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D'Amico D, Valdebenito S, Eugenin EA. The role of Pannexin-1 channels and extracellular ATP in the pathogenesis of the human immunodeficiency virus. Purinergic Signal 2021; 17:563-576. [PMID: 34542793 DOI: 10.1007/s11302-021-09817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022] Open
Abstract
Only recently, the role of large ionic channels such as Pannexin-1 channels and Connexin hemichannels has been implicated in several physiological and pathological conditions, including HIV infection and associated comorbidities. These channels are in a closed stage in healthy conditions, but in pathological conditions including HIV, Pannexin-1 channels and Connexin hemichannels become open. Our data demonstrate that acute and chronic HIV infection induces channel opening (Pannexin and Connexin channels), ATP release into the extracellular space, and subsequent activation of purinergic receptors in immune and non-immune cells. We demonstrated that Pannexin and Connexin channels contribute to HIV infection and replication, the long-term survival of viral reservoirs, and comorbidities such as NeuroHIV. Here, we discuss the available data to support the participation of these channels in the HIV life cycle and the potential therapeutic approach to prevent HIV-associated comorbidities.
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Affiliation(s)
- Daniela D'Amico
- Department of Neuroscience , Cell Biology, and Anatomy, University of Texas Medical Branch (UTMB), Research Building 17, 105 11th Street, Galveston, TX, 77555, USA
| | - Silvana Valdebenito
- Department of Neuroscience , Cell Biology, and Anatomy, University of Texas Medical Branch (UTMB), Research Building 17, 105 11th Street, Galveston, TX, 77555, USA
| | - Eliseo A Eugenin
- Department of Neuroscience , Cell Biology, and Anatomy, University of Texas Medical Branch (UTMB), Research Building 17, 105 11th Street, Galveston, TX, 77555, USA.
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2
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Rates of cognitive impairment in a South African cohort of people with HIV: variation by definitional criteria and lack of association with neuroimaging biomarkers. J Neurovirol 2021; 27:579-594. [PMID: 34241815 DOI: 10.1007/s13365-021-00993-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/14/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
There is wide variation in the reported prevalence of cognitive impairment in people with HIV (PWH). Part of this variation may be attributable to different studies using different methods of combining neuropsychological test scores to classify participants as either cognitively impaired or unimpaired. Our aim was to determine, in a South African cohort of PWH (N = 148), (a) how much variation in reported rates was due to method used to define cognitive impairment and (b) which method correlated best with MRI biomarkers of HIV-related brain pathology. Participants completed detailed neuropsychological assessment and underwent 3 T structural MRI and diffusion tensor imaging (DTI). We used the neuropsychological data to investigate 20 different methods of determining HIV-associated cognitive impairment. We used the neuroimaging data to obtain volumes for cortical and subcortical grey matter and total white matter and DTI metrics for several white matter tracts. Applying each of the 20 methods to the cognitive dataset resulted in a wide variation (20-97%) in estimated rates of impairment. Logistic regression models showed no method was associated with HIV-related neuroimaging abnormalities as measured by structural volumes or DTI metrics. We conclude that for the population from which this sample was drawn, much of the variation in reported rates of cognitive impairment in PWH is due to the method of classification used, and that none of these methods accurately reflects biological effects of HIV in the brain. We suggest that defining HIV-associated cognitive impairment using neuropsychological test performance only is insufficient; pre-morbid functioning, co-morbidities, cognitive symptoms, and functional impairment should always be considered.
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3
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Cerebral alterations in West African HIV and non-HIV adults aged ≥50: An MRI study. Int J Infect Dis 2020; 103:457-463. [PMID: 33310027 PMCID: PMC8620126 DOI: 10.1016/j.ijid.2020.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives: To cross-sectionally describe brain alterations in PLHIV aged above 50 years old, receiving antiretroviral treatment (ART) and living in Senegal compared to HIV-negative subjects. Methods: Twenty PLHIV and 26 HIV-negative subjects with comparable socio-demographic and clinical characteristics underwent an MRI exam (3D-T1 and FLAIR sequences). Global atrophy and White Matter Hyperintensities (WMH) were evaluated. After assessing the feasibility and acceptability of MRI scans in this population, we described atrophy and WHM prevalence and associated factors using logistic regressions. Results: Overall, 43.5% of the study sample were aged ≥60 years, 58.7% were women, and 28.3% had hypertension. The overall prevalence of atrophy and WMH was 19.6% [95% CI: 8.1–31.1] and 30.4% [95% CI: 17.1–43.7]. HIV status had no significant effect on atrophy or WMH. Unemployment and hypertension were significantly associated with atrophy, whereas women were less likely to present atrophy. Aged ≥60 years was the only factor associated with WMH. Conclusions: A high prevalence of atrophy and WMH was observed in West African adults aged over 50 years without a clear HIV impact. As brain MRI studies are critical to better understand cognitive and emotional outcomes, we encourage those studies in older PLHIV in West Africa.
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4
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Cilliers K, Muller CJF. Effect of human immunodeficiency virus on the brain: A review. Anat Rec (Hoboken) 2020; 304:1389-1399. [PMID: 33231355 DOI: 10.1002/ar.24573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Thirty million people are infected with human immunodeficiency virus (HIV) worldwide, and HIV-associated neurocognitive disorder (HAND) is one of the most common comorbidities of HIV. However, the effect of HIV on the brain has not been fully investigated. This article aimed to review the changes to the brain due to HIV in terms of atrophy, diffusion changes, and hyperintensities. Studies have observed significant atrophy in subcortical gray matter, as well as in cortical white and gray matter. Moreover, the ventricles enlarge, and the sulci widen. Although HIV causes changes to the white and gray matter of the brain, few diffusion tensor imaging studies have investigated the changes to gray matter integrity. White and gray matter hyperintensities have frequently been observed in HIV-positive individuals, with the subcortical gray matter (caudate nucleus and putamen) and periventricular white matter frequently affected. In conclusion, subcortical gray matter is the first brain region to be affected and is affected most severely. Additionally, this review highlights the gaps in the literature, since the effect of HIV on the brain is not fully known. Future studies should continue to investigate the effect of HIV on the brain in different stages of the disease, and alternate therapies should be developed since highly active antiretroviral therapy is currently ineffective at treating HAND.
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Affiliation(s)
- Karen Cilliers
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Christo J F Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Western Cape, South Africa.,Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
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5
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Haddow LJ, Godi C, Sokolska M, Cardoso MJ, Oliver R, Winston A, Stöhr W, Clarke A, Chen F, Williams IG, Johnson M, Paton N, Arenas-Pinto A, Golay X, Jäger HR. Brain Perfusion, Regional Volumes, and Cognitive Function in Human Immunodeficiency Virus-positive Patients Treated With Protease Inhibitor Monotherapy. Clin Infect Dis 2020; 68:1031-1040. [PMID: 30084882 DOI: 10.1093/cid/ciy617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Protease inhibitor monotherapy (PIM) for human immunodeficiency virus (HIV) may exert suboptimal viral control in the central nervous system. We determined whether cerebral blood flow (CBF) and regional brain volumes were associated with PIM, and whether specific cognitive domains were associated with imaging biomarkers. METHODS Cognitive assessments and brain magnetic resonance imaging were performed after the final visit of a randomized HIV-treatment strategy trial. Participants were virologically suppressed on triple therapy at trial entry and followed for 3-5 years. We studied 37 patients randomized to ongoing triple therapy and 39 randomized to PIM. Resting CBF and normalized volumes were calculated for brain regions of interest, and correlated with treatment strategy and neuropsychological performance. RESULTS Mean age was 48.1 years (standard deviation 8.6 years), 63 male (83%), and 64 white (84%). Participants had median 8.1 years (interquartile range 6.4, 10.8) of antiretroviral therapy experience and CD4+ counts of median 640 cells/mm3 (interquartile range 490, 780). We found no difference between treatment arms in CBF or regional volumes. Regardless of treatment arm, poorer fine motor performance correlated with lower CBF in the caudate nucleus (P = .01), thalamus (P = .04), frontal cortex (P = .01), occipital cortex (P = .004), and cingulate cortex (P = .02), and was associated with smaller supratentorial white matter volume (decrease of 0.16 in Z-score per -1% of intracranial volume, 95% confidence interval 0.02-0.29; P = .023). CONCLUSIONS PIM does not confer an additional risk of neurological injury compared with triple therapy. There were correlations between fine motor impairment, grey matter hypoperfusion, and white matter volume loss. CLINICAL TRIALS REGISTRATION ISRCTN-04857074.
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Affiliation(s)
- Lewis J Haddow
- Institute of Global Health, University College London, United Kingdom
| | - Claudia Godi
- Institute of Neurology, University College London, United Kingdom.,Department of Neuroradiology, Ospedale San Raffaele, Milan, Italy
| | - Magdalena Sokolska
- Institute of Neurology, University College London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, United Kingdom
| | - M Jorge Cardoso
- Centre for Medical Image Computing, University College London, United Kingdom
| | - Ruth Oliver
- Institute of Neurology, University College London, United Kingdom.,Department of Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Alan Winston
- Department of Medicine, Imperial College London, United Kingdom
| | - Wolfgang Stöhr
- The Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | - Amanda Clarke
- Elton John Centre, Brighton and Sussex University Hospital, United Kingdom
| | - Fabian Chen
- The Florey Sexual Health Clinic, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ian G Williams
- Institute of Global Health, University College London, United Kingdom
| | - Margaret Johnson
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, United Kingdom
| | - Nick Paton
- The Medical Research Council Clinical Trials Unit at University College London, United Kingdom.,Department of Medicine, National University of Singapore
| | - Alejandro Arenas-Pinto
- Institute of Global Health, University College London, United Kingdom.,The Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | - Xavier Golay
- Institute of Neurology, University College London, United Kingdom
| | - Hans Rolf Jäger
- Institute of Neurology, University College London, United Kingdom.,Centre of Medical Imaging, University College London Hospitals NHS Foundation Trust, United Kingdom
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6
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Zahr NM, Sullivan EV, Pohl KM, Pfefferbaum A, Saranathan M. Sensitivity of ventrolateral posterior thalamic nucleus to back pain in alcoholism and CD4 nadir in HIV. Hum Brain Mapp 2020; 41:1351-1361. [PMID: 31785046 PMCID: PMC7268080 DOI: 10.1002/hbm.24880] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/15/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
Volumes of thalamic nuclei are differentially affected by disease-related processes including alcoholism and human immunodeficiency virus (HIV) infection. This MRI study included 41 individuals diagnosed with alcohol use disorders (AUD, 12 women), 17 individuals infected with HIV (eight women), and 49 healthy controls (24 women) aged 39 to 75 years. A specialized, high-resolution acquisition protocol enabled parcellation of five thalamic nuclei: anterior [anterior ventral (AV)], posterior [pulvinar (Pul)], medial [mediodorsal (MD)], and ventral [including ventral lateral posterior (VLp) and ventral posterior lateral (VPl)]. An omnibus mixed-model approach solving for volume considered the "fixed effects" of nuclei, diagnosis, and their interaction while covarying for hemisphere, sex, age, and supratentorial volume (svol). The volume by diagnosis interaction term was significant; the effects of hemisphere and sex were negligible. Follow-up mixed-model tests thus evaluated the combined (left + right) volume of each nucleus separately for effects of diagnosis while controlling for age and svol. Only the VLp showed diagnoses effects and was smaller in the AUD (p = .04) and HIV (p = .0003) groups relative to the control group. In the AUD group, chronic back pain (p = .008) and impaired deep tendon ankle reflex (p = .0005) were associated with smaller VLp volume. In the HIV group, lower CD4 nadir (p = .008) was associated with smaller VLp volume. These results suggest that the VLp is differentially sensitive to disease processes associated with AUD and HIV.
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Affiliation(s)
- Natalie M. Zahr
- Neuroscience ProgramSRI InternationalMenlo ParkCalifornia
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
| | - Kilian M. Pohl
- Neuroscience ProgramSRI InternationalMenlo ParkCalifornia
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
| | - Adolf Pfefferbaum
- Neuroscience ProgramSRI InternationalMenlo ParkCalifornia
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
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7
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Kallianpur KJ, Walker M, Gerschenson M, Shikuma CM, Gangcuangco LMA, Kohorn L, Libutti DE, Nir TM, Jahanshad N, Thompson PM, Paul R. Systemic Mitochondrial Oxidative Phosphorylation Protein Levels Correlate with Neuroimaging Measures in Chronically HIV-Infected Individuals. AIDS Res Hum Retroviruses 2019; 36:83-91. [PMID: 31617381 DOI: 10.1089/aid.2019.0240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Few studies have examined systemic mitochondrial function in conjunction with brain imaging in human immunodeficiency virus (HIV) disease. Oxidative phosphorylation enzyme protein levels of peripheral blood mononuclear cells were measured in association with neuroimaging indices in 28 HIV+ individuals. T1-weighted magnetic resonance imaging yielded volumes of seven brain regions of interest; diffusion tensor imaging determined fractional anisotropy (FA) and mean diffusivity (MD) in the corpus callosum (CC). Higher nicotinamide adenine dinucleotide dehydrogenase levels correlated with lower volumes of thalamus (p = .005) and cerebral white matter (p = .049) and, in the CC, with lower FA (p = .011, body; p = .005, genu; p = .009, total CC) and higher MD (p = .023, body; p = .035, genu; p = .019, splenium; p = .014, total CC). Greater cytochrome c oxidase levels correlated with lower thalamic (p = .034) and cerebellar gray matter (p = .021) volumes. The results indicate that systemic mitochondrial cellular bioenergetics are associated with brain health in HIV.
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Affiliation(s)
- Kalpana J. Kallianpur
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
- Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii
| | - Maegen Walker
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Mariana Gerschenson
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Cecilia M. Shikuma
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Louie Mar A. Gangcuangco
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Lindsay Kohorn
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Daniel E. Libutti
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Talia M. Nir
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck USC School of Medicine, Marina del Rey, California
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck USC School of Medicine, Marina del Rey, California
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck USC School of Medicine, Marina del Rey, California
| | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri
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8
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Nedelcovych MT, Kim BH, Zhu X, Lovell LE, Manning AA, Kelschenbach J, Hadas E, Chao W, Prchalová E, Dash RP, Wu Y, Alt J, Thomas AG, Rais R, Kamiya A, Volsky DJ, Slusher BS. Glutamine Antagonist JHU083 Normalizes Aberrant Glutamate Production and Cognitive Deficits in the EcoHIV Murine Model of HIV-Associated Neurocognitive Disorders. J Neuroimmune Pharmacol 2019; 14:391-400. [PMID: 31209775 DOI: 10.1007/s11481-019-09859-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/28/2019] [Indexed: 12/24/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) have been linked to dysregulation of glutamate metabolism in the central nervous system (CNS) culminating in elevated extracellular glutamate and disrupted glutamatergic neurotransmission. Increased glutamate synthesis via upregulation of glutaminase (GLS) activity in brain immune cells has been identified as one potential source of excess glutamate in HAND. However, direct evidence for this hypothesis in an animal model is lacking, and the viability of GLS as a drug target has not been explored. In this brief report, we demonstrate that GLS inhibition with the glutamine analogue 6-diazo-5-oxo-L-norleucine (DON) can reverse cognitive impairment in the EcoHIV-infected mouse model of HAND. However, due to peripheral toxicity DON is not amenable to clinical use in a chronic disease such as HAND. We thus tested JHU083, a novel, brain penetrant DON prodrug predicted to exhibit improved tolerability. Systemic administration of JHU083 reversed cognitive impairment in EcoHIV-infected mice similarly to DON, and simultaneously normalized EcoHIV-induced increases in cerebrospinal fluid (CSF) glutamate and GLS activity in microglia-enriched brain CD11b + cells without observed toxicity. These studies support the mechanistic involvement of elevated microglial GLS activity in HAND pathogenesis, and identify JHU083 as a potential treatment option. Graphical Abstract Please provide Graphical Abstract caption.Glutamine Antagonist JHU083 Normalizes Aberrant Glutamate Production and Cognitive Deficits in the EcoHIV Murine Model of HIV-Associated Neurocognitive Disorders .
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Affiliation(s)
- Michael T Nedelcovych
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Boe-Hyun Kim
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building Floor 21, Room 42, 1468 Madison Ave, New York, NY, 10029, USA
| | - Xiaolei Zhu
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lyndah E Lovell
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arena A Manning
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA
| | - Jennifer Kelschenbach
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building Floor 21, Room 42, 1468 Madison Ave, New York, NY, 10029, USA
| | - Eran Hadas
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building Floor 21, Room 42, 1468 Madison Ave, New York, NY, 10029, USA
| | - Wei Chao
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building Floor 21, Room 42, 1468 Madison Ave, New York, NY, 10029, USA
| | - Eva Prchalová
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ranjeet P Dash
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ying Wu
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jesse Alt
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ajit G Thomas
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rana Rais
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Atsushi Kamiya
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David J Volsky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building Floor 21, Room 42, 1468 Madison Ave, New York, NY, 10029, USA.
| | - Barbara S Slusher
- Johns Hopkins Drug Discovery, 855 North Wolfe Street, Baltimore, MD, 21205, USA. .,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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9
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Heaps-Woodruff JM, Joska J, Cabeen R, Baker LM, Salminen LE, Hoare J, Laidlaw DH, Wamser-Nanney R, Peng CZ, Engelbrecht S, Seedat S, Stein DJ, Paul RH. White matter fiber bundle lengths are shorter in cART naive HIV: an analysis of quantitative diffusion tractography in South Africa. Brain Imaging Behav 2019; 12:1229-1238. [PMID: 29110194 DOI: 10.1007/s11682-017-9769-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study examines white matter microstructure using quantitative tractography diffusion magnetic resonance imaging (qtdMRI) in HIV+ individuals from South Africa who were naïve or early in the initiation of antiretroviral therapy. Fiber bundle length (FBL) metrics, generated from qtdMRI, for whole brain and six white matter tracts of interest (TOI) were assessed for 135 HIV+ and 21 HIV- individuals. The association between FBL metrics, measures of disease burden, and neuropsychological performance were also investigated. Results indicate significantly reduced sum of whole brain fiber bundle lengths (FBL, p < 0.001), but not average whole brain FBL in the HIV+ group compared to the HIV- controls. The HIV+ group exhibited significantly shorter sum of FBL in all six TOIs examined: the anterior thalamic radiation, cingulum bundle, inferior and superior longitudinal fasciculi, inferior frontal occipital fasciculus, and the uncinate fasciculus. Additionally, average FBLs were significantly shorter select TOIs including the inferior longitudinal fasciculus, cingulum bundle, and the anterior thalamic radiation. Shorter whole brain FBL sum metrics were associated with poorer neuropsychological performance, but were not associated with markers of disease burden. Taken together these findings suggest HIV affects white matter architecture primarily through reductions in white matter fiber numbers and, to a lesser degree, the shortening of fibers along a bundle path.
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Affiliation(s)
| | - John Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ryan Cabeen
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Laurie M Baker
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Lauren E Salminen
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - David H Laidlaw
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.,Department of Computer Science, Brown University, Providence, RI, USA
| | | | - Chun-Zi Peng
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Services (NHLS), Cape Town, South Africa
| | - Soraya Seedat
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Services (NHLS), Cape Town, South Africa
| | - Dan J Stein
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Robert H Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
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10
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Adeli E, Kwon D, Zhao Q, Pfefferbaum A, Zahr NM, Sullivan EV, Pohl KM. Chained regularization for identifying brain patterns specific to HIV infection. Neuroimage 2018; 183:425-437. [PMID: 30138676 PMCID: PMC6197908 DOI: 10.1016/j.neuroimage.2018.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 12/21/2022] Open
Abstract
Human Immunodeficiency Virus (HIV) infection continues to have major adverse public health and clinical consequences despite the effectiveness of combination Antiretroviral Therapy (cART) in reducing HIV viral load and improving immune function. As successfully treated individuals with HIV infection age, their cognition declines faster than reported for normal aging. This phenomenon underlines the importance of improving long-term care, which requires a better understanding of the impact of HIV on the brain. In this paper, automated identification of patients and brain regions affected by HIV infection are modeled as a classification problem, whose solution is determined in two steps within our proposed Chained-Regularization framework. The first step focuses on selecting the HIV pattern (i.e., the most informative constellation of brain region measurements for distinguishing HIV infected subjects from healthy controls) by constraining the search for the optimal parameter setting of the classifier via group sparsity (ℓ2,1-norm). The second step improves classification accuracy by constraining the parameterization with respect to the selected measurements and the Euclidean regularization (ℓ2-norm). When applied to the cortical and subcortical structural Magnetic Resonance Images (MRI) measurements of 65 controls and 65 HIV infected individuals, this approach is more accurate in distinguishing the two cohorts than more common models. Finally, the brain regions of the identified HIV pattern concur with the HIV literature that uses traditional group analysis models.
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Affiliation(s)
- Ehsan Adeli
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Dongjin Kwon
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA; Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Qingyu Zhao
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA; Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA; Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Kilian M Pohl
- Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA.
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11
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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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12
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Randall SR, Warton CMR, Holmes MJ, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM. Larger Subcortical Gray Matter Structures and Smaller Corpora Callosa at Age 5 Years in HIV Infected Children on Early ART. Front Neuroanat 2017; 11:95. [PMID: 29163068 PMCID: PMC5673662 DOI: 10.3389/fnana.2017.00095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Sub-Saharan Africa is home to 90% of HIV infected (HIV+) children. Since the advent of antiretroviral therapy (ART), HIV/AIDS has transitioned to a chronic condition where central nervous system (CNS) damage may be ongoing. Although, most guidelines recommend early ART to reduce CNS viral reservoirs, the brain may be more vulnerable to potential neurotoxic effects of ART during the rapid development phase in the first years of life. Here we investigate differences in subcortical volumes between 5-year-old HIV+ children who received early ART (before age 18 months) and uninfected children using manual tracing of Magnetic Resonance Images. Participants included 61 Xhosa children (43 HIV+/18 uninfected, mean age = 5.4 ± 0.3 years, 25 male) from the children with HIV early antiretroviral (CHER) trial; 27 children initiated ART before 12 weeks of age (ART-Before12Wks) and 16 after 12 weeks (ART-After12Wks). Structural images were acquired on a 3T Allegra MRI in Cape Town and manually traced using MultiTracer. Volumetric group differences (HIV+ vs. uninfected; ART-Before12Wks vs. ART-After12Wks) were examined for the caudate, nucleus accumbens (NA), putamen (Pu), globus pallidus (GP), and corpus callosum (CC), as well as associations within infected children of structure volumes with age at ART initiation and CD4/CD8 as a proxy for immune health. HIV+ children had significantly larger NA and Pu volumes bilaterally and left GP volumes than controls, whilst CC was smaller. Bilateral Pu was larger in both treatment groups compared to controls, while left GP and bilateral NA were enlarged only in ART-After12Wks children. CC was smaller in both treatment groups compared to controls, and smaller in ART-After12Wks compared to ART-Before12Wks. Within infected children, delayed ART initiation was associated with larger Pu volumes, effects that remained significant when controlling for sex and duration of treatment interruption (left β = 0.447, p = 0.005; right β = 0.325, p = 0.051), and lower CD4/CD8 with larger caudates controlling for sex (left β = -0.471, p = 0.002; right β = -0.440, p = 0.003). Volumetric differences were greater in children who initiated ART after 12 weeks. Results suggest damage is ongoing despite early ART and viral load suppression; however, earlier treatment is neuroprotective.
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Affiliation(s)
- Steven R. Randall
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher M. R. Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark F. Cotton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre J. W. van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ernesta M. Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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13
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Resting-state functional magnetic resonance imaging in clade C HIV: within-group association with neurocognitive function. J Neurovirol 2017; 23:875-885. [PMID: 28971331 DOI: 10.1007/s13365-017-0581-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 01/03/2023]
Abstract
Neuroimaging abnormalities are common in chronically infected HIV-positive individuals. The majority of studies have focused on structural or functional brain outcomes in samples infected with clade B HIV. While preliminary work reveals a similar structural imaging phenotype in patients infected with clade C HIV, no study has examined functional connectivity (FC) using resting-state functional magnetic resonance imaging (rs-fMRI) in clade C HIV. In particular, we were interested to explore HIV-only effects on neurocognitive function using associations with rs-fMRI. In the present study, 56 treatment-naïve, clade C HIV-infected participants (age 32.27 ± 5.53 years, education 10.02 ± 1.72 years, 46 female) underwent rs-fMRI and cognitive testing. Individual resting-state networks were correlated with global deficit scores (GDS) in order to explore associations between them within an HIV-positive sample. Results revealed ten regions in six resting-state networks where FC inversely correlated with GDS scores (worse performance). The networks affected included three independent attention networks: the default mode network (DMN), sensorimotor network, and basal ganglia. Connectivity in these regions did not correlate with plasma viral load or CD4 cell count. The design of this study is unique and has not been previously reported in clade B. The abnormalities related to neurocognitive performance reported in this study of clade C may reflect late disease stage and/or unique host/viral dynamics. Longitudinal studies will help to clarify the clinical significance of resting-state alterations in clade C HIV.
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14
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Baker LM, Cooley SA, Cabeen RP, Laidlaw DH, Joska JA, Hoare J, Stein DJ, Heaps-Woodruff JM, Salminen LE, Paul RH. Topological Organization of Whole-Brain White Matter in HIV Infection. Brain Connect 2017; 7:115-122. [PMID: 28076974 DOI: 10.1089/brain.2016.0457] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Infection with human immunodeficiency virus (HIV) is associated with neuroimaging alterations. However, little is known about the topological organization of whole-brain networks and the corresponding association with cognition. As such, we examined structural whole-brain white matter connectivity patterns and cognitive performance in 29 HIV+ young adults (mean age = 25.9) with limited or no HIV treatment history. HIV+ participants and demographically similar HIV- controls (n = 16) residing in South Africa underwent magnetic resonance imaging (MRI) and neuropsychological testing. Structural network models were constructed using diffusion MRI-based multifiber tractography and T1-weighted MRI-based regional gray matter segmentation. Global network measures included whole-brain structural integration, connection strength, and structural segregation. Cognition was measured using a neuropsychological global deficit score (GDS) as well as individual cognitive domains. Results revealed that HIV+ participants exhibited significant disruptions to whole-brain networks, characterized by weaker structural integration (characteristic path length and efficiency), connection strength, and structural segregation (clustering coefficient) than HIV- controls (p < 0.05). GDSs and performance on learning/recall tasks were negatively correlated with the clustering coefficient (p < 0.05) in HIV+ participants. Results from this study indicate disruption to brain network integrity in treatment-limited HIV+ young adults with corresponding abnormalities in cognitive performance.
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Affiliation(s)
- Laurie M Baker
- 1 Department of Psychology, University of Missouri-Saint Louis , Saint Louis, Missouri
| | - Sarah A Cooley
- 2 Department of Neurology, School of Medicine, Washington University in Saint Louis , Saint Louis, Missouri
| | - Ryan P Cabeen
- 3 Keck School of Medicine, University of Southern California , Los Angeles, California
| | - David H Laidlaw
- 4 Computer Science Department, Brown University , Providence, Rhode Island
| | - John A Joska
- 5 Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa
| | - Jacqueline Hoare
- 5 Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa
| | - Dan J Stein
- 5 Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa .,6 MRC Unit on Anxiety & Stress Disorders , Cape Town, South Africa
| | | | - Lauren E Salminen
- 3 Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Robert H Paul
- 1 Department of Psychology, University of Missouri-Saint Louis , Saint Louis, Missouri.,7 Missouri Institute of Mental Health , St. Louis, Missouri
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15
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Paul RH, Phillips S, Hoare J, Laidlaw DH, Cabeen R, Olbricht GR, Su Y, Stein DJ, Engelbrecht S, Seedat S, Salminen LE, Baker LM, Heaps J, Joska J. Neuroimaging abnormalities in clade C HIV are independent of Tat genetic diversity. J Neurovirol 2016; 23:319-328. [PMID: 27913960 DOI: 10.1007/s13365-016-0503-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 01/13/2023]
Abstract
Controversy remains regarding the neurotoxicity of clade C human immunodeficiency virus (HIV-C). When examined in preclinical studies, a cysteine to serine substitution in the C31 dicysteine motif of the HIV-C Tat protein (C31S) results in less severe brain injury compared to other viral clades. By contrast, patient cohort studies identify significant neuropsychological impairment among HIV-C individuals independent of Tat variability. The present study clarified this discrepancy by examining neuroimaging markers of brain integrity among HIV-C individuals with and without the Tat substitution. Thirty-seven HIV-C individuals with the Tat C31S substitution, 109 HIV-C individuals without the Tat substitution (C31C), and 34 HIV- controls underwent 3T structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Volumes were determined for the caudate, putamen, thalamus, corpus callosum, total gray matter, and total white matter. DTI metrics included fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). Tracts of interest included the anterior thalamic radiation (ATR), cingulum bundle (CING), uncinate fasciculus (UNC), and corpus callosum (CC). HIV+ individuals exhibited smaller volumes in subcortical gray matter, total gray matter and total white matter compared to HIV- controls. HIV+ individuals also exhibited DTI abnormalities across multiple tracts compared to HIV- controls. By contrast, neither volumetric nor diffusion indices differed significantly between the Tat C31S and C31C groups. Tat C31S status is not a sufficient biomarker of HIV-related brain integrity in patient populations. Clinical attention directed at brain health is warranted for all HIV+ individuals, independent of Tat C31S or clade C status.
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Affiliation(s)
- Robert H Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA.
| | - Sarah Phillips
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700, South Africa
| | - David H Laidlaw
- Department of Computer Science, Brown University, Providence, RI, 02912, USA
| | - Ryan Cabeen
- Department of Computer Science, Brown University, Providence, RI, 02912, USA
| | - Gayla R Olbricht
- Department of Mathematics and Statistics, Missouri University of Science and Technology, Rolla, MO, 65409, USA
| | - Yuqing Su
- Department of Mathematics and Statistics, Missouri University of Science and Technology, Rolla, MO, 65409, USA
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Services (NHLS), Cape Town, South Africa
| | - Soraya Seedat
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, 7599, South Africa
| | - Lauren E Salminen
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, 90007, USA
| | - Laurie M Baker
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Jodi Heaps
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - John Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700, South Africa
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16
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Cooley SA, Paul RH, Fennema-Notestine C, Morgan EE, Vaida F, Deng Q, Chen JA, Letendre S, Ellis R, Clifford DB, Marra CM, Collier AC, Gelman BB, McArthur JC, McCutchan JA, Simpson DM, Morgello S, Grant I, Ances BM. Apolipoprotein E ε4 genotype status is not associated with neuroimaging outcomes in a large cohort of HIV+ individuals. J Neurovirol 2016; 22:607-614. [PMID: 27021072 PMCID: PMC5040614 DOI: 10.1007/s13365-016-0434-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/27/2016] [Accepted: 03/10/2016] [Indexed: 12/13/2022]
Abstract
Previous neuroimaging studies suggest a negative relationship between the apolipoprotein (ApoE) ε4 allele and brain integrity in human immunodeficiency virus (HIV)-infected (HIV+) individuals, although the presence of this relationship across adulthood remains unclear. The purpose of this study is to clarify the discrepancies using a large, diverse group of HIV+ individuals and multiple imaging modalities sensitive to HIV. The association of ApoE ε4 with structural neuroimaging and magnetic resonance spectroscopy (MRS) was examined in 237 HIV+ individuals in the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study. Cortical and subcortical gray matter, abnormal and total white matter, ventricles, sulcal cerebrospinal fluid (CSF), and cerebellar gray matter, white matter, and CSF volumes, and MRS concentrations of myo-inositol, creatine, N-acetyl-aspartate, and choline in the frontal white matter (FWM), frontal gray matter (FGM), and basal ganglia were examined. Secondary analyses explored this relationship separately in individuals ≥50 years old (n = 173) and <50 years old (n = 63). No significant differences were observed between ApoE ε4+ (ApoE ε3/ε4 and ApoE ε4/ε4) individuals (n = 69) and ApoE ε4- (ApoE ε2/ε3 and ApoE ε3/ε3) individuals (n = 167). When individuals were further divided by age, no significant genotype group differences were identified in individuals <50 or ≥50 years of age on any neuroimaging outcome. The ApoE ε4 allele did not affect brain integrity in this large, diverse sample of HIV+ individuals. The effects of ApoE ε4 may not be apparent until more advanced ages and may be more prominent when present along with other risk factors for neuronal damage.
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Affiliation(s)
| | - Robert H Paul
- University of Missouri - St. Louis, St. Louis, MO, USA
- Missouri Institute of Mental Health, St. Louis, MO, USA
| | | | - Erin E Morgan
- University of California, San Diego, San Diego, CA, USA
| | - Florin Vaida
- University of California, San Diego, San Diego, CA, USA
| | - Qianqian Deng
- University of California, San Diego, San Diego, CA, USA
| | | | | | - Ronald Ellis
- University of California, San Diego, San Diego, CA, USA
| | - David B Clifford
- Washington University in St. Louis, Box 8111 660 South Euclid Ave, Saint Louis, MO, 63110, USA
| | | | | | | | | | | | | | - Susan Morgello
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Igor Grant
- University of California, San Diego, San Diego, CA, USA
| | - Beau M Ances
- Washington University in St. Louis, Box 8111 660 South Euclid Ave, Saint Louis, MO, 63110, USA.
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17
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du Plessis S, Vink M, Joska JA, Koutsilieri E, Bagadia A, Stein DJ, Emsley R. Prefrontal cortical thinning in HIV infection is associated with impaired striatal functioning. J Neural Transm (Vienna) 2016; 123:643-51. [PMID: 27173383 DOI: 10.1007/s00702-016-1571-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/03/2016] [Indexed: 01/17/2023]
Abstract
While cortical thinning has been associated with HIV infection, it is unclear whether this reflects a direct effect of the virus, whether it is related to disruption of subcortical function or whether it is better explained by epiphenomena, such as drug abuse or comorbid medical conditions. The present study investigated the relationship between cortical thickness and subcortical function in HIV+ patients. Specifically, we examined the relationship between prefrontal cortical thickness and striatal function. Twenty-three largely treatment naïve, non-substance abusing HIV+ participants and 19 healthy controls matched for age, gender, and educational status were included. Cortical morphometry was performed using FreeSurfer software analysis. Striatal function was measured during an fMRI stop-signal anticipation task known to engage the striatum. Any cortical regions showing significant thinning were entered as dependent variables into a single linear regression model which included subcortical function, age, CD4 count, and a measure of global cognitive performance as independent predictors. The only cortical region that was significantly reduced after correction for multiple comparisons was the right superior frontal gyrus. Striatal activity was found to independently predict superior frontal gyral cortical thickness. While cortical thinning in HIV infection is likely multifactorial, viral induced subcortical dysfunction appears to play a role.
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Affiliation(s)
- Stéfan du Plessis
- Department of Psychiatry, 2nd Floor Clinical Building, Faculty of Heath Sciences, University of Stellenbosch, Fransie van Zijl Avenue, Tygerberg, Cape Town, 7505, South Africa.
| | - Matthijs Vink
- Departments of Experimental and Developmental Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - John A Joska
- Department of Psychiatry, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Eleni Koutsilieri
- Institute for Virology and Immunobiology, University of Würzburg, Sanderring 2, 97070, Würzburg, Germany
| | - Asif Bagadia
- Department of Radiology, 5th Floor Clinical Building, Faculty of Heath Sciences, University of Stellenbosch, Fransie van Zijl Avenue, Tygerberg, Cape Town, 7505, South Africa
| | - Dan J Stein
- Medical Research Council (Unit on Anxiety and Stress Disorders), 2nd Floor Clinical Building, Faculty of Heath Sciences, University of Stellenbosch, Fransie van Zijl Avenue, Tygerberg, Cape Town, 7505, South Africa.,Department of Psychiatry, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Robin Emsley
- Department of Psychiatry, 2nd Floor Clinical Building, Faculty of Heath Sciences, University of Stellenbosch, Fransie van Zijl Avenue, Tygerberg, Cape Town, 7505, South Africa
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18
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Behrman-Lay AM, Paul RH, Heaps-Woodruff J, Baker LM, Usher C, Ances BM. Human immunodeficiency virus has similar effects on brain volumetrics and cognition in males and females. J Neurovirol 2015; 22:93-103. [PMID: 26306688 DOI: 10.1007/s13365-015-0373-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 05/08/2015] [Accepted: 07/29/2015] [Indexed: 01/13/2023]
Abstract
Most studies that have examined neuropsychological impairments associated with human immunodeficiency virus (HIV) have focused on males, yet females represent one of the largest groups of newly infected patients. Further, few studies have examined neuropsychological performance and neuroimaging outcomes among females compared to males in the modern era of highly active anti-retroviral therapy (HAART). The present study investigated neuropsychological performance and brain volumetrics among HIV+ males (n = 93) and females (n = 44) on stable HAART compared to HIV seronegative (HIV-) males (n = 42) and females (n = 49). Results revealed a significant effect of HIV on neuropsychological performance and neuroimaging measures. An effect of gender, independent of HIV status, was also observed for neuroimaging measures but not neuropsychological performance. Additionally, no significant differences in neuropsychological performance or brain volumetrics were seen between HIV+ males and females. No significant interaction was observed between HIV and gender on either neuropsychological or neuroimaging indices. Our results suggest that both HIV+ males and females treated with HAART experience similar outcomes in terms of brain integrity.
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Affiliation(s)
- Ashley M Behrman-Lay
- Department of Psychology, University of Missouri- Saint Louis, St. Louis, MO, 63110, USA
| | - Robert H Paul
- Department of Psychology, University of Missouri- Saint Louis, St. Louis, MO, 63110, USA
- Missouri Institute of Mental Health, St. Louis, MO, 63110, USA
| | - Jodi Heaps-Woodruff
- Department of Psychology, University of Missouri- Saint Louis, St. Louis, MO, 63110, USA
- Missouri Institute of Mental Health, St. Louis, MO, 63110, USA
| | - Laurie M Baker
- Department of Psychology, University of Missouri- Saint Louis, St. Louis, MO, 63110, USA
| | - Christina Usher
- Department of Psychology, University of Missouri- Saint Louis, St. Louis, MO, 63110, USA
| | - Beau M Ances
- Department of Neurology, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA.
- Department of Radiology, Washington University in Saint Louis, St. Louis, MO, 63110, USA.
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, MO, 63110, USA.
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19
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Abstract
PURPOSE OF REVIEW HIV enters the brain after initial infection, and with time can lead to HIV-associated neurocognitive disorders (HAND). Although the introduction of combination antiretroviral therapy has reduced the more severe forms of HAND, milder forms are still highly prevalent. The 'gold standard' for HAND diagnosis remains detailed neuropsychological performance testing but additional biomarkers (including neuroimaging) may assist in early detection of HAND. RECENT FINDINGS We review the application of recently developed noninvasive MRI and PET techniques in HIV+ individuals. In particular, magnetic resonance spectroscopy may be more sensitive than conventional MRI alone in detecting HIV associated changes. Diffusion tensor imaging has become increasingly popular for assessing changes in white matter structural integrity due to HIV. Both functional MRI and PET have been limitedly performed but could provide keys for characterizing neuropathophysiologic changes due to HIV. SUMMARY It is hoped that continued progress will allow novel neuroimaging methods to be included in future HAND management guidelines.
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20
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Baker LM, Paul RH, Heaps-Woodruff JM, Chang JY, Ortega M, Margolin Z, Usher C, Basco B, Cooley S, Ances BM. The Effect of Central Nervous System Penetration Effectiveness of Highly Active Antiretroviral Therapy on Neuropsychological Performance and Neuroimaging in HIV Infected Individuals. J Neuroimmune Pharmacol 2015; 10:487-92. [PMID: 25900078 DOI: 10.1007/s11481-015-9610-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 04/12/2015] [Indexed: 12/14/2022]
Abstract
The incidence of HIV-associated dementia has been greatly reduced in the era of highly active antiretroviral therapy (HAART); however milder forms of cognitive impairment persist. It remains uncertain whether HAART regimens with a high degree of central nervous system penetration effectiveness (CPE) exert beneficial neurological outcomes in HIV-infected (HIV+) individuals on stable treatment. Sixty-four HIV-infected adults on HAART were assigned a CPE score using a published ranking system and divided into high (≥7; n = 35) and low (<7; n = 29) CPE groups. All participants completed neuropsychological testing in addition to structural neuroimaging. Neuropsychological tests included measures known to be sensitive to HIV with values converted into standardized scores (NPZ-4) based on published normative scores. A semi-automated methodology was utilized to assess brain volumetrics within cortical (grey and white matter) and subcortical (thalamus, caudate, putamen) regions of interest. Analyses assessed NPZ-4 and brain volumetric differences between HIV+ individuals with high and low CPE scores. No significant differences in brain integrity were observed between the two groups. Long-term HAART regimens with a high degree of CPE were not associated with significantly improved neuropsychological or neuroimaging outcomes in HIV+ adults. Results suggest that alternate mechanisms may potentially contribute to better neurological outcomes in the era of HAART.
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Affiliation(s)
- Laurie M Baker
- Department of Psychology, University of Missouri- Saint Louis, Saint Louis, MO, USA
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21
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Association between brain volumes and HAND in cART-naïve HIV+ individuals from Thailand. J Neurovirol 2015; 21:105-12. [PMID: 25604494 DOI: 10.1007/s13365-014-0309-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/14/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023]
Abstract
This study aimed to determine the effects of human immunodeficiency virus (HIV) on brain structure in HIV-infected individuals with and without HIV-associated neurocognitive disorders (HAND). Twenty-nine HIV-uninfected controls, 37 HIV+, treatment-naïve, individuals with HAND (HIV+HAND+; 16 asymptomatic neurocognitive impairment (ANI), 12 mild neurocognitive disorder (MND), and 9 HIV-associated dementia HAD), and 37 HIV+, treatment-naïve, individuals with normal cognitive function (HIV+HAND-) underwent magnetic resonance imaging (MRI) and neuropsychological assessment. The HIV-infected participants had a mean (SD) age of 35 (7) years, mean (interquartile range (IQR)) CD4 count of 221 (83-324), and mean (IQR) log10 plasma viral load of 4.81 (4.39-5.48). Six regions of interest were selected for analyses including total and subcortical gray matter, total white matter, caudate, corpus callosum, and thalamus. The HIV+/HAND+ group exhibited significantly smaller brain volumes compared to the HIV-uninfected group in subcortical gray and total gray matter; however, there were no statistically significant differences in brain volumes between the HIV+HAND+ and HIV+HAND- groups or between HIV+/HAND- and controls. CD4 count at time of combination antiretroviral therapy (cART) initiation was associated with total and subcortical gray matter volumes but not with cognitive measures. Plasma viral load correlated with neuropsychological performance but not brain volumes. The lack of significant differences in brain volumes between HIV+HAND+ and HIV+HAND- suggests that brain atrophy is not a sensitive measure of HAND in subjects without advanced immunosuppression. Alternatively, current HAND diagnostic criteria may not sufficiently distinguish patients based on MRI measures of brain volumes.
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22
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Paul RH, Joska JA, Woods C, Seedat S, Engelbrecht S, Hoare J, Heaps J, Valcour V, Ances B, Baker LM, Salminen LE, Stein DJ. Impact of the HIV Tat C30C31S dicysteine substitution on neuropsychological function in patients with clade C disease. J Neurovirol 2014; 20:627-35. [PMID: 25366660 DOI: 10.1007/s13365-014-0293-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/25/2014] [Accepted: 09/18/2014] [Indexed: 01/31/2023]
Abstract
Previous animal studies have identified a C31S residue substitution in the C30C31 dicysteine motif of the Tat protein that is associated with reduced neurovirulence in clade C human immunodeficiency virus (HIV). However, clinical studies of patients infected with clade C HIV have reported significant levels of cognitive impairment. To date, no study has specifically examined cognitive function in clade C-infected patients as a function of the presence or absence of the Tat C31 substitution. The present study investigated the impact of the Tat C30C31S genetic substitution among individuals residing in South Africa infected with clade C HIV that either exhibited the C30C31 motif (n = 128) or the C31S motif (n = 46). A control group of seronegative individuals was included to examine the overall impact of HIV on cognitive performance. All individuals completed a comprehensive neuropsychological battery consisting of tests sensitive to HIV. Results revealed that clade C-infected individuals performed significantly worse across cognitive tests compared to seronegative controls. However, there were no significant differences in cognitive performances between individuals with the C31S motif versus those without the C31S substitution. Proximal CD4 cell count and plasma viral load were unrelated to cognitive performances for either group. Results confirm that the C31S dicysteine motif substitution of the Tat protein does not appreciably moderate neuropsychological outcomes in clade C. Further, these findings highlight the importance of clinical management of cognitive symptoms among individuals infected with this viral clade worldwide.
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Affiliation(s)
- Robert H Paul
- Department of Psychology and Behavioral Neuroscience, University of Missouri-St. Louis, University Boulevard, St. Louis, USA,
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23
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Potchen MJ, Siddiqi OK, Elafros MA, Koralnik IJ, Theodore WH, Sikazwe I, Kalungwana L, Bositis CM, Birbeck GL. Neuroimaging abnormalities and seizure recurrence in a prospective cohort study of zambians with human immunodeficiency virus and first seizure. Neurol Int 2014; 6:5547. [PMID: 25568738 PMCID: PMC4274408 DOI: 10.4081/ni.2014.5547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/11/2014] [Indexed: 02/06/2023] Open
Abstract
In HIV-positive individuals with first seizure, we describe neuroimaging findings, detail clinical and demographic risk factors for imaging abnormalities, and evaluate the relationship between imaging abnormalities and seizure recurrence to determine if imaging abnormalities predict recurrent seizures. Among 43 participants (mean 37.4 years, 56% were male), 16 (37%) were on antiretroviral drugs, 32 (79%) had advanced HIV disease, and (28) 66% had multiple seizures and/or status epilepticus at enrollment. Among those with cerebrospinal fluid studies, 14/31 (44%) had opportunistic infections (OIs). During follow-up, 9 (21%) died and 15 (35%) experienced recurrent seizures. Edema was associated with OIs (odds ratio: 8.79; confidence interval: 1.03-236) and subcortical atrophy with poorer scores on the International HIV Dementia Scale) (5.2 vs. 9.3; P=0.002). Imaging abnormalities were not associated with seizure recurrence or death (P>0.05). Seizure recurrence occurred in at least a third and over 20% died during follow-up. Imaging was not predictive of recurrent seizure or death, but imaging abnormalities may offer additional diagnostic insights in terms of OI risk and cognitive impairment.
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Affiliation(s)
- Michael J. Potchen
- Neuroradiology Division Department of Imaging Sciences, University of Rochester, NY, USA
| | - Omar K. Siddiqi
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia,Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Melissa A. Elafros
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Igor J. Koralnik
- Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William H. Theodore
- Clinical Epilepsy Section, United States National Institutes of Health, Bethesda, MD, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Lisa Kalungwana
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | | | - Gretchen L. Birbeck
- Epilepsy Division, Department of Neurology, University of Rochester, NY, USA,Chikankata Epilepsy Care Team, Mazabuka, Zambia,Epilepsy Division, Department of Neurology, University of Rochester, 265 Crittenden Blvd, Rochester, NY 14624, USA. +1.585.273.4265 - +1.517.507.5440.
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24
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Ortega M, Heaps JM, Joska J, Vaida F, Seedat S, Stein DJ, Paul R, Ances BM. HIV clades B and C are associated with reduced brain volumetrics. J Neurovirol 2014; 19:479-87. [PMID: 24078556 DOI: 10.1007/s13365-013-0202-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/08/2013] [Accepted: 08/20/2013] [Indexed: 12/16/2022]
Abstract
The human immunodeficiency virus (HIV) has multiple genetic clades with varying prevalence throughout the world. Both HIV clade C (HIV-C) and HIV clade B (HIV-B) can cause cognitive impairment, but it is unclear if these clades are characterized by similar patterns of brain dysfunction. We examined brain volumetrics and neuropsychological performance among highly active antiretroviral therapy (HAART)-naïve HIV-B and HIV-C participants. Thirty-four HAART-naïve HIV-infected (HIV+) participants [17 HIV-B (USA); 17 HIV-C (South Africa)] and 34 age- and education-matched HIV-uninfected (HIV−) participants were evaluated. All participants underwent similar laboratory, neuropsychological, and neuroimaging studies. Brain volume measures were assessed within the caudate, putamen, amygdala, thalamus, hippocampus, corpus callosum, and cortical (gray and white matter) structures. A linear model that included HIV status, region, and their interaction assessed the effects of the virus on brain volumetrics. HIV− and HIV+ individuals were similar in age. On laboratory examination, HIV-C participants had lower CD4 cell counts and higher plasma HIV viral loads than HIV-B individuals. In general, HIV+ participants performed significantly worse on neuropsychological measures of processing speed and memory and had significantly smaller relative volumetrics within the thalamus, hippocampus, corpus callosum, and cortical gray and white matter compared to the respective HIV− controls. Both HIV-B and HIV-C are associated with similar volumetric declines when compared to matched HIV− controls. HIV-B and HIV-C were associated with significant reductions in brain volumetrics and poorer neuropsychological performance; however, no specific effect of HIV clade subtype was evident. These findings suggest that HIV-B and HIV-C both detrimentally affect brain integrity.
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25
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Abstract
The vast majority of people living with human immunodeficiency virus (HIV) infection reside in resource-limited settings. As compared with resource-rich settings, there are important differences in the epidemiology and outcomes of HIV infection in resource-limited settings. Nonetheless, little HIV neurology research occurs in these regions. We will first review clinical, epidemiological, and translational HIV neurology research originating from resource-limited settings. We will then discuss the barriers to conducting neurologic research, such as limited human resources, diagnostics, and access to medications. Finally, we will review existing initiatives to build capacity for research in resource-limited settings. Despite the barriers, there is growing interest in and opportunities for collaborative international neurologic research. Including diverse viral and human populations from across the globe in research opens possibilities for important implementation science, clinically oriented science, and basic science discoveries.
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Affiliation(s)
- Ana-Claire Meyer
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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26
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Masters MC, Ances BM. Role of neuroimaging in HIV-associated neurocognitive disorders. Semin Neurol 2014; 34:89-102. [PMID: 24715492 DOI: 10.1055/s-0034-1372346] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) enters the brain soon after seroconversion and can cause HIV-associated neurocognitive disorders (HAND). Although the more severe and progressive forms of HAND are less prevalent due to combination antiretroviral therapy (cART), ∼ 40% of HIV-infected (HIV+) patients continue to have cognitive impairment. Some HIV+ individuals who have effective plasma HIV-1 RNA suppression with cART still develop HAND. It is often difficult to diagnose HAND in the outpatient setting as detailed neuropsychological performance testing is required. Additional biomarkers that are relatively easy to obtain and clinically relevant are needed for assessing HIV-associated neuropathologic changes. Recently developed noninvasive magnetic resonance imaging (MRI) techniques have great potential to serve as biomarkers. The authors review the application of some of these neuroimaging techniques, magnetic resonance spectroscopy (MRS), volumetric MRI, diffusion tensor imaging (DTI), functional MRI (fMRI), in HIV+ individuals. Each of the neuroimaging methods offers unique insight into mechanisms underlying neuroHIV, could monitor disease progression, and may assist in evaluating the efficacy of particular cART regimens. It is hoped that considerable progress will continue to occur such that some of these neuroimaging methods will be incorporated across multiple sites and included in future HAND guidelines.
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Affiliation(s)
- Mary C Masters
- Department of Neurology, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Beau M Ances
- Department of Neurology, School of Medicine, Washington University in St Louis, St Louis, Missouri
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27
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Clifford DB, Ances BM. HIV-associated neurocognitive disorder. THE LANCET. INFECTIOUS DISEASES 2014; 13:976-86. [PMID: 24156898 DOI: 10.1016/s1473-3099(13)70269-x] [Citation(s) in RCA: 436] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neurological involvement in HIV is often associated with cognitive impairment. Although severe and progressive neurocognitive impairment has become rare in HIV clinics in the era of potent antiretroviral therapy, most patients with HIV worldwide have poor outcomes on formal neurocognitive tests. In this Review, we describe the manifestations of HIV-associated neurocognitive disorder in the era of effective HIV therapy, outline diagnosis and treatment recommendations, and explore the research questions that remain. Although comorbid disorders, such as hepatitis C infection or epilepsy, might cause some impairment, their prevalence is insufficient to explain the frequency with which it is encountered. HIV disease markers, such as viral load and CD4 cell counts, are not strongly associated with ongoing impairment on treatment, whereas cardiovascular disease markers and inflammatory markers are. New cerebrospinal fluid and neuroimaging biomarkers are needed to detect and follow impairment. Ongoing research efforts to optimise HIV therapy within the CNS, and potentially to intervene in downstream mechanisms of neurotoxicity, remain important avenues for future investigation. Ultimately, the full control of virus in the brain is a necessary step in the goal of HIV eradication.
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Affiliation(s)
- David B Clifford
- Department of Neurology and Medicine, Washington University in St Louis, St Louis, MO, USA.
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28
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Tyor W, Fritz-French C, Nath A. Effect of HIV clade differences on the onset and severity of HIV-associated neurocognitive disorders. J Neurovirol 2013; 19:515-22. [PMID: 24129908 DOI: 10.1007/s13365-013-0206-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/20/2013] [Accepted: 09/09/2013] [Indexed: 12/13/2022]
Abstract
The effects of evolutionary pressure on human immunodeficiency virus-1 (HIV) have resulted in a variety of clades and recombinants. The functional implications of HIV clades on disease onset and progression of HIV-associated neurocognitive disorders (HAND) have been suggested by clinical and basic science studies, which will be reviewed in detail. Some clinical studies suggest that patients infected with clade D show the greatest propensity for developing HIV-associated dementia (HAD) followed by clades B, C, and A, respectively. However, there are conflicting reports. This review summarizes clinical studies that have assessed behavioral abnormalities and HIV clade type in HAND patients, focusing on the clades stated above. The limitations include variations in testing used to define the cohorts, patient sample size, lack of HIV clade characterization, combination antiretroviral therapy (cART) availability, and other factors, which are highlighted and compared between clinical studies performed primarily in Africa and India. Basic science studies provide substantial evidence that HIV clade differences can result in varying degrees of neuropathology and are also reviewed in some detail. These studies indicate that there are a number of clade differences, most notably in Tat, that result in different degrees of neurovirulence or neuropathological effects in vitro and in a mouse model of HAND. In order to confirm the hypothesis that HIV clade differences are important determinants of HAND pathogenesis, larger, longitudinal studies that employ standard definitions of HAND and HIV clade testing must be performed. In a larger sense, HAND continues to be highly prevalent despite the advent of cART, and therefore, further studies into HAND pathogenesis are critical to develop better therapies.
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Affiliation(s)
- William Tyor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA,
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29
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Current world literature. Curr Opin Psychiatry 2012; 25:565-73. [PMID: 23037966 DOI: 10.1097/yco.0b013e328359edae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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