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Namagga JK, Rukundo GZ, Batwala V, Niyonzima V, Nantongo H, Nambozi G. Healthcare Workers' Perspectives on the Utilization of the International HIV Dementia Scale for the Screening HIV-Associated Neurocognitive Disorders: A Qualitative Study at TASO Centres in Central and Southwestern Uganda. HIV AIDS (Auckl) 2024; 16:229-243. [PMID: 38827783 PMCID: PMC11144000 DOI: 10.2147/hiv.s444668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction HIV-associated neurocognitive disorders (HAND) are becoming a significant public health concern in the continuum of human immune virus (HIV) treatment. These disorders range from subtle cognitive impairments to severe dementia. Despite many early-stage HAND cases being asymptomatic, healthcare workers (HCWs) rarely perform routine neurocognitive assessments. This leads to a high number of unrecognized cases and increases the risk of HAND among people living with HIV (PLWH). Material and Methods We aimed to explore HCWs' perspectives on integrating the International HIV Dementia Scale (IHDS) into routine care for screening HAND at The AIDS Support Organization (TASO) centres in central and southwestern Uganda. Results We conducted five focus group discussions with 37 HCWs from five TASO centres. Thematic analysis revealed eight key theme: 1) Impaired brain function, 2) Changes in activities of daily living, 3) Promotion of quality care perspectives, 4) Tool applicable and user-friendly, 5) Client increased self-awareness and self-confidence, 6) Integration of IHDS into routine HIV care, 7) Uncertainty about IHDS use, and 8) Continuous training for HCWs. Conclusion As PLWH enjoy longer and healthier lives, their risk for HAND increases, potentially affecting their quality of life. The use of the IHDS has raised awareness among HCWs and improved decision-making through cognitive assessments, emphasizing it value in PLWH. We recommend a prospective study to assess the long-term outcomes and efficacy of increased HAND screening. Furthermore, integrating a HAND screening module into the consolidated HIV guidelines is recommended to enhance its relevance.
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Affiliation(s)
- Jane Kasozi Namagga
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vincent Batwala
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vallence Niyonzima
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hanifah Nantongo
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Nambozi
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
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Bruno F, Abondio P, Bruno R, Ceraudo L, Paparazzo E, Citrigno L, Luiselli D, Bruni AC, Passarino G, Colao R, Maletta R, Montesanto A. Alzheimer's disease as a viral disease: Revisiting the infectious hypothesis. Ageing Res Rev 2023; 91:102068. [PMID: 37704050 DOI: 10.1016/j.arr.2023.102068] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
Alzheimer's disease (AD) represents the most frequent type of dementia in elderly people. Two major forms of the disease exist: sporadic - the causes of which have not yet been fully understood - and familial - inherited within families from generation to generation, with a clear autosomal dominant transmission of mutations in Presenilin 1 (PSEN1), 2 (PSEN2) or Amyloid Precursors Protein (APP) genes. The main hallmark of AD consists of extracellular deposits of amyloid-beta (Aβ) peptide and intracellular deposits of the hyperphosphorylated form of the tau protein. An ever-growing body of research supports the viral infectious hypothesis of sporadic forms of AD. In particular, it has been shown that several herpes viruses (i.e., HHV-1, HHV-2, HHV-3 or varicella zoster virus, HHV-4 or Epstein Barr virus, HHV-5 or cytomegalovirus, HHV-6A and B, HHV-7), flaviviruses (i.e., Zika virus, Dengue fever virus, Japanese encephalitis virus) as well as Human Immunodeficiency Virus (HIV), hepatitis viruses (HAV, HBV, HCV, HDV, HEV), SARS-CoV2, Ljungan virus (LV), Influenza A virus and Borna disease virus, could increase the risk of AD. Here, we summarized and discussed these results. Based on these findings, significant issues for future studies are also put forward.
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Affiliation(s)
- Francesco Bruno
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy; Association for Neurogenetic Research (ARN), Lamezia Terme, CZ, Italy
| | - Paolo Abondio
- Laboratory of Ancient DNA, Department of Cultural Heritage, University of Bologna, Via degli Ariani 1, 48121 Ravenna, Italy.
| | - Rossella Bruno
- Sudent at the Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88050 Catanzaro, Italy
| | - Leognano Ceraudo
- Sudent at the Department of Medical and Surgical Sciences, University of Parma, 43121 Parma, Italy
| | - Ersilia Paparazzo
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende 87036, Italy
| | - Luigi Citrigno
- National Research Council (CNR) - Institute for Biomedical Research and Innovation - (IRIB), 87050 Mangone, Cosenza, Italy
| | - Donata Luiselli
- Laboratory of Ancient DNA, Department of Cultural Heritage, University of Bologna, Via degli Ariani 1, 48121 Ravenna, Italy
| | - Amalia C Bruni
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy; Association for Neurogenetic Research (ARN), Lamezia Terme, CZ, Italy
| | - Giuseppe Passarino
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende 87036, Italy
| | - Rosanna Colao
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy
| | - Raffaele Maletta
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy; Association for Neurogenetic Research (ARN), Lamezia Terme, CZ, Italy
| | - Alberto Montesanto
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende 87036, Italy.
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Mendes JC, Braga MDG, Reis AMM, Silveira MR. Neuropsychiatric adverse drug reactions and associated factors in a cohort of individuals starting dolutegravir-based or efavirenz-based antiretroviral therapy in Belo Horizonte, Brazil. Curr Med Res Opin 2023; 39:523-531. [PMID: 36912019 DOI: 10.1080/03007995.2023.2189855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To measure the incidence of neuropsychiatric adverse drug reactions (ADRs) in individuals living with HIV who initiated antiretroviral therapy (ART) with first-line regimens containing dolutegravir (DTG) or efavirenz (EFV) and associated factors. METHODS Prospective cohort study with individuals living with HIV who started ART with DTG or EFV associated with tenofovir disoproxil and lamivudine in Belo Horizonte, Brazil. Sociodemographic, clinical, and laboratory data were collected from September 2015 to October 2018 in three specialized HIV care services through interviews, clinical records, and computerized systems. We analysed the frequency of neuropsychiatric ADRs recorded in clinical records 12 months after starting antiretroviral use, and the associated factors were investigated using binary logistic regression. RESULTS A total of 152 (35.1%) of the 433 individuals included had neuropsychiatric ADRs. The incidence density was 35.3/100 person-years. The subjects mainly had sleep disorders and disturbances (21.3%), neurological disorders (13.9%), headaches (8.1%), and anxiety disorders and symptoms (3.0%), more frequently in individuals using EFV. A lower likelihood of neuropsychiatric ADRs was associated with using a DTG-based antiretroviral regimen (OR = 0.24; 95% CI = 0.14-0.40) and anxiety or depression signs and symptoms at the onset of treatment (OR = 0.57; 95% CI = 0.37-0.89). CONCLUSION The incidence of neuropsychiatric ADRs was high in individuals starting ART with a lower likelihood of using a DTG-based regimen. The DTG-based regimen had a better safety profile for neuropsychiatric ADRs than the EFV-based regimen.
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Affiliation(s)
- Jullye Campos Mendes
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Maria das Graças Braga
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Adriano Max Moreira Reis
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Departamento de Produtos Farmacêuticos, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Micheline Rosa Silveira
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Faulhaber JR, Baffoe-Bonnie AW, Oursler KK, Vasudeva SS. Update in Human Immunodeficiency Virus and Aging. Infect Dis Clin North Am 2023; 37:153-173. [PMID: 36805011 DOI: 10.1016/j.idc.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Effective and consistent antiretroviral therapy has enabled people with human immunodeficiency virus (HIV) (PWH) to survive longer than previously encountered earlier in the epidemic. Consequently, PWH are subject to the struggles and clinical conditions typically associated with aging. However, the aging process in PWH is not the same as for those who do not have HIV. There is a complex interplay of molecular, microbiologic, and pharmacologic factors that leads to accelerated aging in PWH; this leads to increased risk for certain age-related comorbidities requiring greater vigilance and interventions in routine care.
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Affiliation(s)
- Jason R Faulhaber
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Division of Infectious Diseases, 213 McClanahan St SW, Roanoke, VA 24014, USA.
| | - Anthony W Baffoe-Bonnie
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Division of Infectious Diseases, 213 McClanahan St SW, Roanoke, VA 24014, USA
| | - Krisann K Oursler
- Virginia Tech Carilion School of Medicine, VA Salem Healthcare System, 1970 Roanoke Boulevard Salem, VA 24153-6404, USA
| | - Shikha S Vasudeva
- Virginia Tech Carilion School of Medicine, VA Salem Healthcare System, 1970 Roanoke Boulevard Salem, VA 24153-6404, USA
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Ye F, Alvarez-Carbonell D, Nguyen K, Leskov K, Garcia-Mesa Y, Sreeram S, Valadkhan S, Karn J. Recruitment of the CoREST transcription repressor complexes by Nerve Growth factor IB-like receptor (Nurr1/NR4A2) mediates silencing of HIV in microglial cells. PLoS Pathog 2022; 18:e1010110. [PMID: 35797416 PMCID: PMC9295971 DOI: 10.1371/journal.ppat.1010110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/19/2022] [Accepted: 06/15/2022] [Indexed: 12/13/2022] Open
Abstract
Human immune deficiency virus (HIV) infection in the brain leads to chronic neuroinflammation due to the production of pro-inflammatory cytokines, which in turn promotes HIV transcription in infected microglial cells. However, powerful counteracting silencing mechanisms in microglial cells result in the rapid shutdown of HIV expression after viral reactivation to limit neuronal damage. Here we investigated whether the Nerve Growth Factor IB-like nuclear receptor Nurr1 (NR4A2), which is a repressor of inflammation in the brain, acts directly to restrict HIV expression. HIV silencing following activation by TNF-α, or a variety of toll-like receptor (TLR) agonists, in both immortalized human microglial cells (hμglia) and induced pluripotent stem cells (iPSC)-derived human microglial cells (iMG) was enhanced by Nurr1 agonists. Similarly, overexpression of Nurr1 led to viral suppression, while conversely, knock down (KD) of endogenous Nurr1 blocked HIV silencing. The effect of Nurr1 on HIV silencing is direct: Nurr1 binds directly to the specific consensus binding sites in the U3 region of the HIV LTR and mutation of the Nurr1 DNA binding domain blocked its ability to suppress HIV-1 transcription. Chromatin immunoprecipitation (ChIP) assays also showed that after Nurr1 binding to the LTR, the CoREST/HDAC1/G9a/EZH2 transcription repressor complex is recruited to the HIV provirus. Finally, transcriptomic studies demonstrated that in addition to repressing HIV transcription, Nurr1 also downregulated numerous cellular genes involved in inflammation, cell cycle, and metabolism, further promoting HIV latency and microglial homoeostasis. Nurr1 therefore plays a pivotal role in modulating the cycles of proviral reactivation by potentiating the subsequent proviral transcriptional shutdown. These data highlight the therapeutic potential of Nurr1 agonists for inducing HIV silencing and microglial homeostasis and ultimately for the amelioration of the neuroinflammation associated with HIV-associated neurocognitive disorders (HAND).
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Affiliation(s)
- Fengchun Ye
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - David Alvarez-Carbonell
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Kien Nguyen
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Konstantin Leskov
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Yoelvis Garcia-Mesa
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Sheetal Sreeram
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Saba Valadkhan
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jonathan Karn
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America
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Jadhav S, Yenorkar N, Bondre R, Karemore M, Bali N. Nanomedicines encountering HIV dementia: A guiding star for neurotherapeutics. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Herold CJ, Kong L, Ceballos ME, Schröder J, Toro P. Neurological soft signs and brain morphology in people living with HIV. J Neurovirol 2022; 28:236-247. [PMID: 35352314 PMCID: PMC9187556 DOI: 10.1007/s13365-022-01071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Neurological soft signs (NSS) are a common feature of severe psychiatric disorders such as schizophrenia but are also prevalent in organic brain diseases like HIV-associated neurocognitive disorder (HAND) or Alzheimer’s disease. While distinct associations between NSS, neurocognition, and cerebral regions were demonstrated in schizophrenia, these associations still have to be elucidated in HIV. Therefore, we investigated 36 persons with HIV of whom 16 were neurocognitively healthy and 20 were diagnosed with HAND. NSS were assessed using the Heidelberg scale. NSS scores were correlated with gray matter (GM) using whole brain voxel-based morphometry. Results showed significantly elevated NSS in the HAND group when compared to the neurocognitively healthy with respect to NSS total score and the subscores “orientation” and “complex motor tasks”. While the two groups showed only minor, non-significant GM differences, higher NSS scores (subscales “motor coordination”, “orientation”) were significantly correlated with GM reduction in the right insula and cerebellum (FWE-corrected). Our results corroborate elevated NSS in HIV+ patients with HAND in contrast to cognitively unimpaired patients. In addition, cerebral correlates of NSS with GM reductions in insula and cerebellum were revealed. Taken together, NSS in this patient group could be considered a marker of cerebral damage and neurocognitive deficits.
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Affiliation(s)
- Christina J Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
| | - Li Kong
- Department of Psychology, Shanghai Normal University, Shanghai, China.
| | - María Elena Ceballos
- Department of Infectious Diseases, Medicine School, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Pablo Toro
- Department of Psychiatry, Medicine School, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lam JO, Lee C, Gilsanz P, Hou CE, Leyden WA, Satre DD, Flamm JA, Towner WJ, Horberg MA, Silverberg MJ. Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016. AIDS 2022; 36:437-445. [PMID: 34816805 PMCID: PMC8892590 DOI: 10.1097/qad.0000000000003134] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare dementia incidence and prevalence after age 50 years by HIV status. DESIGN Observational cohort, 2000-2016. METHODS People with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington DC). Dementia diagnoses were obtained from electronic health records. Incidence and prevalence of dementia, overall and by time period (i.e. 2000-2002, 2003-2004, …, 2015-2016), were calculated using Poisson regression. Trends were examined using Joinpoint regression. Rate ratios were used to compare dementia by HIV status with adjustment for sociodemographics, substance use, and clinical factors. RESULTS The study included 13 296 PWH and 155 354 PWoH (at baseline: for both, mean age = 54 years, 89% men; for PWH, 80% with HIV RNA <200 copies/ml). From 2000 to 2016, overall incidence of dementia was higher among PWH [adjusted incidence rate ratio (aIRR) = 1.80, 95% confidence interval (CI) = 1.60-2.04]. Dementia incidence decreased among both PWH and PWoH (-8.0 and -3.1% per period, respectively) but remained higher among PWH in the most recent time period, 2015-2016 (aIRR = 1.58, 95% CI = 1.18-2.12). The overall prevalence of dementia from 2000 to 2016 was higher among PWH [adjusted prevalence ratio (aPR) = 1.86, 95% CI = 1.70-2.04] and was also higher among PWH in 2015-2016 (aPR = 1.75, 95% CI = 1.56-1.97). CONCLUSION Reductions in dementia incidence are encouraging and may reflect ART improvement, but PWH are still more likely to have dementia than PWoH. Monitoring the burden of dementia among PWH is important as this population ages.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
| | - Jason A Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
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Wang L, Zeng Y, Zhou Y, Yu J, Liang M, Qin L, Zhou Y. Win55,212-2 Improves Neural Injury induced by HIV-1 Glycoprotein 120 in Rats by Exciting CB2R. Brain Res Bull 2022; 182:67-79. [DOI: 10.1016/j.brainresbull.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022]
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Sil S, Periyasamy P, Thangaraj A, Niu F, Chemparathy DT, Buch S. Advances in the Experimental Models of HIV-Associated Neurological Disorders. Curr HIV/AIDS Rep 2021; 18:459-474. [PMID: 34427869 DOI: 10.1007/s11904-021-00570-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Involvement of the central nervous system (CNS) in HIV-1 infection is commonly associated with neurological disorders and cognitive impairment, commonly referred to as HIV-associated neurocognitive disorders (HAND). Severe and progressive neurocognitive impairment is rarely observed in the post-cART era; however, asymptomatic and mild neurocognitive disorders still exist, despite viral suppression. Additionally, comorbid conditions can also contribute to the pathogenesis of HAND. RECENT FINDINGS In this review, we summarize the characterization of HAND, factors contributing, and the functional impairments in both preclinical and clinical models. Specifically, we also discuss recent advances in the animal models of HAND and in in vitro cultures and the potential role of drugs of abuse in this model system of HAND. Potential peripheral biomarkers associated with HAND are also discussed. Overall, this review identifies some of the recent advances in the field of HAND in cell culture studies, animal models, clinical findings, and the limitations of each model system, which can play a key role in developing novel therapeutics in the field.
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Affiliation(s)
- Susmita Sil
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA.
| | - Palsamy Periyasamy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA.
| | - Annadurai Thangaraj
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
| | - Fang Niu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
| | - Divya T Chemparathy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5880, USA
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Lam JO, Hou CE, Hojilla JC, Anderson AN, Gilsanz P, Alexeeff SE, Levine-Hall T, Hood N, Lee C, Satre DD, Silverberg MJ. Comparison of dementia risk after age 50 between individuals with and without HIV infection. AIDS 2021; 35:821-828. [PMID: 33394681 PMCID: PMC7969394 DOI: 10.1097/qad.0000000000002806] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare risk of dementia after age 50 by HIV status among individuals in a primary care setting. DESIGN Observational cohort study; participants were identified from 2013 to 2017 and followed through 2019. METHODS Participants were people with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWOH), all at least 50 years old and with no prior diagnosis of dementia. The study setting was Kaiser Permanente Northern California, an integrated healthcare delivery system in the United States. Incident dementia diagnoses and baseline data on sociodemographics, smoking, alcohol use, other substance use, and clinical factors were gathered from the electronic health record. Cumulative proportion of incident dementia by HIV status was assessed using Kaplan--Meier curves. Unadjusted and adjusted hazard ratios for incident dementia by HIV status were generated using Cox proportional hazards models with age as the time scale. RESULTS The study included 5381 PWH and 119 022 PWOH (average age at baseline: 57 and 58 years, respectively). Incident dementia was diagnosed in 117 PWH and 2427 PWOH. By age 80, 25.8% of PWH and 13.8% of PWOH had been diagnosed with dementia, corresponding with an unadjusted hazard ratio of 1.98 (95% CI 1.64-2.39). After adjustment for sociodemographic, substance use, and clinical factors, including frequency of outpatient visits, the risk of dementia among PWH remained elevated (vs. PWOH, adjusted hazard ratio = 1.58, 95% CI 1.31-1.92). CONCLUSION Compared with PWOH, PWH were at 58% higher risk for dementia despite HIV treatment with ART. Research is needed to investigate the potential benefits of targeted risk factor management or earlier cognitive screening in this population.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco
| | - J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Nicole Hood
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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Human TRIM5α: Autophagy Connects Cell-Intrinsic HIV-1 Restriction and Innate Immune Sensor Functioning. Viruses 2021; 13:v13020320. [PMID: 33669846 PMCID: PMC7923229 DOI: 10.3390/v13020320] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/12/2022] Open
Abstract
Human immunodeficiency virus-1 (HIV-1) persists as a global health concern, with an incidence rate of approximately 2 million, and estimated global prevalence of over 35 million. Combination antiretroviral treatment is highly effective, but HIV-1 patients that have been treated still suffer from chronic inflammation and residual viral replication. It is therefore paramount to identify therapeutically efficacious strategies to eradicate viral reservoirs and ultimately develop a cure for HIV-1. It has been long accepted that the restriction factor tripartite motif protein 5 isoform alpha (TRIM5α) restricts HIV-1 infection in a species-specific manner, with rhesus macaque TRIM5α strongly restricting HIV-1, and human TRIM5α having a minimal restriction capacity. However, several recent studies underscore human TRIM5α as a cell-dependent HIV-1 restriction factor. Here, we present an overview of the latest research on human TRIM5α and propose a novel conceptualization of TRIM5α as a restriction factor with a varied portfolio of antiviral functions, including mediating HIV-1 degradation through autophagy- and proteasome-mediated mechanisms, and acting as a viral sensor and effector of antiviral signaling. We have also expanded on the protective antiviral roles of autophagy and outline the therapeutic potential of autophagy modulation to intervene in chronic HIV-1 infection.
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13
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Harling G, Kobayashi LC, Farrell MT, Wagner RG, Tollman S, Berkman L. Social contact, social support, and cognitive health in a population-based study of middle-aged and older men and women in rural South Africa. Soc Sci Med 2020; 260:113167. [PMID: 32688161 PMCID: PMC7441312 DOI: 10.1016/j.socscimed.2020.113167] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/10/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several theories seek to explain how social connections and cognitive function are interconnected in older age. These include that social interaction protects against cognitive decline, that cognitive decline leads to shedding of social connections and that cognitive decline leads to increased instrumental support. We investigated how patterns of social contact, social support and cognitive health in rural South Africa fit with these three theories. METHOD We used data from the baseline of "Health and Aging in Africa: a Longitudinal Study of an INDEPTH community in South Africa" (HAALSI), a population-based study of 5059 individuals aged ≥ 40 years. We evaluated how a range of egocentric social connectedness measures varied by respondents' cognitive function. RESULTS We found that respondents with lower cognitive function had smaller, denser social networks that were more local and more kin-based than their peers. Lower cognitive function was associated with receipt of less social support generally, but this difference was stronger for emotional and informational support than for financial and physical support. Impairment was associated with greater differences among those aged 40-59 and those with any (versus no) educational attainment. CONCLUSIONS The patterns we found suggest that cognitively impaired older adults in this setting rely on their core social networks for support, and that theories relating to social connectedness and cognitive function developed in higher-income and higher-education settings may also apply in lower-resource settings elsewhere.
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Affiliation(s)
- Guy Harling
- Institute for Global Health. University College London, United Kingdom; Africa Health Research Institute, KwaZulu-Natal, South Africa; Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Meagan T Farrell
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
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14
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Baart VM, Houvast RD, de Geus-Oei LF, Quax PHA, Kuppen PJK, Vahrmeijer AL, Sier CFM. Molecular imaging of the urokinase plasminogen activator receptor: opportunities beyond cancer. EJNMMI Res 2020; 10:87. [PMID: 32725278 PMCID: PMC7387399 DOI: 10.1186/s13550-020-00673-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
The urokinase plasminogen activator receptor (uPAR) plays a multifaceted role in almost any process where migration of cells and tissue-remodeling is involved such as inflammation, but also in diseases as arthritis and cancer. Normally, uPAR is absent in healthy tissues. By its carefully orchestrated interaction with the protease urokinase plasminogen activator and its inhibitor (plasminogen activator inhibitor-1), uPAR localizes a cascade of proteolytic activities, enabling (patho)physiologic cell migration. Moreover, via the interaction with a broad range of cell membrane proteins, like vitronectin and various integrins, uPAR plays a significant, but not yet completely understood, role in differentiation and proliferation of cells, affecting also disease progression. The implications of these processes, either for diagnostics or therapeutics, have received much attention in oncology, but only limited beyond. Nonetheless, the role of uPAR in different diseases provides ample opportunity to exploit new applications for targeting. Especially in the fields of oncology, cardiology, rheumatology, neurology, and infectious diseases, uPAR-targeted molecular imaging could offer insights for new directions in diagnosis, surveillance, or treatment options.
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Affiliation(s)
- V M Baart
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - R D Houvast
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - L F de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - P H A Quax
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - P J K Kuppen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - C F M Sier
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Percuros BV, Leiden, The Netherlands.
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15
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Chorea associated with persistent low-level viremia in a patient living with HIV: a case report. J Virus Erad 2020. [DOI: 10.1016/s2055-6640(20)30007-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Screening for HIV-Associated Neurocognitive Impairment: Relevance of Psychological Factors and Era of Commencement of Antiretroviral Therapy. J Assoc Nurses AIDS Care 2019; 30:42-50. [PMID: 30586348 PMCID: PMC6907420 DOI: 10.1097/jnc.0000000000000040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Neurocognitive impairment (NCI) is common in people aging with HIV and can adversely affect health-related quality of life. However, early NCI may be largely asymptomatic and neurocognitive function is rarely assessed in the context of routine clinical care. In this study, we considered the utility of two assessment tools as screens for NCI in patients attending a community-based clinic (N = 58; mean age = 57 years): the Montreal Cognitive Assessment (MoCA) and a 3-item cognitive concerns questionnaire derived from the HIV Dementia Scale. Health-related quality of life and depression/anxiety were also measured. Indication of NCI using the MoCA was more prevalent compared to the 3-item questionnaire and was associated with the patients' initial antiretroviral therapy commencing between the years of 1997 and 2001, independently of age. Findings of the MoCA were not confounded by existing mood disorders, unlike the 3-item questionnaire. Therefore, we suggest implementing the MoCA as an initial screen for NCI.
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17
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Incidence and Properties of Neurologic Disorders Recovered from Iranian Patients with HIV Infection: A Case Series. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.81981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Abstract
BACKGROUND Neurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa. METHODS Seminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. "Nervous System Diseases" "HIV Infections" and "Africa South of the Sahara" and "Seizures" or "Spinal Cord Diseases" or "Peripheral Nervous System Diseases" or "AIDS Dementia Complex" or "Opportunistic Infections" or "Immune Reconstitution Inflammatory Syndrome" or "Stroke". Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders. RESULTS Neurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6-9-month mortality rate of 60-70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%. CONCLUSION Neurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.
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Affiliation(s)
- William P Howlett
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Center for International Health, University of Bergen, Norway
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19
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Morowatisharifabad MA, Movahed E, Farokhzadian J, Nikooie R, Hosseinzadeh M, Askarishahi M, Bidaki R. Antiretroviral therapy adherence and its determinant factors among people living with HIV/AIDS: a case study in Iran. BMC Res Notes 2019; 12:162. [PMID: 30902063 PMCID: PMC6431060 DOI: 10.1186/s13104-019-4204-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/16/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives This descriptive-correlational study was conducted on 122 Iranian people living with HIV (PWHIV), who referred to a behavioral diseases counseling center in 2018. The AIDS Clinical Trial Group (ACTG) questionnaire was used to collect the required data. The study aimed to determine the level of medication adherence and its determinants in PWHIV. Results About 75.4% (confidence interval 67.2%–82.8%) of the samples had a good combined antiretroviral therapy (cART) adherence and 74.6% (n = 91) of them were sure about the positive effects of medications on their health. Patients reported that most important reasons for medication non-adherence included forgetfulness, high drug dosage, lack of knowledge about ART value, and transportation problems.
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Affiliation(s)
| | - Ehsan Movahed
- Health Education and Health Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | | | - Ruhollah Nikooie
- Department of Exercise Physiology, Faculty of Sports Sciences, Shahid Bahonar University, Kerman, Iran
| | - Mahdieh Hosseinzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohsen Askarishahi
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reza Bidaki
- Research Center of Addiction and Behavioral Sciences & Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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20
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Liu D, Zeinolabediny Y, Caccuri F, Ferris G, Fang WH, Weston R, Krupinski J, Colombo L, Salmona M, Corpas R, Sarroca S, Sanfeliu C, Caruso A, Guo B, Zeng X, Slevin M. p17 from HIV induces brain endothelial cell angiogenesis through EGFR-1-mediated cell signalling activation. J Transl Med 2019; 99:180-190. [PMID: 30390010 DOI: 10.1038/s41374-018-0147-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022] Open
Abstract
HIV-associated neurocognitive disorder in HIV patients substantially reduces their quality of life. We previously showed that the HIV matrix protein, p17 could stimulate lymph-angiogenesis in vitro potentially contributing to lymphoma tumour growth and in addition is associated with vascular activation in neuro-degenerating brain tissue; here, therefore, we have investigated the detailed molecular mechanisms of this action. We performed in vitro cell culture, angiogenesis experiments, phospho-protein microarrays and Western blotting to identify cellular signalling induced by p17 within human brain endothelial cells (HbMEC), and inhibitor studies to block p17-induced vascular growth. We also characterised the effects of hippocampal CA1 injection of p17 on epidermal growth factor receptor-1 (EGFR1) expression linked to our murine model of dementia. p17 strongly induced angiogenesis of HbMEC (migration, tube formation and spheroid growth). p17 concomitantly increased phosphorylation of EGFR1 as well as down-stream intermediates ERK1/2, FAK, PLC-γ and PKC-β whilst an inhibitor peptide of EGFR, blocked cell signalling and angiogenesis. Finally, Mice that showed reduced cognitive function and behavioural deficiencies after p17 injection, demonstrated that p17 localised in cortical microvessels and also neurones many of which stained positive for p-EGFR1 by histology/IHC. This work provides strong support that p17 may be involved in initiating and/or perpetuating vascular tissue pathophysiology associated with comorbidity in HIV patients.
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Affiliation(s)
- Donghui Liu
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.,University of Medicine and Pharmacy, Targu Mures, Romania
| | - Yasmin Zeinolabediny
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.,University of Medicine and Pharmacy, Targu Mures, Romania
| | - Francesca Caccuri
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia Medical School, Brescia, Italy
| | - Glenn Ferris
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Wen-Hui Fang
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Ria Weston
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Jerzy Krupinski
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.,Hospital Universitari Mútua de Terrassa, Department of Neurology, Terrassa, Barcelona, Spain
| | - Laura Colombo
- Department of Molecular Biochemistry and Pharmacology, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mario Salmona
- Department of Molecular Biochemistry and Pharmacology, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Ruben Corpas
- Instituto De Investigaciones Biomedicas De Barcelona, CSIC, Barcelona, Spain
| | - Sara Sarroca
- Instituto De Investigaciones Biomedicas De Barcelona, CSIC, Barcelona, Spain
| | - Coral Sanfeliu
- Instituto De Investigaciones Biomedicas De Barcelona, CSIC, Barcelona, Spain
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia Medical School, Brescia, Italy
| | - Baoqiang Guo
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | | | - Mark Slevin
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK. .,University of Medicine and Pharmacy, Targu Mures, Romania. .,Weifang Medical University, Weifang, China.
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21
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Jumare J, El-Kamary SS, Magder L, Hungerford L, Ndembi N, Aliyu A, Dakum P, Umlauf A, Cherner M, Abimiku A, Charurat M, Blattner WA, Royal W. Plasma HIV RNA level is associated with neurocognitive function among HIV-1-infected patients in Nigeria. J Neurovirol 2018; 24:712-719. [PMID: 30168015 PMCID: PMC6279586 DOI: 10.1007/s13365-018-0667-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/06/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
Plasma HIV RNA level has been shown to correlate with HIV disease progression, morbidity, and mortality. We examined the association between levels of plasma HIV RNA and cognitive function among patients in Nigeria. A total of 179 HIV-1-infected participants with available plasma HIV RNA results and followed longitudinally for up to 2 years were included in this study. Blood samples from participants were used for the measurement of plasma HIV RNA and CD4+ T cell count. Utilizing demographic and practice effect-adjusted T scores obtained from a seven-domain neuropsychological test battery, cognitive status was determined by the global deficit score (GDS) approach, with a GDS ≥ 0.5 indicating cognitive impairment. In a longitudinal multivariable linear regression analysis, adjusting for CD4 cell count, Beck's Depression Score, age, gender, years of education, and antiretroviral treatment status, global T scores decreased by 0.35 per log10 increase in plasma HIV RNA [p = 0.033]. Adjusting for the same variables in a multivariable logistic regression, the odds of neurocognitive impairment were 28% higher per log10 increase in plasma HIV RNA (OR 1.28 [95% CI 1.08, 1.51]; p = 0.005). There were statistically significant associations for the speed of information processing, executive, and verbal fluency domains in both linear and logistic regression analyses. We found a significant association between plasma HIV RNA levels and cognitive function in both baseline (cross-sectional) and longitudinal analyses. However, the latter was significantly attenuated due to weak association among antiretroviral-treated individuals.
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Affiliation(s)
- Jibreel Jumare
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Samer S El-Kamary
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Laurence Magder
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Laura Hungerford
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Nicaise Ndembi
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Ahmad Aliyu
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Patrick Dakum
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Anya Umlauf
- University of California San Diego, School of Medicine, San Diego, CA, 92103, USA
| | - Mariana Cherner
- University of California San Diego, School of Medicine, San Diego, CA, 92103, USA
| | - Alash'le Abimiku
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Man Charurat
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | | | - Walter Royal
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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22
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Patel S, Parikh NU, Aalinkeel R, Reynolds JL, Dmello R, Schwartz SA, Mahajan SD. United States National Trends in Mortality, Length of Stay (LOS) and Associated Costs of Cognitive Impairment in HIV Population from 2005 to 2014. AIDS Behav 2018; 22:3198-3208. [PMID: 29705930 DOI: 10.1007/s10461-018-2128-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We evaluated national trends of in-hospital discharge rates, mortality outcomes, health care costs, length of stay in HIV patients with cognitive disorders. Neurological involvement in HIV is commonly associated with cognitive impairment termed as HIV-associated neurocognitive disorder (HAND) which includes a spectrum of neurocognitive dysfunction associated with HIV infection. Although severe and progressive neurocognitive impairment has become rare in HIV patients in the era of potent antiretroviral therapy, a majority of HIV patients have mild to moderate degree of neurocognitive impairment. Study population for this analysis was derived from the Nationwide Inpatient Sample from 2005 to 2014. Patients with ICD-9 code of HIV (042) with discharge diagnosis (Dx) listed top 1 through 5 were included in the analysis. Within this population, we identified patients with cognitive impairment using ICD-9 codes of 294 (persistent mental disorders; organic psychotic brain syndromes (chronic), 323.9 (encephalitis, myelitis, and encephalomyelitis), 331.83 (mild cognitive impairment) with Dx listed from 1 to 25. Patient variables obtained included: age, race, gender, length of stay, in-hospital mortality and insurance status. Hospital level variables included teaching status, location and region of country. SAS 9.4 software was used for data analysis. Comparisons of variables between hospitalized HIV patients with and without HAND showed significant increase in cost per hospital admissions, longer hospital stay and higher risk of mortality in patients with HAND.
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Affiliation(s)
- Smit Patel
- Neurology Department, University of Connecticut, UCONN Health, Farmington, CT, 06030, USA
| | - Neil U Parikh
- University of Central Florida, 4000 Central Florida Blvd, Orlando, FL, 32816, USA
| | - Ravikumar Aalinkeel
- Division of Allergy Immunology & Rheumatology, Department of Medicine, 6074 Clinical and Translational Research Center, State University of New York at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Jessica L Reynolds
- Division of Allergy Immunology & Rheumatology, Department of Medicine, 6074 Clinical and Translational Research Center, State University of New York at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Rashmi Dmello
- Division of Allergy Immunology & Rheumatology, Department of Medicine, 6074 Clinical and Translational Research Center, State University of New York at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Stanley A Schwartz
- Division of Allergy Immunology & Rheumatology, Department of Medicine, 6074 Clinical and Translational Research Center, State University of New York at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Supriya D Mahajan
- Division of Allergy Immunology & Rheumatology, Department of Medicine, 6074 Clinical and Translational Research Center, State University of New York at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA.
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The "Frail" Brain Blood Barrier in Neurodegenerative Diseases: Role of Early Disruption of Endothelial Cell-to-Cell Connections. Int J Mol Sci 2018; 19:ijms19092693. [PMID: 30201915 PMCID: PMC6164949 DOI: 10.3390/ijms19092693] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 02/06/2023] Open
Abstract
The main neurovascular unit of the Blood Brain Barrier (BBB) consists of a cellular component, which includes endothelial cells, astrocytes, pericytes, microglia, neurons, and oligodendrocytes as well as a non-cellular component resulting from the extracellular matrix. The endothelial cells are the major vital components of the BBB able to preserve the brain homeostasis. These cells are situated along the demarcation line between the bloodstream and the brain. Therefore, an alteration or the progressive disruption of the endothelial layer may clearly impair the brain homeostasis. The proper functioning of the brain endothelial cells is generally ensured by two elements: (1) the presence of junction proteins and (2) the preservation of a specific polarity involving an apical-luminal and a basolateral-abluminal membrane. This review intends to identify the molecular mechanisms underlying BBB function and their changes occurring in early stages of neurodegenerative processes in order to develop novel therapeutic strategies aimed to counteract neurodegenerative disorders.
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24
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Toro P, Ceballos ME, Pesenti J, Inostroza M, Valenzuela D, Henríquez F, Forno G, Herold C, Schröder J, Calderón J. Neurological soft signs as a marker of cognitive impairment severity in people living with HIV. Psychiatry Res 2018; 266:138-142. [PMID: 29870954 DOI: 10.1016/j.psychres.2018.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/19/2018] [Accepted: 04/22/2018] [Indexed: 12/24/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) include asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia. Early recognition of HAND is crucial, and usually requires thorough neuropsychological testing. Neurological soft signs (NSS), i.e. minor motor and sensory changes, a common feature in severe psychiatric disorders, may facilitate early diagnosis. NSS were examined using the Heidelberg NSS Scale in 18 patients with ANI, 21 with MND, 28 HIV positive patients without HAND, and 39 healthy controls matched for age, gender, and education. The highest NSS scores were obtained in the MND patients (13.3 ± 10.0, p < 0.0001) followed by those with ANI (11.7 ± 10.6), the HIV positive subjects without neurocognitive deficits (8.0 ± 4.1) and the healthy controls (3.8 ± 3.2). This result was confirmed when age and years of school education were entered as covariates. No significant correlations between NSS and CD4 counts or any other clinical variables were found among the HIV positive groups. Our results demonstrate that NSS are frequently found in both ANI and MND but not HIV positive patients without neurocognitive deficits. NSS may facilitate the screening of HIV positive patients for ANI and MND as an easier and less expensive clinical tool.
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Affiliation(s)
- Pablo Toro
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile; Advanced Center for Chronic Disease (ACCDiS), Medicine School, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - María Elena Ceballos
- Department of Infectious Diseases, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - José Pesenti
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - María Inostroza
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Daniela Valenzuela
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Fernando Henríquez
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gonzalo Forno
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Christina Herold
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Jorge Calderón
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
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25
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Etlouba Y, Laher A, Motara F, Moolla M, Ariefdien N. First Presentation with Psychotic Symptoms to the Emergency Department. J Emerg Med 2018; 55:78-86. [DOI: 10.1016/j.jemermed.2018.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 10/16/2022]
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26
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Zahr NM. The Aging Brain With HIV Infection: Effects of Alcoholism or Hepatitis C Comorbidity. Front Aging Neurosci 2018; 10:56. [PMID: 29623036 PMCID: PMC5874324 DOI: 10.3389/fnagi.2018.00056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
As successfully treated individuals with Human Immunodeficiency Virus (HIV)-infected age, cognitive and health challenges of normal aging ensue, burdened by HIV, treatment side effects, and high prevalence comorbidities, notably, Alcohol Use Disorders (AUD) and Hepatitis C virus (HCV) infection. In 2013, people over 55 years old accounted for 26% of the estimated number of people living with HIV (~1.2 million). The aging brain is increasingly vulnerable to endogenous and exogenous insult which, coupled with HIV infection and comorbid risk factors, can lead to additive or synergistic effects on cognitive and motor function. This paper reviews the literature on neuropsychological and in vivo Magnetic Resonance Imaging (MRI) evaluation of the aging HIV brain, while also considering the effects of comorbidity for AUD and HCV.
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Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
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27
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Laher A, Ariefdien N, Etlouba Y. HIV prevalence among first-presentation psychotic patients. HIV Med 2017; 19:271-279. [PMID: 29282832 DOI: 10.1111/hiv.12575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES First-episode psychosis is a frequent emergency department (ED) presentation that may potentially be secondary to an underlying life-threatening HIV-related condition. The aim of this study was to determine the prevalence of HIV infection in patients presenting with a first episode of psychosis. METHODS Medical records of 159 consecutive African, Asian, White and mixed ethnicity patients presenting to a tertiary academic hospital ED with a first episode of psychotic features were prospectively reviewed. RESULTS Of the 159 subjects, 63 (39.6%) were HIV positive. An underlying medical condition was the most common aetiology of psychosis in both HIV-positive (84.2%) and HIV-negative (35.4%) subjects, but was significantly more common in HIV-positive individuals (P < 0.001). Substance-induced psychotic disorders and other primary psychiatric disorders were significantly more common in subjects without HIV infection (P < 0.001 and P < 0.001, respectively). While there were more men in the HIV-negative group (66.7%), gender distribution was almost equal in the HIV-infected group (49.2% male). Overall, as well as in both groups, most subjects were of African race, were unemployed and had not completed high school. CONCLUSIONS Co-occurrence of HIV infection was a frequent finding in first-episode psychotic individuals residing in a high-prevalence HIV setting. These individuals are more likely to have an underlying medical condition precipitating the onset of psychosis, not to have been initiated on antiretroviral therapy and to present with a low CD4 cell count and high HIV viral load.
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Affiliation(s)
- A Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Emergency Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - N Ariefdien
- Department of Emergency Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.,Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Y Etlouba
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Emergency Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Abstract
PURPOSE OF REVIEW This study aimed to evaluate current barriers to HIV cure strategies and interventions for neurocognitive dysfunction with a particular focus on recent advancements over the last 3 years. RECENT FINDINGS Optimal anti-retroviral therapy (ART) poses challenges to minimise neurotoxicity, whilst ensuring blood-brain barrier penetration and minimising the risk of cerebrovascular disease. CSF biomarkers, BCL11B and neurofilament light chain may be implicated with a neuroinflammatory cascade leading to cognitive impairment. Diagnostic imaging with diffusion tensor imaging and resting-state fMRI show promise in future diagnosis and monitoring of HAND. The introduction of ART has resulted in a dramatic decline in HIV-associated dementia. Despite this reduction, milder forms of HIV-associated neurocognitive disorder (HAND) are still prevalent and are clinically significant. The central nervous system (CNS) has been recognised as a probable reservoir and sanctuary for HIV, representing a significant barrier to management interventions.
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Gaskill PJ, Miller DR, Gamble-George J, Yano H, Khoshbouei H. HIV, Tat and dopamine transmission. Neurobiol Dis 2017; 105:51-73. [PMID: 28457951 PMCID: PMC5541386 DOI: 10.1016/j.nbd.2017.04.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/04/2017] [Accepted: 04/16/2017] [Indexed: 01/02/2023] Open
Abstract
Human Immunodeficiency Virus (HIV) is a progressive infection that targets the immune system, affecting more than 37 million people around the world. While combinatorial antiretroviral therapy (cART) has lowered mortality rates and improved quality of life in infected individuals, the prevalence of HIV associated neurocognitive disorders is increasing and HIV associated cognitive decline remains prevalent. Recent research has suggested that HIV accessory proteins may be involved in this decline, and several studies have indicated that the HIV protein transactivator of transcription (Tat) can disrupt normal neuronal and glial function. Specifically, data indicate that Tat may directly impact dopaminergic neurotransmission, by modulating the function of the dopamine transporter and specifically damaging dopamine-rich regions of the CNS. HIV infection of the CNS has long been associated with dopaminergic dysfunction, but the mechanisms remain undefined. The specific effect(s) of Tat on dopaminergic neurotransmission may be, at least partially, a mechanism by which HIV infection directly or indirectly induces dopaminergic dysfunction. Therefore, precisely defining the specific effects of Tat on the dopaminergic system will help to elucidate the mechanisms by which HIV infection of the CNS induces neuropsychiatric, neurocognitive and neurological disorders that involve dopaminergic neurotransmission. Further, this will provide a discussion of the experiments needed to further these investigations, and may help to identify or develop new therapeutic approaches for the prevention or treatment of these disorders in HIV-infected individuals.
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Affiliation(s)
- Peter J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, United States.
| | - Douglas R Miller
- Department of Neuroscience, University of Florida, Gainesville, FL 32611, United States
| | - Joyonna Gamble-George
- Department of Neuroscience, University of Florida, Gainesville, FL 32611, United States
| | - Hideaki Yano
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
| | - Habibeh Khoshbouei
- Department of Neuroscience, University of Florida, Gainesville, FL 32611, United States.
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Mukerji SS, Gonzalez RG, Gandhi RT, Kraft S. Case 20-2017 - A 48-Year-Old Man with Weight Loss, Confusion, Skin Lesions, and Pancytopenia. N Engl J Med 2017; 376:2580-2589. [PMID: 28657866 PMCID: PMC9165433 DOI: 10.1056/nejmcpc1616401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Shibani S Mukerji
- From the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Harvard Medical School - both in Boston
| | - Rajesh T Gandhi
- From the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Harvard Medical School - both in Boston
| | - Stefan Kraft
- From the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Harvard Medical School - both in Boston
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Kamal S, Locatelli I, Wandeler G, Sehhat A, Bugnon O, Metral M, Du Pasquier R, Gutbrod K, Cavassini M, Schneider MP. The Presence of Human Immunodeficiency Virus-Associated Neurocognitive Disorders Is Associated With a Lower Adherence to Combined Antiretroviral Treatment. Open Forum Infect Dis 2017; 4:ofx070. [PMID: 28584853 PMCID: PMC5450901 DOI: 10.1093/ofid/ofx070] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are defined according to their diagnostic degrees as follows: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. Because high adherence to combined antiretroviral therapy (cART) is required to maintain viral suppression among HIV-infected patients, it is important to investigate the impact of HAND on medication adherence. Our study hypothesis was that patients with HAND had a lower medication adherence than patients who did not have HAND. METHODS This was an observational, exploratory, 2-center pilot study of patients who had a state-of-the-art neurocognitive assessment performed between January 2011 and June 2015 while also being followed at their respective adherence clinics. Adherence was measured with electronic monitors. Patients' sociodemographic characteristics, HIV viral load, and CD4 counts were retrieved from the Swiss HIV Cohort Study database. At each time t, adherence was computed as the proportion of patients taking medication as prescribed at that time. RESULTS We included 59 patients, with a median (Q1, Q3) age of 53 years (47-58) and 39 (66%) were male participants. Twenty-two patients (35%) had no neurocognitive deficits, 16 (27%) patients had HAND, and 21 (35%) patients had non-HAND (mostly depression). Implementation over 3 years showed a significant decline (50%) in medication adherence among patients diagnosed with HAND in comparison with patients who had a normal neuropsychological status or a non-HIV-related cognitive deficit (implementation stayed 90% during follow-up). CONCLUSIONS Our findings support the hypothesis that HAND is associated with reduced cART adherence.
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Affiliation(s)
- Susan Kamal
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Isabella Locatelli
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Department of Social and Preventive Medicine, University of Lausanne, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Asemaneh Sehhat
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | | | | | - Klemens Gutbrod
- Department of Neuropsychology, University Hospital and University of Bern, Switzerland; and
| | - Matthias Cavassini
- Infectious Disease Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Marie P Schneider
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
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Lamers SL, Fogel GB, Liu ES, Nolan DJ, Salemi M, Barbier AE, Rose R, Singer EJ, McGrath MS. Predicted coreceptor usage at end-stage HIV disease in tissues derived from subjects on antiretroviral therapy with an undetectable plasma viral load. INFECTION GENETICS AND EVOLUTION 2017; 51:194-197. [PMID: 28392467 DOI: 10.1016/j.meegid.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/05/2023]
Abstract
HIV cure research is increasingly focused on anatomical tissues as sites for residual HIV replication during combined antiretroviral therapy (cART). Tissue-based HIV could contribute to low-level immune activation and viral rebound over the course of infection and could also influence the development of diseases, such as atherosclerosis, neurological disorders and cancers. cART-treated subjects have a decreased and irregular presence of HIV among tissues, which has resulted in a paucity of actual evidence concerning how or if HIV persists, replicates and evolves in various anatomical sites during therapy. In this study, we pooled 1806 HIV envelope V3 loop sequences from twenty-six tissue types (seventy-one total tissues) of six pre-cART subjects, four subjects with an unknown cART history who died with profound AIDS, and five subjects who died while on cART with an undetectable plasma viral load. A computational approach was used to assess sequences for their ability to utilize specific cellular coreceptors (R5, R5 and X4, or X4). We found that autopsied tissues obtained from virally suppressed cART+ subjects harbored both integrated and expressed viruses with similar coreceptor usage profiles to subjects with no or ineffective cART therapy (i.e., significant plasma viral load at death). The study suggests that tissue microenvironments provide a sanctuary for the continued evolution of HIV despite cART.
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Affiliation(s)
- S L Lamers
- Bioinfoexperts, LLC, Thibodaux, LA, USA.
| | - G B Fogel
- Natural Selection, Inc., San Diego, CA, USA
| | - E S Liu
- Natural Selection, Inc., San Diego, CA, USA
| | - D J Nolan
- Bioinfoexperts, LLC, Thibodaux, LA, USA; The University of Florida Emerging Pathogens Institute and the Department of Pathology and Laboratory Medicine, Gainesville, FL, USA
| | - M Salemi
- The University of Florida Emerging Pathogens Institute and the Department of Pathology and Laboratory Medicine, Gainesville, FL, USA
| | | | - R Rose
- Bioinfoexperts, LLC, Thibodaux, LA, USA
| | - E J Singer
- The National Neurological AIDS Bank, University of California, Los Angeles, CA, USA; David Geffen School of Medicine and Olive View-UCLA Medical Center, Department of Pathology and Laboratory Medicine, Los Angeles, USA
| | - M S McGrath
- The AIDS and Cancer Specimen Resource, San Francisco, CA, USA; The University of California Department of Medicine, San Francisco, CA, USA
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Lamers SL, Rose R, Maidji E, Agsalda-Garcia M, Nolan DJ, Fogel GB, Salemi M, Garcia DL, Bracci P, Yong W, Commins D, Said J, Khanlou N, Hinkin CH, Sueiras MV, Mathisen G, Donovan S, Shiramizu B, Stoddart CA, McGrath MS, Singer EJ. HIV DNA Is Frequently Present within Pathologic Tissues Evaluated at Autopsy from Combined Antiretroviral Therapy-Treated Patients with Undetectable Viral Loads. J Virol 2016; 90:8968-83. [PMID: 27466426 PMCID: PMC5044815 DOI: 10.1128/jvi.00674-16] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/20/2016] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED HIV infection treatment strategies have historically defined effectiveness through measuring patient plasma HIV RNA. While combined antiretroviral therapy (cART) can reduce plasma viral load (pVL) to undetectable levels, the degree that HIV is eliminated from other anatomical sites remains unclear. We investigated the HIV DNA levels in 229 varied autopsy tissues from 20 HIV-positive (HIV(+)) cART-treated study participants with low or undetectable plasma VL and cerebrospinal fluid (CSF) VL prior to death who were enrolled in the National Neurological AIDS Bank (NNAB) longitudinal study and autopsy cohort. Extensive medical histories were obtained for each participant. Autopsy specimens, including at least six brain and nonbrain tissues per participant, were reviewed by study pathologists. HIV DNA, measured in tissues by quantitative and droplet digital PCR, was identified in 48/87 brain tissues and 82/142 nonbrain tissues at levels >200 HIV copies/million cell equivalents. No participant was found to be completely free of tissue HIV. Parallel sequencing studies from some tissues recovered intact HIV DNA and RNA. Abnormal histological findings were identified in all participants, especially in brain, spleen, lung, lymph node, liver, aorta, and kidney. All brain tissues demonstrated some degree of pathology. Ninety-five percent of participants had some degree of atherosclerosis, and 75% of participants died with cancer. This study assists in characterizing the anatomical locations of HIV, in particular, macrophage-rich tissues, such as the central nervous system (CNS) and testis. Additional studies are needed to determine if the HIV recovered from tissues promotes the pathogenesis of inflammatory diseases, such as HIV-associated neurocognitive disorders, cancer, and atherosclerosis. IMPORTANCE It is well-known that combined antiretroviral therapy (cART) can reduce plasma HIV to undetectable levels; however, cART cannot completely clear HIV infection. An ongoing question is, "Where is HIV hiding?" A well-studied HIV reservoir is "resting" T cells, which can be isolated from blood products and succumb to cART once activated. Less-studied reservoirs are anatomical tissue samples, which have unknown cART penetration, contain a comparably diverse spectrum of potentially HIV-infected immune cells, and are important since <2% of body lymphocytes actually reside in blood. We examined 229 varied autopsy specimens from 20 HIV(+) participants who died while on cART and identified that >50% of tissues were HIV infected. Additionally, we identified considerable pathology in participants' tissues, especially in brain, spleen, lung, lymph node, liver, aorta, and kidney. This study substantiates that tissue-associated HIV is present despite cART and can inform future studies into HIV persistence.
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Affiliation(s)
| | | | - Ekaterina Maidji
- Division of Experimental Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Melissa Agsalda-Garcia
- The University of Hawaii, Department of Tropical Medicine, Medical Microbiology & Pharmacology and Hawaii Center for AIDS, Honolulu, Hawaii, USA
| | - David J Nolan
- Bioinfoexperts, LLC, Thibodaux, Louisiana, USA The University of Florida Emerging Pathogens Institute, Department of Pathology and Laboratory Medicine, Gainesville, Florida, USA
| | - Gary B Fogel
- Natural Selection, Inc., San Diego, California, USA
| | - Marco Salemi
- The University of Florida Emerging Pathogens Institute, Department of Pathology and Laboratory Medicine, Gainesville, Florida, USA
| | - Debra L Garcia
- The AIDS and Cancer Specimen Resource, San Francisco, California, USA University of California, San Francisco, Department of Medicine, San Francisco, California, USA
| | - Paige Bracci
- The AIDS and Cancer Specimen Resource, San Francisco, California, USA University of California, San Francisco, Department of Medicine, San Francisco, California, USA
| | - William Yong
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA David Geffen School of Medicine and Olive View-UCLA Medical Center, Department of Pathology and Laboratory Medicine, Los Angeles, California, USA
| | - Deborah Commins
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jonathan Said
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA David Geffen School of Medicine and Olive View-UCLA Medical Center, Department of Pathology and Laboratory Medicine, Los Angeles, California, USA
| | - Negar Khanlou
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA David Geffen School of Medicine and Olive View-UCLA Medical Center, Department of Pathology and Laboratory Medicine, Los Angeles, California, USA
| | - Charles H Hinkin
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA UCLA School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, California, USA
| | - Miguel Valdes Sueiras
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA David Geffen School of Medicine and Olive View-UCLA Medical Center, Department of Neurology, Los Angeles, California, USA
| | - Glenn Mathisen
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Suzanne Donovan
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Bruce Shiramizu
- The University of Hawaii, Department of Tropical Medicine, Medical Microbiology & Pharmacology and Hawaii Center for AIDS, Honolulu, Hawaii, USA
| | - Cheryl A Stoddart
- Division of Experimental Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Michael S McGrath
- The AIDS and Cancer Specimen Resource, San Francisco, California, USA University of California, San Francisco, Department of Medicine, San Francisco, California, USA
| | - Elyse J Singer
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA David Geffen School of Medicine and Olive View-UCLA Medical Center, Department of Neurology, Los Angeles, California, USA
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Sajja RK, Rahman S, Cucullo L. Drugs of abuse and blood-brain barrier endothelial dysfunction: A focus on the role of oxidative stress. J Cereb Blood Flow Metab 2016; 36:539-54. [PMID: 26661236 PMCID: PMC4794105 DOI: 10.1177/0271678x15616978] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 10/13/2015] [Indexed: 02/01/2023]
Abstract
Psychostimulants and nicotine are the most widely abused drugs with a detrimental impact on public health globally. While the long-term neurobehavioral deficits and synaptic perturbations are well documented with chronic use of methamphetamine, cocaine, and nicotine, emerging human and experimental studies also suggest an increasing incidence of neurovascular complications associated with drug abuse. Short- or long-term administration of psychostimulants or nicotine is known to disrupt blood-brain barrier (BBB) integrity/function, thus leading to an increased risk of brain edema and neuroinflammation. Various pathophysiological mechanisms have been proposed to underlie drug abuse-induced BBB dysfunction suggesting a central and unifying role for oxidative stress in BBB endothelium and perivascular cells. This review discusses drug-specific effects of methamphetamine, cocaine, and tobacco smoking on brain microvascular crisis and provides critical assessment of oxidative stress-dependent molecular pathways focal to the global compromise of BBB. Additionally, given the increased risk of human immunodeficiency virus (HIV) encephalitis in drug abusers, we have summarized the synergistic pathological impact of psychostimulants and HIV infection on BBB integrity with an emphasis on unifying role of endothelial oxidative stress. This mechanistic framework would guide further investigations on specific molecular pathways to accelerate therapeutic approaches for the prevention of neurovascular deficits by drugs of abuse.
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Affiliation(s)
- Ravi K Sajja
- Center for Blood-Brain Barrier Research, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Shafiqur Rahman
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, SD, USA
| | - Luca Cucullo
- Center for Blood-Brain Barrier Research, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, USA
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Gene Expression in HIV-Associated Neurocognitive Disorders: A Meta-Analysis. J Acquir Immune Defic Syndr 2016; 70:479-88. [PMID: 26569176 DOI: 10.1097/qai.0000000000000800] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To identify differentially expressed (DE) genes in HIV-associated neurocognitive disorders (HAND) patients in comparison with HIV-infected patients without HAND and controls. DESIGN A meta-analysis of publicly available gene expression data from HIV postmortem brain tissue studies. METHODS We selected studies using clearly defined inclusion and exclusion criteria. Within study data preprocessing and individual analyses were performed for each brain region. The following meta-analytic methods were applied: combining P values, combining effect sizes with and without a permutation method. The DE genes were defined with a false discovery rate less than 5% using Benjamini-Hochberg method. RESULTS Our meta-analysis on 3 studies encompasses analyses of over 48 postmortem brains [25 HAND, 7 HIV encephalitis (HIVE), 8 HIV-infected patients, and 8 controls]. Overall, 411 genes in white matter were DE in HAND with HIVE patients when comparing with controls. Of these, 94 genes were significantly expressed in all statistical methods. These 94 genes participate in significant pathways such as immune system, interferon response, or antigen presentation. Sixty-six of the 94 genes were significantly upregulated with log2 intensities greater than 2-fold. Strong examples of the highly upregulated genes were PSMB8-AS1, APOL6, TRIM69, PSME1, CTSB, HLA-E, GPNMB, UBE2L6, PSME2, NET1, CAPG, B2M, RPL38, GBP1, and PLSCR1. Only BTN3A2 was expressed in HAND with HIVE patients as compared with HAND patients without HIVE. CONCLUSION A number of genes were DE in our meta-analysis that were not identified in the individual analyses. The meta-analytic approach has increased statistical power for identifying DE genes in HAND.
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Erskine D, Khundakar AA. Stereological approaches to dementia research using human brain tissue. J Chem Neuroanat 2016; 76:73-81. [PMID: 26777894 DOI: 10.1016/j.jchemneu.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/12/2016] [Indexed: 01/01/2023]
Abstract
The relationship between the clinical features of dementia disorders and the resultant changes in underlying neuropathological mechanisms has long been of interest to researchers working in the field of neurodegenerative disorders. The majority of neuropathological research in dementia has utilized semi-quantitative analysis of protein inclusions, which have defined the hallmark histological features of the conditions. However, the advent of three-dimensional stereological techniques has enabled unbiased and fully quantitative assessment of brain tissue. The present review focuses on studies that have used these techniques to elucidate important relationships between neuropathological changes and clinical features and, in doing so, revealed important mechanistic insights into the pathophysiology of dementia disorders.
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Affiliation(s)
- D Erskine
- Institute of Neuroscience and Newcastle University Institute for Ageing, Newcastle University, United Kingdom
| | - A A Khundakar
- Institute of Neuroscience and Newcastle University Institute for Ageing, Newcastle University, United Kingdom.
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Heikinheimo T, Poutiainen E, Salonen O, Elovaara I, Ristola M. Three-decade neurological and neurocognitive follow-up of HIV-1-infected patients on best-available antiretroviral therapy in Finland. BMJ Open 2015; 5:e007986. [PMID: 26546135 PMCID: PMC4636633 DOI: 10.1136/bmjopen-2015-007986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Is it possible to live without neurocognitive or neurological symptoms after being infected with HIV for a very long time? These study patients with decades-long HIV infection in Finland were observed in this follow-up study during three time periods: 1986-1990, in 1997 and in 2013. SETTING Patients from greater Helsinki area were selected from outpatient's unit of infectious diseases. PARTICIPANTS The study included 80 HIV patients. Patients with heavy alcohol consumption, central nervous system disorder or psychiatric disease were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The patients underwent neurological and neuropsychological examinations, MRI of the brain and laboratory tests, including blood CD4 cells and plasma HIV-1 RNA. Neuropsychological examination included several measures: subtests of Wechsler Adult Intelligence Scale, Wechsler Memory Scale-Revised, list learning, Stroop and Trail-Making-B test. The Beck Depression Inventory and Fatigue Severity Scale were also carried out. The obtained data from the three time periods were compared with each other. RESULTS Owing to high mortality among the original 80 patients, eventually, 17 participated in all three examinations performed between 1986 and 2013. The time from the HIV diagnosis was 27 (23-30) years. Blood CD4 cells at the diagnosis were 610 (29-870) cells/mm(3), and the nadir CD4 168 (4-408) cells/mm(3). The time on combined antiretroviral treatment was 13 (5-17) years. 9 patients suffered from fatigue, 5 had polyneuropathy and 3 had lacunar cerebral infarcts. There was a subtle increase of brain atrophy in 2 patients. Mild depressive symptoms were common. The neuropsychological follow-up showed typical age-related cognitive changes. No HIV-associated dementia features were detected. CONCLUSIONS Polyneuropathy, fatigue and mild depression were common, but more severe neurological abnormalities were absent. These long-term surviving HIV-seropositive patients, while on best-available treatment, showed no evidence of HIV-associated neurocognitive disorder in neuropsychological and neuroradiological evaluations.
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Affiliation(s)
- T Heikinheimo
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - E Poutiainen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
- Rehabilitation Foundation, Helsinki, Finland
| | - O Salonen
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - I Elovaara
- Neuroimmunology Unit, Medical School, University of Tampere, Tampere, Finland
| | - M Ristola
- Department of Infectious Diseases at Aurora Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Haziot MEJ, Barbosa Junior SP, Vidal JE, de Oliveira FTM, de Oliveira ACP. Neuroimaging of HIV-associated neurocognitive disorders. Dement Neuropsychol 2015; 9:380-384. [PMID: 29213987 PMCID: PMC5619320 DOI: 10.1590/1980-57642015dn94000380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/10/2015] [Indexed: 11/29/2022] Open
Abstract
A significant increase in the incidence of cognitive impairment in HIV/AIDS patients has been continuously observed. Consequently, three classification categories of cognitive impairment have been proposed: asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), that correspond to the mild and intermediate forms, and HIV-associated dementia (HAD) for the most severe cases. HIV-associated neurocognitive disorders (HAND) is a broad term that encompasses these three categories. Moreover, the application of neuroimaging methods has led to a major breakthrough in understanding of the neurological changes in HIV, providing greater reliability in the exclusion of associated diseases and allowing earlier diagnosis. Therefore, abnormalities and/or specific neuroimaging elements may soon be incorporated into the HAND classification criteria, which will be of great value in the management of these diseases, including in the optimization of high CNS penetration antiretroviral regimens.
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Affiliation(s)
- Michel Elyas Jung Haziot
- Neuroscience Research Group / Institute of Infectious
Diseases Emílio Ribas of the University of São Paulo, SP,
Brazil
- Neurology Department of the Santa Casa de São
Paulo, SP, Brazil
| | - Silas Pereira Barbosa Junior
- Neuroscience Research Group / Institute of Infectious
Diseases Emílio Ribas of the University of São Paulo, SP,
Brazil
| | - José E. Vidal
- Neuroscience Research Group / Institute of Infectious
Diseases Emílio Ribas of the University of São Paulo, SP,
Brazil
- Department of Infectious Diseases of the University of
São Paulo, SP, Brazil
| | | | - Augusto César Penalva de Oliveira
- Neuroscience Research Group / Institute of Infectious
Diseases Emílio Ribas of the University of São Paulo, SP,
Brazil
- Neurology Department of the Santa Casa de São
Paulo, SP, Brazil
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The brain's Geppetto-microbes as puppeteers of neural function and behaviour? J Neurovirol 2015; 22:14-21. [PMID: 26047662 DOI: 10.1007/s13365-015-0355-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/27/2015] [Accepted: 05/20/2015] [Indexed: 02/06/2023]
Abstract
Research on the microbiome and its interaction with various host organs, including the brain, is increasingly gaining momentum. With more evidence establishing a comprehensive microbiota-gut-brain axis, questions have been raised as to the extent to which microbes influence brain physiology and behaviour. In parallel, there is a growing literature showing active behavioural manipulation in favour of the microbe for certain parasites. However, it seems unclear where the hidden majority of microbes are localised on the parasitism-mutualism spectrum. A long evolutionary history intimately connects host and microbiota, which complicates this classification. In this conceptual minireview, we discuss current hypotheses on host-microbe interaction and argue that novel experimental approaches and theoretical concepts, such as the hologenome theory, are necessary to incorporate transgenerational epigenetic inheritance of the microbiome into evolutionary theories.
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HIV-associated neurocognitive disorders: the relationship of HIV infection with physical and social comorbidities. BIOMED RESEARCH INTERNATIONAL 2015; 2015:641913. [PMID: 25815329 PMCID: PMC4359826 DOI: 10.1155/2015/641913] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/29/2015] [Indexed: 12/14/2022]
Abstract
The prevalence of HIV (human immunodeficiency virus) associated neurocognitive disorders (HAND) will undoubtedly increase with the improved longevity of HIV-infected persons. HIV infection, itself, as well as multiple physiologic and psychosocial factors can contribute to cognitive impairment and neurologic complications. These comorbidities confound the diagnosis, assessment, and interventions for neurocognitive disorders. In this review, we discuss the role of several key comorbid factors that may contribute significantly to the development and progression of HIV-related neurocognitive impairment, as well as the current status of diagnostic strategies aimed at identifying HIV-infected individuals with impaired cognition and future research priorities and challenges.
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Mehraj V, Jenabian MA, Vyboh K, Routy JP. Immune Suppression by Myeloid Cells in HIV Infection: New Targets for Immunotherapy. Open AIDS J 2014; 8:66-78. [PMID: 25624956 PMCID: PMC4302459 DOI: 10.2174/1874613601408010066] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 11/11/2014] [Accepted: 11/28/2014] [Indexed: 02/07/2023] Open
Abstract
Over thirty years of extensive research has not yet solved the complexity of HIV pathogenesis leading to a continued need for a successful cure. Recent immunotherapy-based approaches are aimed at controlling the infection by reverting immune dysfunction. Comparatively less appreciated than the role of T cells in the context of HIV infection, the myeloid cells including macrophages monocytes, dendritic cells (DCs) and neutrophils contribute significantly to immune dysfunction. Host restriction factors are cellular proteins expressed in these cells which are circumvented by HIV. Guided by the recent literature, the role of myeloid cells in HIV infection will be discussed highlighting potential targets for immunotherapy. HIV infection, which is mainly characterized by CD4 T cell dysfunction, also manifests in a vicious cycle of events comprising of inflammation and immune activation. Targeting the interaction of programmed death-1 (PD-1), an important regulator of T cell function; with PD-L1 expressed mainly on myeloid cells could bring promising results. Macrophage functional polarization from pro-inflammatory M1 to anti-inflammatory M2 and vice versa has significant implications in viral pathogenesis. Neutrophils, recently discovered low density granular cells, myeloid derived suppressor cells (MDSCs) and yolk sac macrophages provide new avenues of research on HIV pathogenesis and persistence. Recent evidence has also shown significant implications of neutrophil extracellular traps (NETs), antimicrobial peptides and opsonizing antibodies. Further studies aimed to understand and modify myeloid cell restriction mechanisms have the potential to contribute in the future development of more effective anti-HIV interventions that may pave the way to viral eradication.
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Affiliation(s)
- Vikram Mehraj
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada ; Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Mohammad-Ali Jenabian
- Département des Sciences Biologiques et Centre de recherche BioMed, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Kishanda Vyboh
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada ; Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada ; Research Institute, McGill University Health Centre, Montreal, QC, Canada ; Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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Jamroz-Wiśniewska A, Jaworski J, Suszek D, Janczarek M, Stelmasiak Z, Rejdak K, Bartosik-Psujek H. Disappearance of white matter lesions on MRI and clinical recovery after initiating antiretroviral therapy in a case of HIV infection presenting as spastic paraparesis. Neurol Neurochir Pol 2014; 48:378-81. [PMID: 25440019 DOI: 10.1016/j.pjnns.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 08/16/2014] [Accepted: 09/29/2014] [Indexed: 11/26/2022]
Abstract
We present a case of a 30-year-old Polish female who presented with increasing for about 2 years spastic paraparesis and urinary incontinence. She denied any risky sexual behaviors, drug abuse, there was no history of surgery or blood transfusions. MRI of the brain showed diffuse, hyperintensive in T2, poorly defined lesions in the white matter. About 3 months later paraparesis increased and control MRI showed progression of previously described lesions. She was then diagnosed with HIV infection. There was a suspicion of progressive multifocal leucoencephalopathy (PML) or vacuolar myelopathy in the course of HIV infection. Antiretroviral treatment was initiated leading, together with rehabilitation, to a progressive improvement of symptoms. Pathological lesions on brain MRI completely disappeared. In conclusion, HIV test should be done in every patient with neurological signs of unknown cause.
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Affiliation(s)
| | - Jacek Jaworski
- Department of Neurology, Lublin Medical University, Lublin, Poland
| | - Dorota Suszek
- Department of Rheumatology, Lublin Medical University, Lublin, Poland
| | - Marzena Janczarek
- Department of Interventional Radiology and Neuroradiology, Lublin Medical University, Lublin, Poland
| | | | - Konrad Rejdak
- Department of Neurology, Lublin Medical University, Lublin, Poland
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Churchill MJ, Cowley DJ, Wesselingh SL, Gorry PR, Gray LR. HIV-1 transcriptional regulation in the central nervous system and implications for HIV cure research. J Neurovirol 2014; 21:290-300. [PMID: 25060300 DOI: 10.1007/s13365-014-0271-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 12/15/2022]
Abstract
Human immunodeficiency virus type-1 (HIV-1) invades the central nervous system (CNS) during acute infection which can result in HIV-associated neurocognitive disorders in up to 50% of patients, even in the presence of combination antiretroviral therapy (cART). Within the CNS, productive HIV-1 infection occurs in the perivascular macrophages and microglia. Astrocytes also become infected, although their infection is restricted and does not give rise to new viral particles. The major barrier to the elimination of HIV-1 is the establishment of viral reservoirs in different anatomical sites throughout the body and viral persistence during long-term treatment with cART. While the predominant viral reservoir is believed to be resting CD4(+) T cells in the blood, other anatomical compartments including the CNS, gut-associated lymphoid tissue, bone marrow, and genital tract can also harbour persistently infected cellular reservoirs of HIV-1. Viral latency is predominantly responsible for HIV-1 persistence and is most likely governed at the transcriptional level. Current clinical trials are testing transcriptional activators, in the background of cART, in an attempt to purge these viral reservoirs and reverse viral latency. These strategies aim to activate viral transcription in cells constituting the viral reservoir, so they can be recognised and cleared by the immune system, while new rounds of infection are blocked by co-administration of cART. The CNS has several unique characteristics that may result in differences in viral transcription and in the way latency is established. These include CNS-specific cell types, different transcription factors, altered immune surveillance, and reduced antiretroviral drug bioavailability. A comprehensive understanding of viral transcription and latency in the CNS is required in order to determine treatment outcomes when using transcriptional activators within the CNS.
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Affiliation(s)
- Melissa J Churchill
- Center for Biomedical Research, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Victoria, Australia,
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