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Babiloni C, Del Percio C, Piervincenzi C, Carducci F, Ferri R, Onorati P, Toma G, Ferracuti S, Roma P, Correr V, Di Campli F, Aceti A, Salvatore M, Soricelli A, Teti E, Pennica A, Sarmati L, Vullo V, D'Ettorre G, Mastroianni C, Petsas N, Pantano P, Floris R, Stocchi F, Andreoni M, Di Perri G, Calcagno A, Noce G. Parietal resting-state EEG alpha source connectivity is associated with subcortical white matter lesions in HIV-positive people. Clin Neurophysiol 2023; 156:19-27. [PMID: 37844524 DOI: 10.1016/j.clinph.2023.09.006] [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: 02/25/2020] [Revised: 08/07/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Parietal resting-state electroencephalographic (rsEEG) alpha (8-10 Hz) source connectivity is abnormal in HIV-positive persons. Here we tested whether this abnormality may be associated with subcortical white matter vascular lesions in the cerebral hemispheres. METHODS Clinical, rsEEG, and magnetic resonance imaging (MRI) datasets in 38 HIV-positive persons and clinical and rsEEG datasets in 13 healthy controls were analyzed. Radiologists visually evaluated the subcortical white matter hyperintensities from T2-weighted FLAIR MRIs (i.e., Fazekas scale). In parallel, neurophysiologists estimated the eLORETA rsEEG source lagged linear connectivity from parietal cortical regions of interest. RESULTS Compared to the HIV participants with no/negligible subcortical white matter hyperintensities, the HIV participants with mild/moderate subcortical white matter hyperintensities showed lower parietal interhemispheric rsEEG alpha lagged linear connectivity. This effect was also observed in HIV-positive persons with unimpaired cognition. This rsEEG marker allowed good discrimination (area under the receiver operating characteristic curve > 0.80) between the HIV-positive individuals with different amounts of subcortical white matter hyperintensities. CONCLUSIONS The parietal rsEEG alpha source connectivity is associated with subcortical white matter vascular lesions in HIV-positive persons, even without neurocognitive disorders. SIGNIFICANCE Those MRI-rsEEG markers may be used to screen HIV-positive persons at risk of neurocognitive disorders.
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Affiliation(s)
- Claudio Babiloni
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele Cassino, Cassino, (FR), Italy.
| | - Claudio Del Percio
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy
| | | | - Filippo Carducci
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy
| | | | - Paolo Onorati
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy
| | - Ginevra Toma
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Paolo Roma
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Valentina Correr
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Francesco Di Campli
- Infectious Diseases, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonio Aceti
- Infectious Diseases, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Soricelli
- IRCCS Synlab SDN, Naples, Italy; Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | - Elisabetta Teti
- Clinical Infectious Diseases, University of Rome "Tor Vergata", Rome, Italy
| | - Alfredo Pennica
- Infectious Diseases, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Patrizia Pantano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Roberto Floris
- Diagnostic and Interventional Radiology, University of Rome "Tor Vergata", Rome, Italy
| | - Fabrizio Stocchi
- IRCCS San Raffaele, Rome, Italy; Telematic University San Raffaele, Rome, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, University of Rome "Tor Vergata", Rome, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
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Weber MT, Finkelstein A, Uddin MN, Reddy EA, Arduino RC, Wang L, Tivarus ME, Zhong J, Qui X, Schifitto G. Longitudinal Effects of Combination Antiretroviral Therapy on Cognition and Neuroimaging Biomarkers in Treatment-Naïve People with HIV. Neurology 2022; 99:e1045-e1055. [PMID: 36219802 PMCID: PMC9519252 DOI: 10.1212/wnl.0000000000200829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While combination antiretroviral therapy (cART) has dramatically increased the life expectancy of people with HIV (PWH), nearly 50% develop HIV-associated neurocognitive disorders (HAND)1. This may be due to previously uncontrolled HIV viral replication, immune activation maintained by residual viral replication2 or activation from other sources3, 4, or cART-associated neurotoxicity5. The aim of this study was to determine the effect of cART on cognition and neuroimaging biomarkers markers in people with HIV (PWH) before and after initiation of cART compared to HIV negative controls (HC) and HIV elite controllers (EC) who remain untreated. METHODS We recruited three groups of participants from the University of Rochester, McGovern Medical School and SUNY Upstate Medical University: 1) ART-treatment-naïve PWH; 2) age-matched HC; and 3) EC. Participants underwent brain MRI and clinical and neuropsychological assessments at baseline, one year, and two years. PWH were also assessed 12 weeks after initiating cART. Volumetric analysis and fractal dimensionality (FD) were calculated for cortical and subcortical regions. Mixed effect regressions examined the effect of group and imaging variables on cognition. RESULTS We enrolled 47 PWH, 58 HC, and 10 EC. At baseline, PWH had worse cognition and lower cortical volumes than HC. Cognition improved following initiation of cART and remained stable over time. Greater cortical thickness was associated with better cognition at baseline; greater FD of parietal, temporal and occipital lobes was associated with better cognition at baseline and longitudinally. At baseline, EC had worse cognition, lower cortical thickness and lower FD in all four lobes and caudate than PWH and HC. Greater cortical thickness, hippocampal volumes and FD of frontal, temporal and occipital lobes were associated with better cognition longitudinally. CONCLUSIONS Initiation of cART in PWH is associated with improvement in brain structure and cognition. However, significant differences persist over time compared to HC. Similar trends in EC suggest that results are due to HIV infection rather than treatment. Stronger associations between cognition and FD suggest this imaging metric may be a more sensitive marker of neuronal injury than cortical thickness and volumetric measures.
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Affiliation(s)
- Miriam T Weber
- Department of Neurology, University of Rochester, Rochester, NY USA .,Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY USA
| | - Alan Finkelstein
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Md Nasir Uddin
- Department of Neurology, University of Rochester, Rochester, NY USA
| | | | - Roberto C Arduino
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Lu Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester NY, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester NY, USA
| | - Jianhui Zhong
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA.,Department of Imaging Sciences, University of Rochester Medical Center, Rochester NY, USA.,Department of Physics and Astronomy, University of Rochester, Rochester NY, USA
| | - Xing Qui
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester, Rochester, NY USA.,Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
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8
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Mina Y, Wu T, Hsieh HC, Hammoud DA, Shah S, Lau CY, Ham L, Snow J, Horne E, Ganesan A, Rapoport SI, Tramont EC, Reich DS, Agan BK, Nath A, Smith BR. Association of White Matter Hyperintensities With HIV Status and Vascular Risk Factors. Neurology 2021; 96:e1823-e1834. [PMID: 33637630 PMCID: PMC8105972 DOI: 10.1212/wnl.0000000000011702] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To test the hypothesis that brain white matter hyperintensities (WMH) are more common in people living with HIV (PLWH), even in the setting of well-controlled infection, and to identify clinical measures that correlate with these abnormalities. METHODS Research brain MRI scans, acquired within longitudinal studies evaluating neurocognitive outcomes, were reviewed to determine WMH load using the Fazekas visual rating scale in PLWH with well-controlled infection (antiretroviral therapy for at least 1 year and plasma viral load <200 copies/mL) and in sociodemographically matched controls without HIV (CWOH). The primary outcome measure of this cross-sectional analysis was increased WMH load, determined by total Fazekas score ≥2. Multiple logistic regression analysis was performed to evaluate the effect of HIV serostatus on WMH load and to identify MRI, CSF, and clinical variables that associate with WMH in the PLWH group. RESULTS The study included 203 PLWH and 58 CWOH who completed a brain MRI scan between April 2014 and March 2019. The multiple logistic regression analysis, with age and history of tobacco use as covariates, showed that the adjusted odds ratio of the PLWH group for increased WMH load is 3.7 (95% confidence interval 1.8-7.5; p = 0.0004). For the PLWH group, increased WMH load was associated with older age, male sex, tobacco use, hypertension, and hepatitis C virus coinfection, and also with the presence of measurable tumor necrosis factor α in CSF. CONCLUSION Our results suggest that HIV serostatus affects the extent of brain WMH. This effect is mainly associated with aging and modifiable comorbidities.
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Affiliation(s)
- Yair Mina
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Tianxia Wu
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Hsing-Chuan Hsieh
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Dima A Hammoud
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Swati Shah
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Chuen-Yen Lau
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Lillian Ham
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Joseph Snow
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Elizabeth Horne
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Anuradha Ganesan
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Stanley I Rapoport
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Edmund C Tramont
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Daniel S Reich
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Brian K Agan
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Avindra Nath
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Bryan R Smith
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD.
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