEG). Significant oscillatory neural responses were imaged using a beamforming approach to illuminate the spatiotemporal dynamics of neuronal activity. HIV-infected patients were significantly less accurate on the working memory task and their neuronal dynamics indicated that encoding operations were preserved, while memory maintenance processes were abnormal. Specifically, no group differences were detected during the encoding period, yet dysfunction in occipital, fronto-temporal, hippocampal, and cerebellar cortices emerged during memory maintenance. In addition, task performance in the controls covaried with occipital alpha synchronization and activity in right prefrontal cortices. In conclusion, working memory impairments are common and significantly impact the daily functioning and independence of HIV-infected patients. These impairments likely reflect deficits in the maintenance of memory representations, not failures to adequately encode stimuli.
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28
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Hakkers CS, Arends JE, Barth RE, Du Plessis S, Hoepelman AIM, Vink M. Review of functional MRI in HIV: effects of aging and medication. J Neurovirol 2016; 23:20-32. [PMID: 27718211 PMCID: PMC5329077 DOI: 10.1007/s13365-016-0483-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/12/2016] [Accepted: 09/09/2016] [Indexed: 12/25/2022]
Abstract
HIV-associated neurocognitive disorder (HAND) is a frequently occurring comorbidity of HIV infection. Evidence suggests this condition starts subclinical before a progression to a symptomatic stage. Blood oxygenated level dependent (BOLD) fMRI has shown to be a sensitive tool to detect abnormal brain function in an early stage and might therefore be useful to evaluate the effect of HIV infection on brain function. An extensive literature search was performed in June 2015. Eligibility criteria for included studies were as follows: (1) conducting with HIV-positive patients, (2) using BOLD fMRI, and (3) including a HIV-negative control group. A total of 19 studies were included in the review including 931 participants. Differences in activation between HIV-positive and -negative participants were found when testing multiple domains, i.e., attention, (working) memory, and especially executive functioning. Overall, HIV-positive patients showed hyperactivation in task-related brain regions despite equal performances as controls. Task performance was degraded only for the most complex tasks. A few studies investigated the effect of aging on fMRI, and most of them found no interaction with HIV infection. Only three studies evaluated the effect of combination antiretroviral therapy (cART) on functional data suggesting an increase in activation with the use of cART. fMRI is a sensitive instrument to detect subtle cognitive changes in HIV patients. Open questions remain regarding the effects of cART on fMRI and the effects of aging on fMRI.
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Affiliation(s)
- C S Hakkers
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - J E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - R E Barth
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - S Du Plessis
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - A I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - M Vink
- Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
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Association between striatal dopamine D2/D3 receptors and brain activation during visual attention: effects of sleep deprivation. Transl Psychiatry 2016; 6:e828. [PMID: 27244237 PMCID: PMC5070053 DOI: 10.1038/tp.2016.93] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 03/01/2016] [Accepted: 03/05/2016] [Indexed: 01/09/2023] Open
Abstract
Sleep deprivation (SD) disrupts dopamine (DA) signaling and impairs attention. However, the interpretation of these concomitant effects requires a better understanding of dopamine's role in attention processing. Here we test the hypotheses that D2/D3 receptors (D2/D3R) in dorsal and ventral striatum would distinctly regulate the activation of attention regions and that, by decreasing D2/D3, SD would disrupt these associations. We measured striatal D2/D3R using positron emission tomography with [(11)C]raclopride and brain activation to a visual attention (VA) task using 4-Tesla functional magnetic resonance imaging. Fourteen healthy men were studied during rested wakefulness and also during SD. Increased D2/D3R in striatum (caudate, putamen and ventral striatum) were linearly associated with higher thalamic activation. Subjects with higher D2/D3R in caudate relative to ventral striatum had higher activation in superior parietal cortex and ventral precuneus, and those with higher D2/D3R in putamen relative to ventral striatum had higher activation in anterior cingulate. SD impaired the association between striatal D2/D3R and VA-induced thalamic activation, which is essential for alertness. Findings suggest a robust DAergic modulation of cortical activation during the VA task, such that D2/D3R in dorsal striatum counterbalanced the stimulatory influence of D2/D3R in ventral striatum, which was not significantly disrupted by SD. In contrast, SD disrupted thalamic activation, which did not show counterbalanced DAergic modulation but a positive association with D2/D3R in both dorsal and ventral striatum. The counterbalanced dorsal versus ventral striatal DAergic modulation of VA activation mirrors similar findings during sensorimotor processing (Tomasi et al., 2015) suggesting a bidirectional influence in signaling between the dorsal caudate and putamen and the ventral striatum.
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Meade CS, Cordero DM, Hobkirk AL, Metra BM, Chen NK, Huettel SA. Compensatory activation in fronto-parietal cortices among HIV-infected persons during a monetary decision-making task. Hum Brain Mapp 2016; 37:2455-67. [PMID: 27004729 DOI: 10.1002/hbm.23185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/27/2016] [Accepted: 03/09/2016] [Indexed: 12/25/2022] Open
Abstract
HIV infection can cause direct and indirect damage to the brain and is consistently associated with neurocognitive disorders, including impairments in decision-making capacities. The tendency to devalue rewards that are delayed (temporal discounting) is relevant to a range of health risk behaviors. Making choices about delayed rewards engages the executive control network of the brain, which has been found to be affected by HIV. In this case-control study of 18 HIV-positive and 17 HIV-negative adults, we examined the effects of HIV on brain activation during a temporal discounting task. Functional MRI (fMRI) data were collected while participants made choices between smaller, sooner rewards and larger, delayed rewards. Choices were individualized based on participants' unique discount functions, so each participant experienced hard (similarly valued), easy (disparately valued), and control choices. fMRI data were analyzed using a mixed-effects model to identify group-related differences associated with choice difficulty. While there was no difference between groups in behavioral performance, the HIV-positive group demonstrated significantly larger increases in activation within left parietal regions and bilateral prefrontal regions during easy trials and within the right prefrontal cortex and anterior cingulate during hard trials. Increasing activation within the prefrontal regions was associated with lower nadir CD4 cell count and risk-taking propensity. These results support the hypothesis that HIV infection can alter brain functioning in regions that support decision making, providing further evidence for HIV-associated compensatory activation within fronto-parietal cortices. A history of immunosuppression may contribute to these brain changes. Hum Brain Mapp 37:2455-2467, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina.,Department of Psychology & Neuroscience, Duke University, Durham, North Carolina
| | | | - Andrea L Hobkirk
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina
| | | | - Nan-Kuei Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Scott A Huettel
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina.,Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
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Chang L, Løhaugen GC, Douet V, Miller EN, Skranes J, Ernst T. Neural correlates of working memory training in HIV patients: study protocol for a randomized controlled trial. Trials 2016; 17:62. [PMID: 26833223 PMCID: PMC4736265 DOI: 10.1186/s13063-016-1160-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/07/2016] [Indexed: 12/31/2022] Open
Abstract
Background Potent combined antiretroviral therapy decreased the incidence and severity of HIV-associated neurocognitive disorders (HAND); however, no specific effective pharmacotherapy exists for HAND. Patients with HIV commonly have deficits in working memory and attention, which may negatively impact many other cognitive domains, leading to HAND. Since HAND may lead to loss of independence in activities of daily living and negative emotional well-being, and incur a high economic burden, effective treatments for HAND are urgently needed. This study aims to determine whether adaptive working memory training might improve cognitive functions and neural network efficiency and possibly decrease neuroinflammation. This study also aims to assess whether subjects with the LMX1A-rs4657412 TT(AA) genotype show greater training effects from working memory training than TC(AG) or CC(GG)-carriers. Methods/Design 60 HIV-infected and 60 seronegative control participants will be randomized to a double-blind active-controlled study, using adaptive versus non-adaptive Cogmed Working Memory Training® (CWMT), 20–25 sessions over 5–8 weeks. Each subject will be assessed with near- and far-transfer cognitive tasks, self-reported mood and executive function questionnaires, and blood-oxygenation level-dependent functional MRI during working memory (n-back) and visual attention (ball tracking) tasks, at baseline, 1-month, and 6-months after CWMT. Furthermore, genotyping for LMX1A-rs4657412 will be performed to identify whether subjects with the TT(AA)-genotype show greater gain or neural efficiency after CWMT than those with other genotypes. Lastly, cerebrospinal fluid will be obtained before and after CWMT to explore changes in levels of inflammatory proteins (cytokines and chemokines) and monoamines. Discussion Improving working memory in HIV patients, using CWMT, might slow the progression or delay the onset of HAND. Observation of decreased brain activation or normalized neural networks, using fMRI, after CWMT would lead to a better understanding of how neural networks are modulated by CWMT. Moreover, validating the greater training gain in subjects with the LMX1A-TT(AA) genotype could lead to a personalized approach for future working memory training studies. Demonstrating and understanding the neural correlates of the efficacy of CWMT in HIV patients could lead to a safe adjunctive therapy for HAND, and possibly other brain disorders. Trial registration ClinicalTrial.gov, NCT02602418.
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Affiliation(s)
- L Chang
- Department of Medicine, John A. Burns School of Medicine, The Queen's Medical Center, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor UH Tower, Honolulu, HI, USA.
| | - G C Løhaugen
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway. .,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - V Douet
- Department of Medicine, John A. Burns School of Medicine, The Queen's Medical Center, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor UH Tower, Honolulu, HI, USA.
| | - E N Miller
- UCLA Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA.
| | - J Skranes
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway. .,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - T Ernst
- Department of Medicine, John A. Burns School of Medicine, The Queen's Medical Center, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor UH Tower, Honolulu, HI, USA.
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HIV Infection Is Associated with Impaired Striatal Function during Inhibition with Normal Cortical Functioning on Functional MRI. J Int Neuropsychol Soc 2015; 21:722-31. [PMID: 26435417 DOI: 10.1017/s1355617715000971] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the present study was to investigate the effect of HIV infection on cortical and subcortical regions of the frontal-striatal system involved in the inhibition of voluntary movement. Functional MRI (fMRI) studies suggest that human immunodeficiency virus (HIV) infection is associated with frontostriatal dysfunction. While frontostriatal systems play a key role in behavioral inhibition, there are to our knowledge no fMRI studies investigating the potential impact of HIV on systems involved during the inhibition of voluntary movement. A total of 17 combined antiretroviral therapy (cART) naïve HIV+ participants as well as 18 age, gender, ethnic, education matched healthy controls performed a modified version of the stop-signal paradigm. This paradigm assessed behavior as well as functional brain activity associated with motor execution, reactive inhibition (outright stopping) and proactive inhibition (anticipatory response slowing before stopping). HIV+ participants showed significantly slower responses during motor execution compared to healthy controls, whereas they had normal proactive response slowing. Putamen hypoactivation was evident in the HIV+ participants based on successful stopping, indicating subcortical dysfunction during reactive inhibition. HIV+ participants showed normal cortical functioning during proactive inhibition. Our data provide evidence that HIV infection is associated with subcortical dysfunction during reactive inhibition, accompanied by relatively normal higher cortical functioning during proactive inhibition. This suggests that HIV infection may primarily involve basic striatal-mediated control processes in cART naïve participants.
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Abstract
OBJECTIVE Functional MRI has thus far demonstrated that HIV has an impact on frontal-striatal systems involved in executive functioning. The potential impact of HIV on frontal-striatal systems involved in reward processing has yet to be examined by functional MRI. This study therefore aims to investigate the effects of HIV infection on reward processing by examining the function of the ventral-striatal reward system during a monetary incentive delay task. DESIGN This is a cross-sectional case-control study. METHODS Eighteen combined antiretroviral therapy-naive HIV-positive (HIV+) participants, as well as 16 matched healthy controls, performed a monetary incentive delay task. This paradigm assesses behaviour as well as functional brain activity-associated reward anticipation and reward outcome. RESULTS HIV+ participants showed a general decrease in activation associated with both neutral as well as potentially rewarding cues in their ventral striatum. We found normal activity related to reward outcome in the orbito-frontal cortex. Despite HIV+ participants' reaction times being significantly slower when independently measured from the reward paradigm, this performance deficit normalized during the performance of the reward task. CONCLUSION HIV caused a decrease in activity during cue processing in the ventral striatum, with normal cortical functioning during reward outcome processing. Our results therefore suggest that HIV not only has an impact on fronto-striatal systems involved in executive functioning, but also has a direct impact on the function of the ventral-striatal reward system.
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Hatchard T, Smith AM, Halchuk RE, Longo CA, Fried PA, Hogan MJ, Cameron I. Effects of low-level alcohol use on cognitive interference: an fMRI study in young adults. Alcohol 2015; 49:7-13. [PMID: 25477199 DOI: 10.1016/j.alcohol.2014.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/05/2014] [Accepted: 07/03/2014] [Indexed: 01/01/2023]
Abstract
Alcohol consumption is widely known to adversely affect human health. Its neuropathology is largely evident in the cerebellum and frontal lobes, particularly in the immature brains of adolescents and young adults. It may also have a long-lasting impact on executive functioning. The Ottawa Prenatal Prospective Study (OPPS) has followed participants over 20 years, from birth to young adulthood, and has collected data on potentially confounding lifestyle variables, such as prenatal drug exposure and current drug use. The present study investigated the neural activity of 29 young adults from the OPPS using fMRI. The main objective was to discover the impact of regular low-level alcohol consumption on the cognitive interference of these participants, as they performed a Counting Stroop task. Results indicated that, despite a lack of performance differences, young adults who use alcohol on a regular basis differ significantly from non-users with respect to their neural activity as they perform this task. Areas that were significantly more activated in users compared to non-users included the cerebellum, thalamus, fusiform gyrus, prefrontal cortex, and precuneus. The observed activity suggests a significant impact of early alcohol use on neurocognitive functioning despite relatively low levels of alcohol consumption.
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Abstract
Antiretroviral therapy extends the lifespan of human immunodeficiency virus (HIV)-infected patients, but many survivors develop premature impairments in cognition. These residual cognitive impairments may involve aberrant deposition of amyloid β-peptides (Aβ). By unknown mechanisms, Aβ accumulates in the lysosomal and autophagic compartments of neurons in the HIV-infected brain. Here we identify the molecular events evoked by the HIV coat protein gp120 that facilitate the intraneuronal accumulation of Aβ. We created a triple transgenic gp120/APP/PS1 mouse that recapitulates intraneuronal deposition of Aβ in a manner reminiscent of the HIV-infected brain. In cultured neurons, we found that the HIV coat protein gp120 increased the transcriptional expression of BACE1 through repression of PPARγ, and increased APP expression by promoting interaction of the translation-activating RBP heterogeneous nuclear ribonucleoprotein C with APP mRNA. APP and BACE1 were colocalized into stabilized membrane microdomains, where the β-cleavage of APP and Aβ formation were enhanced. Aβ-peptides became localized to lysosomes that were engorged with sphingomyelin and calcium. Stimulating calcium efflux from lysosomes with a TRPM1 agonist promoted calcium efflux, luminal acidification, and cleared both sphingomyelin and Aβ from lysosomes. These findings suggest that therapeutics targeted to reduce lysosomal pH in neurodegenerative conditions may protect neurons by facilitating the clearance of accumulated sphingolipids and Aβ-peptides.
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Wilson TW, Heinrichs-Graham E, Becker KM, Aloi J, Robertson KR, Sandkovsky U, White ML, O'Neill J, Knott NL, Fox HS, Swindells S. Multimodal neuroimaging evidence of alterations in cortical structure and function in HIV-infected older adults. Hum Brain Mapp 2014; 36:897-910. [PMID: 25376125 DOI: 10.1002/hbm.22674] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/22/2014] [Accepted: 10/17/2014] [Indexed: 11/06/2022] Open
Abstract
Combination antiretroviral therapy transformed human immunodeficiency virus (HIV)-infection from a terminal illness to a manageable condition, but these patients remain at a significantly elevated risk of developing cognitive impairments and the mechanisms are not understood. Some previous neuroimaging studies have found hyperactivation in frontoparietal networks of HIV-infected patients, whereas others reported aberrations restricted to sensory cortices. In this study, we utilize high-resolution structural and neurophysiological imaging to determine whether alterations in brain structure, function, or both contribute to HIV-related cognitive impairments. HIV-infected adults and individually matched controls completed 3-Tesla structural magnetic resonance imaging (sMRI) and a mechanoreception task during magnetoencephalography (MEG). MEG data were examined using advanced beamforming methods, and sMRI data were analyzed using the latest voxel-based morphometry methods with DARTEL. We found significantly reduced theta responses in the postcentral gyrus and increased alpha activity in the prefrontal cortices of HIV-infected patients compared with controls. Patients also had reduced gray matter volume in the postcentral gyrus, parahippocampal gyrus, and other regions. Importantly, reduced gray matter volume in the left postcentral gyrus was spatially coincident with abnormal MEG responses in HIV-infected patients. Finally, left prefrontal and postcentral gyrus activity was correlated with neuropsychological performance and, when used in conjunction, these two MEG findings had a sensitivity and specificity of over 87.5% for HIV-associated cognitive impairment. This study is the first to demonstrate abnormally increased activity in association cortices with simultaneously decreased activity in sensory areas. These MEG findings had excellent sensitivity and specificity for HIV-associated cognitive impairment, and may hold promise as a potential disease marker.
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Affiliation(s)
- Tony W Wilson
- Department of Pharmacology and Experimental Neurosciences, University of Nebraska Medical Center (UNMC), Omaha, Nebraska; Department of Neurological Sciences, UNMC, Omaha, Nebraska; Center for Magnetoencephalography, UNMC, Omaha, Nebraska
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Connolly CG, Bischoff-Grethe A, Jordan SJ, Woods SP, Ellis RJ, Paulus MP, Grant I. Altered functional response to risky choice in HIV infection. PLoS One 2014; 9:e111583. [PMID: 25347679 PMCID: PMC4210250 DOI: 10.1371/journal.pone.0111583] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/06/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Risky decision-making is commonly observed in persons at risk for and infected with HIV and is associated with executive dysfunction. Yet it is currently unknown whether HIV alters brain processing of risk-taking decision-making. METHODS This study examined the neural substrate of a risky decision-making task in 21 HIV seropositive (HIV+) and 19 seronegative (HIV-) comparison participants. Functional magnetic resonance imaging was conducted while participants performed the risky-gains task, which involves choosing among safe (20 cents) and risky (40/80 cent win or loss) choices. Linear mixed effects analyses examining group and decision type were conducted. Robust regressions were performed to examine the relationship between nadir CD4 count and Kalichman sexual compulsivity and brain activation in the HIV+ group. The overlap between the task effects and robust regressions was explored. RESULTS Although there were no serostatus effects in behavioral performance on the risky-gains task, HIV+ individuals exhibited greater activation for risky choices in the basal ganglia, i.e. the caudate nucleus, but also in the anterior cingulate, dorsolateral prefrontal cortex, and insula relative to the HIV- group. The HIV+ group also demonstrated reduced functional responses to safe choices in the anterior cingulate and dorsolateral prefrontal cortex relative to the HIV- group. HIV+ individuals with higher nadir CD4 count and greater sexual compulsivity displayed lower differential responses to safe versus risky choices in many of these regions. CONCLUSIONS This study demonstrated fronto-striatal loop dysfunction associated with HIV infection during risky decision-making. Combined with similar between-group task behavior, this suggests an adaptive functional response in regions critical to reward and behavioral control in the HIV+ group. HIV-infected individuals with higher CD4 nadirs demonstrated activation patterns more similar to seronegative individuals. This suggests that the severity of past immunosuppression (CD4 nadir) may exert a legacy effect on processing of risky choices in the HIV-infected brain.
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Affiliation(s)
- Colm G. Connolly
- Dept of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Amanda Bischoff-Grethe
- Dept of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- * E-mail: (ABG); (IG)
| | - Stephan J. Jordan
- Dept of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Steven Paul Woods
- Dept of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, United States of America
| | - Ronald J. Ellis
- Department of Neurosciences, University of California San Diego, San Diego, California, United States of America
| | - Martin P. Paulus
- Dept of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- Psychiatry Service, VA San Diego Healthcare System, La Jolla, California, United States of America
| | - Igor Grant
- Dept of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, United States of America
- * E-mail: (ABG); (IG)
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Neural dysregulation during a working memory task in human immunodeficiency virus-seropositive and hepatitis C coinfected individuals. J Neurovirol 2014; 20:398-411. [PMID: 24867610 DOI: 10.1007/s13365-014-0257-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/21/2014] [Accepted: 05/09/2014] [Indexed: 01/27/2023]
Abstract
Cognitive and functional neural correlates of human immunodeficiency virus (HIV) are only partially understood at present. Variability in neural response, which has been noted in the literature, may relate to clinical factors associated with HIV, including time since HIV diagnosis, CD4 count and nadir, HIV viral load, and comorbid infectious processes, especially hepatitis C. The present investigation evaluated working memory-related functional neural activation in 26 HIV+ participants, 28 demographically matched HIV-seronegative individuals, and 8 HIV+ individuals with hepatitis C coinfection. Analyses examined impact of HIV infection duration, CD4 count and nadir, HIV viral load, and hepatitis C serostatus. Results showed that HIV-seronegative participants had fastest reaction times, and during the working memory task, HIV+ participants with hepatitis C coinfection showed strongest bias toward commission errors; however, signal detection (i.e., overall task performance) was equivalent across groups. Functional magnetic resonance imaging (fMRI) results showed HIV-related greater activation to an easier vigilance task and HIV-related lower activation to a more difficult working memory task, consistent with reduced cognitive reserve. Hepatitis C coinfection related to diffuse neural dysregulation. Correlational analyses suggested relationships of increasingly severe disease with poorer functioning in brain regions linked to error monitoring and attention regulation.
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HIV infection and the fronto-striatal system: a systematic review and meta-analysis of fMRI studies. AIDS 2014; 28:803-11. [PMID: 24300546 DOI: 10.1097/qad.0000000000000151] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Functional MRI studies investigating the impact of HIV on the brain have implicated the involvement of fronto-striatal circuitry. However, to date there is no review and meta-analysis of this work. We systematically reviewed the literature and performed a meta-analysis of functional magnetic resonance imaging (fMRI) studies in HIV-infected individuals using a well validated tool recently developed for use in fMRI, 'GingerALE'. Twenty-one studies (468 HIV+, 270 HIV- controls) were qualitatively reviewed, of which six (105 HIV+, 102 controls) utilized fMRI paradigms engaging the fronto-striatal-parietal network, making a quantitative analysis possible. Our meta-analysis revealed consistent functional differences in the left inferior frontal gyrus and caudate nucleus between infected participants and controls across these studies. This fronto-striatal dysfunction was qualitatively related to cognitive impairment, disease progression and treatment effects. Although further work needs to be done to further delineate the potentially confounding influence of substance abuse and HIV-related comorbidities, as well as HIV's effect on functional haemodynamic vascular coupling, these findings indicate that further investigation of the fronto-striatal sub-networks in HIV-infected patients is warranted.
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Becker KM, Heinrichs-Graham E, Fox HS, Robertson KR, Sandkovsky U, O'Neill J, Swindells S, Wilson TW. Decreased MEG beta oscillations in HIV-infected older adults during the resting state. J Neurovirol 2013; 19:586-94. [PMID: 24297500 DOI: 10.1007/s13365-013-0220-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/26/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022]
Abstract
The introduction of combination antiretroviral therapy significantly reduced the prevalence of the most severe form of HIV-associated neurocognitive disorders (HAND). Despite this decline, 35-70 % of HIV-infected patients continue to develop mild motor and cognitive impairments. Although neuropsychological studies have shown that HAND affects a wide array of cognitive functions, a formal diagnosis is still based on the exclusion of opportunistic infections and other common ailments, as no specific tests or biomarkers are currently available. In this study, we used magnetoencephalography (MEG) to measure neural activity during the resting-state in 15 HIV-infected older patients and a demographically matched group of 15 uninfected controls. MEG is a noninvasive and direct measure of neural activity with excellent spatiotemporal resolution. All MEG data were coregistered to structural magnetic resonance images, corrected for head motion, fitted to a regional-level source model, and subjected to spectral analyses to quantify population-level neural oscillatory activity. We found that HIV-infected persons exhibited decreased beta oscillations in the supplementary motor area bilaterally, paracentral lobule, posterior cingulate, and bilateral regions of the superior parietal lobule relative to healthy controls. Beta oscillations in the posterior cingulate, a critical component of the default mode network, were also positively correlated with patient scores on the memory recall aspect of the Hopkins Verbal Learning Test-Revised. These results demonstrate that chronic HIV infection does not uniformly disturb cortical function, and that neuronal populations in dorsomedial motor and parietal cortices are especially affected. These findings also suggest that resting-state MEG recordings may hold significant promise as a functional biomarker for identifying HAND and monitoring disease progression.
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Affiliation(s)
- Katherine M Becker
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
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Wilson TW, Fox HS, Robertson KR, Sandkovsky U, O'Neill J, Heinrichs-Graham E, Knott NL, Swindells S. Abnormal MEG oscillatory activity during visual processing in the prefrontal cortices and frontal eye-fields of the aging HIV brain. PLoS One 2013; 8:e66241. [PMID: 23840428 DOI: 10.137/journal.pone.0066241] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/03/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Shortly after infection, HIV enters the brain and causes widespread inflammation and neuronal damage, which ultimately leads to neuropsychological impairments. Despite a large body of neuroscience and imaging studies, the pathophysiology of these HIV-associated neurocognitive disorders (HAND) remains unresolved. Previous neuroimaging studies have shown greater activation in HIV-infected patients during strenuous tasks in frontal and parietal cortices, and less activation in the primary sensory cortices during rest and sensory stimulation. METHODS High-density magnetoencephalography (MEG) was utilized to evaluate the basic neurophysiology underlying attentive, visual processing in older HIV-infected adults and a matched non-infected control group. Unlike other neuroimaging methods, MEG is a direct measure of neural activity that is not tied to brain metabolism or hemodynamic responses. During MEG, participants fixated on a centrally-presented crosshair while intermittent visual stimulation appeared in their top-right visual-field quadrant. All MEG data was imaged in the time-frequency domain using beamforming. RESULTS Uninfected controls had increased neuronal synchronization in the 6-12 Hz range within the right dorsolateral prefrontal cortex, right frontal eye-fields, and the posterior cingulate. Conversely, HIV-infected patients exhibited decreased synchrony in these same neural regions, and the magnitude of these decreases was correlated with neuropsychological performance in several cortical association regions. CONCLUSIONS MEG-based imaging holds potential as a noninvasive biomarker for HIV-related neuronal dysfunction, and may help identify patients who have or may develop HAND. Reduced synchronization of neural populations in the association cortices was strongly linked to cognitive dysfunction, and likely reflects the impact of HIV on neuronal and neuropsychological health.
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Affiliation(s)
- Tony W Wilson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, USA.
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Wilson TW, Fox HS, Robertson KR, Sandkovsky U, O'Neill J, Heinrichs-Graham E, Knott NL, Swindells S. Abnormal MEG oscillatory activity during visual processing in the prefrontal cortices and frontal eye-fields of the aging HIV brain. PLoS One 2013. [PMID: 23840428 PMCID: PMC3688779 DOI: 10.1371/journal.pone.0066241] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Shortly after infection, HIV enters the brain and causes widespread inflammation and neuronal damage, which ultimately leads to neuropsychological impairments. Despite a large body of neuroscience and imaging studies, the pathophysiology of these HIV-associated neurocognitive disorders (HAND) remains unresolved. Previous neuroimaging studies have shown greater activation in HIV-infected patients during strenuous tasks in frontal and parietal cortices, and less activation in the primary sensory cortices during rest and sensory stimulation. Methods High-density magnetoencephalography (MEG) was utilized to evaluate the basic neurophysiology underlying attentive, visual processing in older HIV-infected adults and a matched non-infected control group. Unlike other neuroimaging methods, MEG is a direct measure of neural activity that is not tied to brain metabolism or hemodynamic responses. During MEG, participants fixated on a centrally-presented crosshair while intermittent visual stimulation appeared in their top-right visual-field quadrant. All MEG data was imaged in the time-frequency domain using beamforming. Results Uninfected controls had increased neuronal synchronization in the 6–12 Hz range within the right dorsolateral prefrontal cortex, right frontal eye-fields, and the posterior cingulate. Conversely, HIV-infected patients exhibited decreased synchrony in these same neural regions, and the magnitude of these decreases was correlated with neuropsychological performance in several cortical association regions. Conclusions MEG-based imaging holds potential as a noninvasive biomarker for HIV-related neuronal dysfunction, and may help identify patients who have or may develop HAND. Reduced synchronization of neural populations in the association cortices was strongly linked to cognitive dysfunction, and likely reflects the impact of HIV on neuronal and neuropsychological health.
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Affiliation(s)
- Tony W Wilson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, USA.
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Wilson TW, Heinrichs-Graham E, Robertson KR, Sandkovsky U, O'Neill J, Knott NL, Fox HS, Swindells S. Functional brain abnormalities during finger-tapping in HIV-infected older adults: a magnetoencephalography study. J Neuroimmune Pharmacol 2013; 8:965-74. [PMID: 23749418 DOI: 10.1007/s11481-013-9477-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/16/2013] [Indexed: 01/23/2023]
Abstract
Despite the availability of combination antiretroviral therapy, at least mild cognitive dysfunction is commonly observed in HIV-infected patients, with an estimated prevalence of 35-70 %. Neuropsychological studies of these HIV-associated neurocognitive disorders (HAND) have documented aberrations across a broad range of functional domains, although the basic pathophysiology remains unresolved. Some of the most common findings have been deficits in fine motor control and reduced psychomotor speed, but to date no neuroimaging studies have evaluated basic motor control in HAND. In this study, we used magnetoencephalography (MEG) to evaluate the neurophysiological processes that underlie motor planning in older HIV-infected adults and a matched, uninfected control group. MEG is a noninvasive and direct measure of neural activity with good spatiotemporal precision. During the MEG recording, participants fixated on a central crosshair and performed a finger-tapping task with the dominant hand. All MEG data was corrected for head movements, preprocessed, and imaged in the time-frequency domain using beamforming methodology. All analyses focused on the pre-movement beta desynchronization, which is known to be an index of movement planning. Our results demonstrated that HIV-1-infected patients have deficient beta desynchronization relative to controls within the left/right precentral gyri, and the supplementary motor area. In contrast, HIV-infected persons showed abnormally strong beta responses compared to controls in the right dorsolateral prefrontal cortex and medial prefrontal areas. In addition, the amplitude of beta activity in the primary and supplementary motor areas correlated with scores on the Grooved Pegboard test in HIV-infected adults. These results demonstrate that primary motor and sensory regions may be particularly vulnerable to HIV-associated damage, and that prefrontal cortices may serve a compensatory role in maintaining motor performance levels in infected patients.
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Affiliation(s)
- Tony W Wilson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, 988422 Nebraska Medical Center, Omaha, NE 68198, USA.
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Neuroimaging studies of the aging HIV-1-infected brain. J Neurovirol 2012; 18:291-302. [PMID: 22653528 DOI: 10.1007/s13365-012-0114-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 01/17/2023]
Abstract
Highly active antiretroviral therapy (HAART) has increased life expectancy among HIV-infected individuals, and by 2015, at least half of all HIV-infected individuals will be over 50 years of age. Neurodegenerative processes associated with aging may be facilitated by HIV-1 infection, resulting in premature brain aging. This review will highlight brain abnormalities in HIV patients in the setting of aging, focusing on recent neuroimaging studies of the structural, physiological, functional and neurochemical changes. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy studies performed during the pre-HAART era or on antiretroviral-naive subjects suggest an accelerated aging process, while those on HAART-treated subjects suggest premature brain atrophy. Diffusion tensor imaging studies yielded conflicting findings on the relationship between HIV and age in neuroasymptomatic individuals. Functional MRI studies found evidence of premature or accelerated aging processes in the brains of HIV subjects. Lastly, many age-related illnesses such as diabetes, stroke, and depression, as well as comorbid substance abuse, may further exacerbate the aging process in the HIV-infected brain, leading to premature or accelerated age-related brain changes. Given the different pathologic or physiologic changes in the brain assessed by the different neuroimaging techniques, using a multimodal approach in longitudinal follow-up studies is recommended for future studies.
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Winston A, Garvey L. Effects of different antiretroviral agents on cerebral function in HIV-infected individuals. Future Virol 2011. [DOI: 10.2217/fvl.11.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Since the advent of effective antiretroviral therapy, the incidence of severe HIV-associated brain disease has declined dramatically; however, more subtle forms of cerebral impairment, known as HIV-associated neurocognitive disorders, are becoming increasingly recognized. Some of the risk factors for this impairment are well described and include nadir CD4+ cell count. However, the effects of different antiretroviral agents on cerebral function are only beginning to be unraveled. Overall, there are clear beneficial effects on neurocognitive function from antiretroviral therapy. Recent data suggest that some antiretroviral agents have more potent effects on improving cerebral function, whereas other antiretroviral agents may even be associated with direct cerebral toxicities.
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Affiliation(s)
| | - Lucy Garvey
- Department of Medicine, Imperial College, Norfolk Place, London W2 1PG, UK; Clinical Trials, Winston Churchill Wing, St Mary’s Hospital, Imperial College London, Praed Street, London W2 1NY, UK
- Department of HIV & GU Medicine, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London W2 1NY, UK
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Andres MA, Feger U, Nath A, Munsaka S, Jiang CS, Chang L. APOE ε 4 allele and CSF APOE on cognition in HIV-infected subjects. J Neuroimmune Pharmacol 2011; 6:389-98. [PMID: 21184197 PMCID: PMC4899041 DOI: 10.1007/s11481-010-9254-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
Abstract
The significance of the cerebrospinal fluid (CSF) Apolipoprotein E (APOE) level and whether it might have differential effects on brain function due to the presence of APOE ε 4 allele(s) in HIV-infected patients are unknown. However, APOE ε 4 allele has been associated with greater incidence of HIV-associated dementia and accelerated progression of HIV infection. Here, we show further evidence for the role of APOE ε 4 in promoting cognitive impairment. We measured the APOE levels in the CSF of HIV-infected individuals. HIV+ subjects showed lower CSF APOE proteins than SN controls (-19%, p= 0.03). While SN subjects with or without ε 4 allele showed no difference in CSF APOE levels, ε 4+ HIV+ subjects had similar levels to the SN subjects but higher levels than ε 4- HIV+ subjects (+34%, p= 0.01). Furthermore, while HIV+ subjects with ε 2 or ε 3 allele(s) showed a positive relationship between their CSF APOE levels and cognitive performance on the speed of processing domain (r= +0.35, p= 0.05), ε 4+ HIV+ subjects, in contrast, exhibited a negative relationship such that those with higher levels of CSF APOE(4) performed worse on the HIV Dementia Scale (r= -0.61, p= 0.02), had lower Global Cognitive Scores (r= -0.57, p= 0.03), and had poorer performance on tests involving learning (ε 4 allele x [APOE] interaction, p = 0.01). Our findings also suggest that the relatively higher levels of CSF APOE in ε 4+ HIV+ (having primarily APOE4 isoforms) may negatively impact the brain and lead to poorer cognitive outcomes, while those individuals without the ε 4 allele (with primarily APOE2 or APOE3 isoforms) may show compensatory responses that lead to better cognitive performance.
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Affiliation(s)
- Marilou A Andres
- Pacific Biosciences Research Center, University of Hawaii, 1993 East-West Road, Honolulu, HI 96822, USA.
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Ernst T, Jiang CS, Nakama H, Buchthal S, Chang L. Lower brain glutamate is associated with cognitive deficits in HIV patients: a new mechanism for HIV-associated neurocognitive disorder. J Magn Reson Imaging 2011; 32:1045-53. [PMID: 21031507 DOI: 10.1002/jmri.22366] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To determine whether subjects with human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) show altered concentrations of brain glutamate (GLU), and whether lower GLU levels correlate with cognitive deficits. MATERIALS AND METHODS GLU concentrations were measured in the basal ganglia, frontal gray and white matter, and parietal gray matter of 45 HIV-positive and 46 age-and-education-matched HIV-negative subjects using echo-time averaged proton magnetic resonance spectroscopy ((1)H MRS). RESULTS Compared to controls, HIV subjects with cognitive deficits had lower GLU in the parietal gray matter, while those without cognitive deficits tended to show higher basal ganglia GLU. Lower parietal and frontal gray matter GLU were associated with a greater number of nucleoside reverse transcriptase inhibitors, and were predictive of poorer cognitive performance. Correlations between GLU and cognitive performance, but not the other findings, remained significant after correction for multiple comparisons. CONCLUSION Parietal gray matter GLU is lower in HIV subjects with cognitive deficits. This reduction might result from reduced astrocytic reuptake of GLU, secondary excitotoxicity, and mitochondrial toxicity from antiretroviral treatments. The glutamatergic system may play an important role in the pathophysiology of HAND, and brain GLU on (1)H MRS may provide an early surrogate marker for monitoring disease severity and treatment effects.
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Affiliation(s)
- Thomas Ernst
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, and Queen's Medical Center, Honolulu, Hawai'i 96813, USA.
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Simioni S, Cavassini M, Annoni JM, Hirschel B, Du Pasquier RA. HIV-associated neurocognitive disorders: a changing pattern. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.10.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Combination antiretroviral therapy has dramatically decreased the incidence of HIV-related mortality and serious opportunistic diseases, among which is HIV-associated dementia. However, minor forms of cognitive dysfunction have not disappeared and may even have increased in frequency. Aging of HIV+ patients, insufficient penetration of antiretroviral drugs into the brain with continuous low-grade viral production and inflammation may play a role. A putative neurotoxicity of combination antiretroviral therapy is controversial. In this article, we will discuss these aspects, as well as clinical and pathophysiological features shared by HIV-associated neurocognitive disorders and other neurodegenerative diseases, especially Alzheimer’s disease. This article will briefly summarize the current clinical trials on neuroprotective agents, and the management of patients with neurocognitive disorders will be discussed.
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Affiliation(s)
- Samanta Simioni
- Division of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jean-Marie Annoni
- Division of Neurology, Geneva University Hospital, Rue Gabrielle–Perret–Gentil 4, 1211 Geneva 14, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospital, Rue Gabrielle–Perret–Gentil 4, 1211 Geneva 14, Switzerland
| | - Renaud A Du Pasquier
- Department of Immunology, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011 Lausanne, Switzerland
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Silveri MM, Rogowska J, McCaffrey A, Yurgelun-Todd DA. Adolescents at risk for alcohol abuse demonstrate altered frontal lobe activation during Stroop performance. Alcohol Clin Exp Res 2010; 35:218-28. [PMID: 21073483 DOI: 10.1111/j.1530-0277.2010.01337.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and adolescents, family history positive (FH+) for alcoholism, exhibit differences in brain structure and functional activation when compared to family history negative (FH-) counterparts. Given that frontal brain regions, and associated reciprocal connections with limbic structures, undergo the most dramatic maturational changes during adolescence, the objective of this study was to compare functional brain activation during a frontally mediated test of response inhibition in 32 adolescents separated into low-risk (FH-) and high-risk (FH+) groups. METHODS Functional magnetic resonance (fMRI) blood oxygen level-dependent data were acquired at 1.5 Tesla during performance of Stroop Color Naming, Word Reading, and Interference. Preprocessing and statistical analyses, covaried for age, were conducted in SPM99 using a search territory that included superior, middle, and inferior frontal gyri (trigone region), anterior cingulate gyrus (CG), and left and right amygdala. RESULTS Significantly greater activation in the fronto-limbic search territory was observed in FH+ relative to FH- subjects during Stroop Interference. In addition, a significant regression between brain activation and family history density was observed, with a greater density being associated with increased activation in regions including middle frontal gyrus (BA9) and CG (BA24). CONCLUSIONS These data demonstrate a significant influence of FH status on brain activation during the performance of a response inhibition task, perhaps reflecting a neurobiological vulnerability associated with FH status that may include reduced neuronal efficiency and/or recruitment of additional neuronal resources. These findings are important given that the adolescent developmental period is already associated with reduced inhibitory capacity, even prior to the onset of alcohol use.
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Affiliation(s)
- Marisa M Silveri
- Brain Imaging Center, McLean Hospital, Belmont, Massachusetts 02478, USA.
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Müller-Oehring EM, Schulte T, Rosenbloom MJ, Pfefferbaum A, Sullivan EV. Callosal degradation in HIV-1 infection predicts hierarchical perception: a DTI study. Neuropsychologia 2010; 48:1133-43. [PMID: 20018201 PMCID: PMC2828526 DOI: 10.1016/j.neuropsychologia.2009.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 11/02/2009] [Accepted: 12/10/2009] [Indexed: 10/20/2022]
Abstract
HIV-1 infection affects white matter circuits linking frontal, parietal, and subcortical regions that subserve visuospatial attention processes. Normal perception requires the integration of details, preferentially processed in the left hemisphere, and the global composition of an object or scene, preferentially processed in the right hemisphere. We tested whether HIV-related callosal white matter degradation contributes to disruption of selective lateralized visuospatial and attention processes. A hierarchical letter target detection paradigm was devised, where large (global) letters were composed of small (local) letters. Participants were required to identify target letters among distractors presented at global, local, both or neither level. Attention was directed to one (global or local) or both levels. Participants were 21 HIV-1 infected and 19 healthy control men and women who also underwent Diffusion Tensor Imaging (DTI). HIV-1 participants showed impaired hierarchical perception owing to abnormally enhanced global facilitation effects but no impairment in attentional control on local-global feature selection. DTI metrics revealed poorer fiber integrity of the corpus callosum in HIV-1 than controls that was more pronounced in posterior than anterior regions. Analysis revealed a double dissociation of anterior and posterior callosal compromise in HIV-1 infection: compromise in anterior but not posterior callosal fiber integrity predicted response conflict elicited by global targets, whereas compromise in posterior but not anterior callosal fiber integrity predicted response facilitation elicited by global targets. We conclude that component processes of visuospatial perception are compromised in HIV-1 infection attributable, at least in part, to degraded callosal microstructural integrity relevant for local-global feature integration.
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Affiliation(s)
- Eva M. Müller-Oehring
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
| | - Tilman Schulte
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
| | - Margaret J. Rosenbloom
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
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