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Timtim SH, Simmons AN, Hays C, Strigo I, Sorg S, Ellis R, Keltner JR. HIV peripheral neuropathy-related degeneration of white matter tracts to sensorimotor cortex. J Neurovirol 2022; 28:505-513. [PMID: 36207560 PMCID: PMC9797459 DOI: 10.1007/s13365-022-01051-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 01/13/2023]
Abstract
Human immunodeficiency virus-associated distal sensory polyneuropathy (HIV-DSP) affects up to 50% of people with HIV and is associated with depression, unemployment, and generally worsened quality of life. Previous work on the cortical mechanism of HIV neuropathy found decreased gray matter volume in the bilateral midbrain, thalamus, and posterior cingulate cortex, but structural connectivity in this context remains under-studied. Here we examine alterations in white matter microstructure using diffusion imaging, hypothesizing that cortical white matter degeneration would be observed in continuation of the peripheral white matter atrophy previously observed in HIV-DSP. Male HIV seropositive patients (n = 57) experiencing varying degrees of HIV neuropathy underwent single-shell diffusion tensor imaging with 51 sampling directions. The scans were pooled using tractography and connectometry to create a quantitative map of white matter tract integrity, measured in generalized fractional anisotropy (GFA). The relationship between GFA and neuropathy severity was evaluated with linear regression. Correction for multiple comparisons was done using false discovery rate (FDR), a statistical method commonly used in genomics and imaging to minimize false positives when thousands of individual comparisons are made. Neuropathy severity was associated with decreased GFA along thalamocortical radiations leading along the lateral thalamus to sensorimotor cortex, with r = -0.405 (p < 0.001; FDR), as well as with the superior bilateral cingulum (r = -0.346 (p < 0.05; FDR)). Among a population of HIV neuropathy patients, greater neuropathy severity was correlated with lower white matter integrity running from midbrain to somatosensory cortex. This suggests ascending deafferentation extending from damaged peripheral nerves further downstream than seen previously, into the axons of third-order neurons. There is also evidence of cingulum degeneration, implying some more complex mechanism beyond the ascending atrophy observed here.
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Affiliation(s)
- Sara H Timtim
- UCSD, University of California San Diego School of Medicine, San Diego, CA, USA.
| | - Alan N Simmons
- UCSD, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Chelsea Hays
- UCSD, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Irina Strigo
- UCSF, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Scott Sorg
- UCSD, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Ronald Ellis
- UCSD, University of California San Diego School of Medicine, San Diego, CA, USA
| | - John R Keltner
- UCSD, University of California San Diego School of Medicine, San Diego, CA, USA
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2
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Hays Weeks CC, Simmons AN, Strigo IA, Timtim S, Ellis RJ, Keltner JR. Distal neuropathic pain in HIV is associated with functional connectivity patterns in default mode and salience networks. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1004060. [PMID: 36313219 PMCID: PMC9596968 DOI: 10.3389/fpain.2022.1004060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
HIV-associated distal neuropathic pain (DNP) is one of the most prevalent, disabling, and treatment-resistant complications of HIV, but its biological underpinnings are incompletely understood. While data specific to mechanisms underlying HIV DNP are scarce, functional neuroimaging of chronic pain more broadly implicates the role of altered resting-state functional connectivity within and between salience network (SN) and default mode network (DMN) regions. However, it remains unclear the extent to which HIV DNP is associated with similar alterations in connectivity. The current study aimed to bridge this gap in the literature through examination of resting-state functional connectivity patterns within SN and DMN regions among people with HIV (PWH) with and without DNP. Resting state functional magnetic resonance imaging (rs-fMRI) scans were completed among 62 PWH with HIV-associated peripheral neuropathy, of whom 27 reported current DNP and 35 did not. Using subgrouping group iterative multiple estimation, we compared connectivity patterns in those with current DNP to those without. We observed weaker connectivity between the medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC) and stronger connectivity between the anterior cingulate cortex (ACC) and thalamus among those reporting DNP. Overall, these findings implicate altered within DMN (i.e., MPFC-PCC) and within SN (i.e., ACC-thalamus) connectivity as potential manifestations of adaptation to pain from neuropathy and/or mechanisms underlying the development/maintenance of DNP. Findings are discussed in the context of differential brain response to pain (i.e., mind wandering, pain aversion, pain facilitation/inhibition) and therapeutic implications.
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Affiliation(s)
| | - Alan N. Simmons
- CESAMH, VA San Diego Healthcare System, San Diego, United States,Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Irina A. Strigo
- Department of Psychiatry, UC San Francisco, CA, United States
| | - Sara Timtim
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Ronald J. Ellis
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States,Department of Neurosciences, UC San Diego, La Jolla, CA, United States
| | - John R. Keltner
- CESAMH, VA San Diego Healthcare System, San Diego, United States,Department of Psychiatry, UC San Diego, La Jolla, CA, United States,Correspondence: John R. Keltner
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Pires KL, Baranda MSDM, Brum TMA, Pessôa B, Pupe CCB, do Nascimento OJM. HIV-associated painful neuropathy: where are we? ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:607-615. [PMID: 35946704 PMCID: PMC9387191 DOI: 10.1590/0004-282x-anp-2021-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND After the advent of combination antiretroviral therapy, infection with the human immunodeficiency virus (HIV) ceased to be a devastating disease, but sensory neuropathy resulting from the permanence of the virus and the side effects of treatment have worsened the morbidities of these patients. OBJECTIVE To investigate the quality of life of 64 HIV-positive patients: 24 with painful neuropathy (case group) and 40 without painful neuropathy (control group). The impact of other factors on quality of life was also assessed. METHODS To assess painful neuropathy, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, Douleur Neuropathique 4 (DN4) questions and Neuropathy Disability Score (NDS) were used. The Short Form Health Survey (SF-36) scale was used to assess quality of life. Factors related or unrelated to HIV were obtained through the medical history and analysis on medical records. RESULTS The quality of life of patients with neuropathic pain was worse in six of the eight domains of the SF-36 scale. The number of clinical manifestations related to HIV, length of time with detectable viral load since diagnosis, length of time since the diagnosis of HIV infection and length of time of HAART use had a negative impact on quality of life. Higher levels of CD4, education and family income had a positive impact. CONCLUSIONS Painful neuropathy related to HIV is a factor that worsens the quality of life of patients infected with this virus and should be included in the clinical evaluation.
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Affiliation(s)
- Karina Lebeis Pires
- Universidade Federal Fluminense, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
| | | | - Talita Mota Almeida Brum
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
| | - Bruno Pessôa
- Universidade Federal Fluminense, Departamento de Neurocirurgia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
| | - Camila Castelo Branco Pupe
- Universidade Federal Fluminense, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
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Expression of Human Immunodeficiency Virus Transactivator of Transcription (HIV-Tat 1-86) Protein Alters Nociceptive Processing that is Sensitive to Anti-Oxidant and Anti-Inflammatory Interventions. J Neuroimmune Pharmacol 2022; 17:152-164. [PMID: 33619645 PMCID: PMC8380260 DOI: 10.1007/s11481-021-09985-4] [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: 06/26/2020] [Accepted: 01/24/2021] [Indexed: 12/29/2022]
Abstract
Despite the success of combined antiretroviral therapy (cART) in reducing viral load, a substantial portion of Human Immunodeficiency Virus (HIV)+ patients report chronic pain. The exact mechanism underlying this co-morbidity even with undetectable viral load remains unknown, but the transactivator of transcription (HIV-Tat) protein is of particular interest. Functional HIV-Tat protein is observed even in cerebrospinal fluid of patients who have an undetectable viral load. It is hypothesized that Tat protein exposure is sufficient to induce neuropathic pain-like manifestations via both activation of microglia and generation of oxidative stress. iTat mice conditionally expressed Tat(1-86) protein in the central nervous system upon daily administration of doxycycline (100 mg/kg/d, i.p., up to 14 days). The effect of HIV-Tat protein exposure on the well-being of the animal was assessed using sucrose-evoked grooming and acute nesting behavior for pain-depressed behaviors, and the development of hyperalgesia assessed with warm-water tail-withdrawal and von Frey assays for thermal hyperalgesia and mechanical allodynia, respectively. Tissue harvested at select time points was used to assess ex vivo alterations in oxidative stress, astrocytosis and microgliosis, and blood-brain barrier integrity with assays utilizing fluorescence-based indicators. Tat protein induced mild thermal hyperalgesia but robust mechanical allodynia starting after 4 days of exposure, reaching a nadir after 7 days. Changes in nociceptive processing were associated with reduced sucrose-evoked grooming behavior without altering acute nesting behavior, and in spinal cord dysregulated free radical generation as measured by DCF fluorescence intensity, altered immunohistochemical expression of the gliotic markers, Iba-1 and GFAP, and increased permeability of the blood-brain barrier to the small molecule fluorescent tracer, sodium fluorescein, in a time-dependent manner. Pretreatment with the anti-inflammatory, indomethacin (1 mg/kg/d, i.p.), the antioxidant, methylsulfonylmethane (100 mg/kg/d i.p.), or the immunomodulatory agent, dimethylfumarate (100 mg/kg/d p.o.) thirty minutes prior to daily injections of doxycycline (100 mg/kg/d i.p.) over 7 days significantly attenuated the development of Tat-induced mechanical allodynia. Collectively, the data suggests that even acute exposure to HIV-1 Tat protein at pathologically relevant levels is sufficient to produce select neurophysiological and behavioral manifestations of chronic pain consistent with that reported by HIV-positive patients.
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Diaz MM, Caylor J, Strigo I, Lerman I, Henry B, Lopez E, Wallace MS, Ellis RJ, Simmons AN, Keltner JR. Toward Composite Pain Biomarkers of Neuropathic Pain—Focus on Peripheral Neuropathic Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:869215. [PMID: 35634449 PMCID: PMC9130475 DOI: 10.3389/fpain.2022.869215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
Chronic pain affects ~10–20% of the U.S. population with an estimated annual cost of $600 billion, the most significant economic cost of any disease to-date. Neuropathic pain is a type of chronic pain that is particularly difficult to manage and leads to significant disability and poor quality of life. Pain biomarkers offer the possibility to develop objective pain-related indicators that may help diagnose, treat, and improve the understanding of neuropathic pain pathophysiology. We review neuropathic pain mechanisms related to opiates, inflammation, and endocannabinoids with the objective of identifying composite biomarkers of neuropathic pain. In the literature, pain biomarkers typically are divided into physiological non-imaging pain biomarkers and brain imaging pain biomarkers. We review both types of biomarker types with the goal of identifying composite pain biomarkers that may improve recognition and treatment of neuropathic pain.
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Affiliation(s)
- Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
- *Correspondence: Monica M. Diaz
| | - Jacob Caylor
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Irina Strigo
- Department of Psychiatry, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Imanuel Lerman
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Brook Henry
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Eduardo Lopez
- Department of Psychiatry, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mark S. Wallace
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Ronald J. Ellis
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Alan N. Simmons
- Department of Psychiatry, San Diego & Center of Excellence in Stress and Mental Health, Veteran Affairs Health Care System, University of California, San Diego, San Diego, CA, United States
| | - John R. Keltner
- Department of Psychiatry, San Diego & San Diego VA Medical Center, University of California, San Diego, San Diego, CA, United States
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Bischoff-Grethe A, Ellis RJ, Tapert SF, Paulus MP, Grant I. Prior Methamphetamine Use Disorder History Does Not Impair Interoceptive Processing of Soft Touch in HIV Infection. Viruses 2021; 13:v13122476. [PMID: 34960745 PMCID: PMC8705776 DOI: 10.3390/v13122476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Interoception, defined as the sense of the internal state of one’s body, helps motivate goal-directed behavior. Prior work has shown that methamphetamine (METH) use disorder is associated with altered interoception, and that this may contribute to risky behavior. As people with HIV (PWH) may also experience disrupted bodily sensations (e.g., neuropathy), an important question is whether PWH with a history of METH use disorder might exhibit greater impairment of interoceptive processing. Methods: Eighty-three participants stratified by HIV infection and a past history of methamphetamine use disorder experienced a soft touch paradigm that included slow brush strokes on the left forearm and palm during blood-oxygen level-dependent functional MRI acquisition. To assess differences in interoception and reward, voxelwise analyses were constrained to the insula, a hub for the evaluation of interoceptive cues, and the striatum, which is engaged in reward processing. Results: Overall, individuals with a history of METH use disorder had an attenuated neural response to pleasant touch in both the insula and striatum. Longer abstinence was associated with greater neural response to touch in the insula, suggesting some improvement in responsivity. However, only PWH with no METH use disorder history had lower brain activation in the insula relative to non-using seronegative controls. Conclusions: Our findings suggest that while METH use disorder history and HIV infection independently disrupt the neural processes associated with interoception, PWH with METH use disorder histories do not show significant differences relative to non-using seronegative controls. These findings suggest that the effects of HIV infection and past methamphetamine use might not be additive with respect to interoceptive processing impairment.
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Affiliation(s)
- Amanda Bischoff-Grethe
- Department of Psychiatry, University of California, San Diego 9500 Gilman Drive, MC 0738 La Jolla, San Diego, CA 92093, USA; (S.F.T.); (I.G.)
- Correspondence:
| | - Ronald J. Ellis
- Department of Neurosciences, University of California, La Jolla, San Diego, CA 92093, USA;
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego 9500 Gilman Drive, MC 0738 La Jolla, San Diego, CA 92093, USA; (S.F.T.); (I.G.)
| | | | - Igor Grant
- Department of Psychiatry, University of California, San Diego 9500 Gilman Drive, MC 0738 La Jolla, San Diego, CA 92093, USA; (S.F.T.); (I.G.)
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Strigo IA, Keltner JR, Ellis RJ, Simmons AN. Association of painful human immunodeficiency virus distal sensory polyneuropathy with aberrant expectation of pain relief: functional magnetic resonance imaging evidence. Brain Commun 2021; 3:fcab260. [PMID: 34859214 PMCID: PMC8633742 DOI: 10.1093/braincomms/fcab260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/14/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022] Open
Abstract
Mechanisms underlying chronic neuropathic pain associated with HIV-associated distal sensory polyneuropathy are poorly understood, yet 40% of those with distal neuropathy (or 20% of all people with HIV) suffer from this debilitating condition. Central pain processing mechanisms are thought to contribute to the development of HIV neuropathic pain, yet studies investigating central mechanisms for HIV neuropathic pain are few. Considering the motivational nature of pain, we aimed to examine the degree to which expectation of pain onset and expectation of pain offset are altered in sixty-one male patients with HIV-related distal sensory polyneuropathy with (N = 30) and without (N = 31) chronic neuropathic pain. By contrasting painful (foot) and non-painful (hand) sites between those with and without neuropathic pain, we could identify unique neural structures that showed altered activation during expectation of pain offset or relief. Our results showed no evidence for peripheral mechanisms evidenced by lack of significant between group differences in thermo-sensation, subjective pain response or epidermal nerve fibre density. Likewise, we found no significant differences between groups in subjective or brain mechanisms underlying the expectation of pain onset. Conversely, we found significant interaction within right anterior insula during expectation of pain offset in our study in that individuals in the pain group compared to the no-pain group exhibited increased anterior insula activation on the painful compared to the non-painful site. Our findings are consistent with abnormal processing of expectation of pain offset or abnormal pain relief-related mechanisms potentially due to increased emotional distress regarding the experience of chronic endogenous pain.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory Research, San Francisco Veterans Affairs Health Care Center, San Francisco, CA 94121, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
| | - John R Keltner
- Stress and Neuroimaging Laboratory Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92151, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Ronald J Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Alan N Simmons
- Stress and Neuroimaging Laboratory Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92151, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.,Center of Excellence in Stress and Mental Health Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92161, USA
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Diaz MM, Keltner JR, Simmons AN, Franklin D, Moore RC, Clifford D, Collier AC, Gelman BB, Marra PD,C, McCutchan JA, Morgello S, Sacktor N, Best B, Notestine CF, Weibel SG, Grant I, Marcotte TD, Vaida F, Letendre S, Heaton R, Ellis RJ. Paresthesia Predicts Increased Risk of Distal Neuropathic Pain in Older People with HIV-Associated Sensory Polyneuropathy. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:1850-1856. [PMID: 33565583 PMCID: PMC8502467 DOI: 10.1093/pm/pnab056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Distal sensory polyneuropathy (DSP) is a disabling consequence of human immunodeficiency virus (HIV), leading to poor quality of life and more frequent falls in older age. Neuropathic pain and paresthesia are prevalent symptoms; however, there are currently no known curative treatments and the longitudinal course of pain in HIV-associated DSP is poorly characterized. METHODS This was a prospective longitudinal study of 265 people with HIV (PWH) enrolled in the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study with baseline and 12-year follow-up evaluations. Since pain and paresthesia are highly correlated, statistical decomposition was used to separate the two symptoms at baseline. Multivariable logistic regression analyses of decomposed variables were used to determine the effects of neuropathy symptoms at baseline on presence and worsening of distal neuropathic pain at 12-year follow-up, adjusted for covariates. RESULTS Mean age was 56 ± 8 years, and 21% were female at follow-up. Nearly the entire cohort (96%) was on antiretroviral therapy (ART), and 82% had suppressed (≤50 copies/mL) plasma viral loads at follow-up. Of those with pain at follow-up (n = 100), 23% had paresthesia at the initial visit. Decomposed paresthesia at baseline increased the risk of pain at follow-up (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.18, 2.07), and decomposed pain at baseline predicted a higher frequency of pain at follow-up (OR 1.96 [95% CI 1.51, 2.58]). CONCLUSIONS Paresthesias are a clinically significant predictor of incident pain at follow-up among aging PWH with DSP. Development of new therapies to encourage neuroregeneration might take advantage of this finding to choose individuals likely to benefit from treatment preventing incident pain.
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Affiliation(s)
- Monica M Diaz
- Department of Neurosciences, University of California, San Diego, La Jolla, California
| | - John R Keltner
- Center of Excellence in Stress and Mental Health, San Diego Veterans Health System, San Diego, California
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego Veterans Health System, San Diego, California
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Donald Franklin
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | | | | | | | | | - J Allen McCutchan
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Susan Morgello
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ned Sacktor
- Johns Hopkins University, Baltimore, Maryland
| | - Brookie Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
| | | | - Sara Gianella Weibel
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Thomas D Marcotte
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Scott Letendre
- Department of Psychiatry, University of California, San Diego, La Jolla, California
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Robert Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, La Jolla, California
- Department of Psychiatry, University of California, San Diego, La Jolla, California
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Maiga Y, Sangho O, Konipo F, Diallo S, Coulibaly SDP, Sangare M, Péréon Y, Giumelli B, Sanou M, Coulibaly A, Diallo S, Daou M, Traoré Z, Albakaye M, Traoré HA, Guinto CO, Ouologem M, Kuate-Tegueu C, Bouhassira D, Cowan R, Nizard J. Neuropathic pain in Mali: The current situation, comprehensive hypothesis, which therapeutic strategy for Africa? eNeurologicalSci 2021; 22:100312. [PMID: 33537467 PMCID: PMC7841313 DOI: 10.1016/j.ensci.2021.100312] [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: 03/02/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION According to the taxonomy of the International Association for the Study of Pain (IASP 2011), neuropathic pain (NeuP) is defined as "pain caused by a lesion or disease of the somatosensory nervous system". NeuP is currently well-defined clinically, despite a high degree of etiological variation, and it has become a significant public health problem. This work aimed to study the situation regarding NeuP in current practice in Mali, as well as to analyze the therapeutic environment of the patients. METHODOLOGY This was a retrospective and cross-sectional study, carried out in two phases: (1) compilation of the files of patients according to the ICD-11, over a period of 24 months (2) a second prospective phase regarding the Knowledge, Attitudes, and Practices (KAP) of general practitioners and neurologists in regard to NeuP. The focus of the first phase of the study was the files of the patients who had undergone a consultation at the Gabriel Touré UHC. The second phase of the study focused on the general practitioners (Community Health Centers (comHC) of Bamako) and neurologists (Malian or not). RESULTS Over the period of the study, 7840 patients were seen in consultation in the Department of Neurology, of whom 903 for NeuP, thus amounting to a NeuP frequency of 11.5%. Women accounted for 58.9% (532/903), with a sex ratio of 1.4. Using a comparative normal law, the difference in frequency was statistically significant between males and females (p < 10-7) and between two age groups (p 〈10-3). The 49-58 years of age group was represented the most. Diabetic NeuP (21%), lumbar radiculopathies (14%), HIV/AIDS NeuP (13%), and post-stroke NeuP (11%) were the most represented. The survey among the carers revealed: a need for training, a low level of compliance with the therapeutic guidelines, and the use of traditional medicine by the patients. DISCUSSION/CONCLUSION This work confirms that NeuP is encountered frequently in current practice, and its optimal management will involve specific training of carers and improvement of access to the medications recommended in this indication. In light of this issue, we revisit the debate regarding the concept of essential medications and the relevance of taking into account effective medications for the treatment of NeuP.
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Affiliation(s)
- Youssoufa Maiga
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
- Laboratoire de Thérapeutique (EA3826), Faculté de Médecine de Nantes, Nantes, France
| | - Oumar Sangho
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Fatoumata Konipo
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Seybou Diallo
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | | | - Modibo Sangare
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Yann Péréon
- Laboratoire d'Explorations Fonctionnelles, Centre de Référence Maladies Neuromusculaires Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, CHU de Nantes, France
| | | | - Martin Sanou
- Faculté de Chirurgie Dentaire, Université de Nantes, France
| | - Awa Coulibaly
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Salimata Diallo
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Mariam Daou
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | | | - Mohamed Albakaye
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Hamar A. Traoré
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Cheick Oumar Guinto
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | | | - Callixte Kuate-Tegueu
- Département de Médecine Interne et Spécialités, FMSB, Université de Yaoundé 1, Cameroon
| | - Didier Bouhassira
- INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92 100 Boulogne-Billancourt, France
| | - Robert Cowan
- Department of Neurology, Stanford University, California, USA
| | - Julien Nizard
- Laboratoire de Thérapeutique (EA3826), Faculté de Médecine de Nantes, Nantes, France
- Centre Fédératif Douleur Soins Palliatifs et Support, Laboratoire de Thérapeutique, CHU Nantes, Nantes, France
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10
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Jazebi N, Evans C, Kadaru HS, Kompella D, Raji M, Fang F, Pappolla M, Tang SJ, Chung JM, Hammock B, Fang X. HIV-related Neuropathy: Pathophysiology, Treatment and Challenges. JOURNAL OF NEUROLOGY AND EXPERIMENTAL NEUROSCIENCE 2021; 7:15-24. [PMID: 35252633 PMCID: PMC8896895 DOI: 10.17756/jnen.2021-082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
HIV-sensory neuropathy (HIV-SN) is a debilitating complication in HIV patients with or without anti-retroviral treatment (ART). Common symptoms of HIV-SN include pain, decreased sensation, paresthesias, and dysesthesias in a symmetric stocking-glove distribution. While HIV-1 protein such as gp120 is implicated in HIV-SN (e.g. impaired large-diameter fiber), ART itself was recently shown to contribute to HIV-SN in HIV patients and impair thin fiber. Multiple host mechanisms may play roles during the pathogenesis of HIV-SN, including neuron-glia interactions in the spinal dorsal horn (SDH), inflammation, mitochondrial dysfunction and endoplasmic reticulum stress. Concurrent infections, such as tuberculosis, also carry a higher likelihood of HIV-SN as well as environmental or genetic predisposition. Pro-inflammatory cytokines such as IL-1, IL2 receptor-alpha, and tumor necrosis factor (TNF) along with abnormal lactate levels have been identified as potential players within the complex pathophysiology of this condition. In this paper, we review the pathophysiology of HIV neuropathy, focusing on the various treatment options available or under investigation. Although several treatment options are available e.g., the capsaicin patch and spinal cord stimulation, symptomatic control of HIV-SN are often challenging. Alternative approaches such as self-hypnosis, resistance exercise, cannabinoids, and acupuncture have all shown promising results, but need further investigation.
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Affiliation(s)
- Noushin Jazebi
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555
| | - Chad Evans
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555
| | - Hima S Kadaru
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555
| | - Divya Kompella
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555
| | - Mukaila Raji
- Department of Medicine, University of Texas Medical Branch, Galveston, TX 77555
| | - Felix Fang
- Department of Neuroscience & Cell Biology, University of Texas Medical Branch, Galveston, TX 77555
| | - Miguel Pappolla
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555
| | - Shao-Jun Tang
- Department of Neuroscience & Cell Biology, University of Texas Medical Branch, Galveston, TX 77555
| | - Jin Mo Chung
- Department of Neuroscience & Cell Biology, University of Texas Medical Branch, Galveston, TX 77555
| | - Bruce Hammock
- Department of Entomology and Nematology & Comprehensive Cancer Center, University of California Davis, Davis, CA 95616, USA
| | - Xiang Fang
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555
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11
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Keltner JR, Tong A, Visser E, Jenkinson M, Connolly CG, Dasca A, Sheringov A, Calvo Z, Umbao E, Mande R, Bilder MB, Sahota G, Franklin DR, Corkran S, Grant I, Archibald S, Vaida F, Brown GG, Atkinson JH, Simmons AN, Ellis RJ. Evidence for a novel subcortical mechanism for posterior cingulate cortex atrophy in HIV peripheral neuropathy. J Neurovirol 2020; 26:530-543. [PMID: 32524422 DOI: 10.1007/s13365-020-00850-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/10/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022]
Abstract
We previously reported that neuropathic pain was associated with smaller posterior cingulate cortical (PCC) volumes, suggesting that a smaller/dysfunctional PCC may contribute to development of pain via impaired mind wandering. A gap in our previous report was lack of evidence for a mechanism for the genesis of PCC atrophy in HIV peripheral neuropathy. Here we investigate if volumetric differences in the subcortex for those with neuropathic paresthesia may contribute to smaller PCC volumes, potentially through deafferentation of ascending white matter tracts resulting from peripheral nerve damage in HIV neuropathy. Since neuropathic pain and paresthesia are highly correlated, statistical decomposition was used to separate pain and paresthesia symptoms to determine which regions of brain atrophy are associated with both pain and paresthesia and which are associated separately with pain or paresthesia. HIV+ individuals (N = 233) with and without paresthesia in a multisite study underwent structural brain magnetic resonance imaging. Voxel-based morphometry and a segmentation/registration tool were used to investigate regional brain volume changes associated with paresthesia. Analysis of decomposed variables found that smaller midbrain and thalamus volumes were associated with paresthesia rather than pain. However, atrophy in the PCC was related to both pain and paresthesia. Peak thalamic atrophy (p = 0.004; MNI x = - 14, y = - 24, z = - 2) for more severe paresthesia was in a region with reciprocal connections with the PCC. This provides initial evidence that smaller PCC volumes in HIV peripheral neuropathy are related to ascending white matter deafferentation caused by small fiber damage observed in HIV peripheral neuropathy.
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Affiliation(s)
- John R Keltner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA. .,VA San Diego Healthcare System, San Diego, CA, USA. .,UCSD Department of Psychiatry, UCSD HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B, Mailcode 8231, San Diego, CA, 92103-8231, USA.
| | - Alan Tong
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Eelke Visser
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England
| | - Colm G Connolly
- Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Alyssa Dasca
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Aleks Sheringov
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Zachary Calvo
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Earl Umbao
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Rohit Mande
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mary Beth Bilder
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Gagandeep Sahota
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Stephanie Corkran
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sarah Archibald
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Florin Vaida
- Department of Family and Preventative Medicine, University of California San Diego, San Diego, CA, USA
| | - Gregory G Brown
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - J Hampton Atkinson
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Alan N Simmons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, CA, USA
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12
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Cirino TJ, Harden SW, McLaughlin JP, Frazier CJ. Region-specific effects of HIV-1 Tat on intrinsic electrophysiological properties of pyramidal neurons in mouse prefrontal cortex and hippocampus. J Neurophysiol 2020; 123:1332-1341. [PMID: 32101482 DOI: 10.1152/jn.00029.2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human immunodeficiency virus (HIV)-1 transactivator of transcription protein (Tat) is a viral protein that promotes transcription of the HIV genome and possesses cell-signaling properties. Long-term exposure of central nervous system (CNS) tissue to HIV-1 Tat is theorized to contribute to HIV-associated neurodegenerative disorder (HAND). In the current study, we sought to directly evaluate the effect of HIV-1 Tat expression on the intrinsic electrophysiological properties of pyramidal neurons located in layer 2/3 of the medial prefrontal cortex and in area CA1 of the hippocampus. Toward that end, we drove Tat expression with doxycycline (100 mg·kg-1·day-1 ip) in inducible Tat (iTat) transgenic mice for 7 days and then performed single-cell electrophysiological studies in acute tissue slices made through the prefrontal cortex and hippocampus. Control experiments were performed in doxycycline-treated G-tg mice, which retain the tetracycline-sensitive promoter but do not express Tat. Our results indicated that the predominant effects of HIV-1 Tat expression are excitatory in medial prefrontal cortical pyramidal neurons yet inhibitory in hippocampal pyramidal neurons. Notably, in these two populations, HIV-1 Tat expression produced differential effects on neuronal gain, membrane time constant, resting membrane potential, and rheobase. Similarly, we also observed distinct effects on action potential kinetics and afterhyperpolarization, as well as on the current-voltage relationship in subthreshold voltage ranges. Collectively, these data provide mechanistic evidence of complex and region-specific changes in neuronal physiology by which HIV-1 Tat protein may promote cognitive deficits associated with HAND.NEW & NOTEWORTHY We drove expression of human immunodeficiency virus (HIV)-1 transactivator of transcription protein (Tat) protein in inducible Tat (iTat) transgenic mice for 7 days and then examined the effects on the intrinsic electrophysiological properties of pyramidal neurons located in the medial prefrontal cortex (mPFC) and in the hippocampus. Our results reveal a variety of specific changes that promote increased intrinsic excitability of layer II/III mPFC pyramidal neurons and decreased intrinsic excitability of hippocampal CA1 pyramidal neurons, highlighting both cell type and region-specific effects.
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Affiliation(s)
- Thomas J Cirino
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Scott W Harden
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Jay P McLaughlin
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Charles J Frazier
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida
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13
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Zahr NM, Pohl KM, Pfefferbaum A, Sullivan EV. Dissociable Contributions of Precuneus and Cerebellum to Subjective and Objective Neuropathy in HIV. J Neuroimmune Pharmacol 2019; 14:436-447. [PMID: 30741374 PMCID: PMC6689464 DOI: 10.1007/s11481-019-09837-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/25/2019] [Indexed: 01/22/2023]
Abstract
Neuropathy, typically diagnosed by the presence of either symptoms or signs of peripheral nerve dysfunction, remains a frequently reported complication in the antiretroviral (ART)-treated HIV population. This study was conducted in 109 healthy controls and 57 HIV-infected individuals to investigate CNS regions associated with neuropathy. An index of objective neuropathy was computed based on 4 measures: deep tendon ankle reflex, vibration sense (great toes), position sense (great toes), and 2-point discrimination (feet). Subjective neuropathy (self-report of pain, aching, or burning; pins and needles; or numbness in legs or feet) was also evaluated. Structural MRI data were available for 126/166 cases. The HIV relative to the healthy control group was impaired on all 4 signs of neuropathy. Within the HIV group, an objective neuropathy index of 1 (bilateral impairment on 1 measure) or 2 (bilateral impairment on at least 2/4 measures) was associated with older age and a smaller volume of the cerebellar vermis. Moderate to severe symptoms of neuropathy were associated with more depressive symptoms, reduced quality of life, and a smaller volume of the parietal precuneus. This study is consistent with the recent contention that ART-treated HIV-related neuropathy has a CNS component. Distinguishing subjective symptoms from objective signs of neuropathy allowed for a dissociation between the precuneus, a brain region involved in conscious information processing and the vermis, involved in fine tuning of limb movements. Graphical Abstract In HIV patients, objective signs of neuropathy correlated with smaller cerebellar vermis (red) volumes whereas subjective symptoms of neuropathy were associated with smaller precuneus (blue) volumes.
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Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA.
| | - Kilian M Pohl
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA
| | - Adolf Pfefferbaum
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA
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14
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Upadhyay J, Geber C, Hargreaves R, Birklein F, Borsook D. A critical evaluation of validity and utility of translational imaging in pain and analgesia: Utilizing functional imaging to enhance the process. Neurosci Biobehav Rev 2018; 84:407-423. [PMID: 28807753 PMCID: PMC5729102 DOI: 10.1016/j.neubiorev.2017.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
Assessing clinical pain and metrics related to function or quality of life predominantly relies on patient reported subjective measures. These outcome measures are generally not applicable to the preclinical setting where early signs pointing to analgesic value of a therapy are sought, thus introducing difficulties in animal to human translation in pain research. Evaluating brain function in patients and respective animal model(s) has the potential to characterize mechanisms associated with pain or pain-related phenotypes and thereby provide a means of laboratory to clinic translation. This review summarizes the progress made towards understanding of brain function in clinical and preclinical pain states elucidated using an imaging approach as well as the current level of validity of translational pain imaging. We hypothesize that neuroimaging can describe the central representation of pain or pain phenotypes and yields a basis for the development and selection of clinically relevant animal assays. This approach may increase the probability of finding meaningful new analgesics that can help satisfy the significant unmet medical needs of patients.
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Affiliation(s)
| | - Christian Geber
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany; DRK Schmerz-Zentrum Mainz, Mainz, Germany
| | - Richard Hargreaves
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States
| | - Frank Birklein
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany
| | - David Borsook
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States.
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15
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Keltner JR, Connolly CG, Vaida F, Jenkinson M, Fennema-Notestine C, Archibald S, Akkari C, Schlein A, Lee J, Wang D, Kim S, Li H, Rennels A, Miller DJ, Kesidis G, Franklin DR, Sanders C, Corkran S, Grant I, Brown GG, Atkinson JH, Ellis RJ. HIV Distal Neuropathic Pain Is Associated with Smaller Ventral Posterior Cingulate Cortex. PAIN MEDICINE 2017; 18:428-440. [PMID: 27497320 DOI: 10.1093/pm/pnw180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective . Despite modern antiretroviral therapy, HIV-associated neuropathy is one of the most prevalent, disabling and treatment-resistant complications of HIV disease. The presence and intensity of distal neuropathic pain is not fully explained by the degree of peripheral nerve damage. A better understanding of brain structure in HIV distal neuropathic pain may help explain why some patients with HIV neuropathy report pain while the majority does not. Previously, we reported that more intense distal neuropathic pain was associated with smaller total cerebral cortical gray matter volumes. The objective of this study was to determine which parts of the cortex are smaller. Methods . HIV positive individuals with and without distal neuropathic pain enrolled in the multisite (N = 233) CNS HIV Antiretroviral Treatment Effects (CHARTER) study underwent structural brain magnetic resonance imaging. Voxel-based morphometry was used to investigate regional brain volumes in these structural brain images. Results . Left ventral posterior cingulate cortex was smaller for HIV positive individuals with versus without distal neuropathic pain (peak P = 0.017; peak t = 5.15; MNI coordinates x = -6, y = -54, z = 20). Regional brain volumes within cortical gray matter structures typically associated with pain processing were also smaller for HIV positive individuals having higher intensity ratings of distal neuropathic pain. Conclusions . The posterior cingulate is thought to be involved in inhibiting the perception of painful stimuli. Mechanistically a smaller posterior cingulate cortex structure may be related to reduced anti-nociception contributing to increased distal neuropathic pain.
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Affiliation(s)
- John R Keltner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Colm G Connolly
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Florin Vaida
- Department of Family and Preventative Medicine, University of California San Diego Medical Center, San Diego, California, USA
| | - Mark Jenkinson
- Department of Clinical Neurosciences, University of Oxford, Oxford, England
| | | | - Sarah Archibald
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Cherine Akkari
- Psychiatry, University of California San Diego, California, USA
| | | | - Jisu Lee
- Psychiatry, University of California San Diego, California, USA
| | - Dongzhe Wang
- Department of Electrical Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - Sung Kim
- Psychiatry, University of California San Diego, California, USA
| | - Han Li
- Psychiatry, University of California San Diego, California, USA
| | - Austin Rennels
- Psychiatry, University of California San Diego, California, USA
| | - David J Miller
- Department of Electrical Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - George Kesidis
- Department of Electrical Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Chelsea Sanders
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Stephanie Corkran
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Gregory G Brown
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - J Hampton Atkinson
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Ronald J Ellis
- Neurosciences, University of California San Diego, San Diego, California, USA
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16
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The P2X 7 receptor in dorsal root ganglia is involved in HIV gp120-associated neuropathic pain. Brain Res Bull 2017; 135:25-32. [PMID: 28919433 DOI: 10.1016/j.brainresbull.2017.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 05/10/2017] [Accepted: 09/13/2017] [Indexed: 01/28/2023]
Abstract
Human immunodeficiency virus (HIV)-associated neuropathic pain is common, and studies have shown that HIV envelope glycoprotein 120 (gp120) can directly stimulate primary sensory afferent neurons causing hyperalgesia. The P2X7 receptor in the dorsal root ganglia (DRG) is involved in pain transmission and is closely related to the inflammatory and immune response. In this study, we aimed to explore the role of the P2X7 receptor in gp120-induced neuropathic pain using a rat model specific for this type of pain. The results showed that mechanical hyperalgesia, thermal hyperalgesia and P2X7 expression levels were increased in rats treated with gp120. The P2X7 antagonist, brilliant blue G (BBG), decreased hyperalgesia and P2X7 expression levels in rats treated with gp120. BBG also decreased IL-1β and TNF-α receptor expression and ERK1/2 phosphorylation levels and increased IL-10 expression in the gp120-treated rat DRG. In addition, P2X7 agonist (BzATP)-activated currents in DRG neurons cultured with gp120 were larger than those in control neurons, and the inhibitory effect of BBG on BzATP-induced currents in gp120-treated DRG neurons was larger than that in control neurons. Therefore, inhibition of the P2X7 receptor in rat DRG relieved gp120-induced mechanical hyperalgesia and thermal hyperalgesia.
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17
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Castillo D, Ernst T, Cunningham E, Chang L. Altered Associations between Pain Symptoms and Brain Morphometry in the Pain Matrix of HIV-Seropositive Individuals. J Neuroimmune Pharmacol 2017; 13:77-89. [PMID: 28866752 DOI: 10.1007/s11481-017-9762-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
Pain remains highly prevalent in HIV-seropositive (HIV+) patients despite their well-suppressed viremia with combined antiretroviral therapy. Investigating brain abnormalities within the pain matrix, and in relation to pain symptoms, in HIV+ participants may provide objective biomarkers and insights regarding their pain symptoms. We used Patient-Reported Outcome Measurement Information System (PROMIS®) pain questionnaire to evaluate pain symptoms (pain intensity, pain interference and pain behavior), and structural MRI to assess brain morphometry using FreeSurfer (cortical area, cortical thickness and subcortical volumes were evaluated in 12 regions within the pain matrix). Compared to seronegative (SN) controls, HIV+ participants had smaller surface areas in prefrontal pars triangularis (right: p = 0.04, left: p = 0.007) and right anterior cingulate cortex (p = 0.03) and smaller subcortical regions (thalamus: p ≤ 0.003 bilaterally; right putamen: p = 0.01), as well as higher pain scores (pain intensity-p = 0.005; pain interference-p = 0.008; pain-behavior-p = 0.04). Furthermore, higher pain scores were associated with larger cortical areas, thinner cortices and larger subcortical volumes in HIV+ participants; but smaller cortical areas, thicker cortices and smaller subcortical volumes in SN controls (interaction-p = 0.009 to p = 0.04). These group differences in the pain-associated brain abnormalities suggest that HIV+ individuals have abnormal pain responses. Since these abnormal pain-associated brain regions belong to the affective component of the pain matrix, affective symptoms may influence pain perception in HIV+ patients and should be treated along with their physical pain symptoms. Lastly, associations of lower pain scores with better physical or mental health scores, regardless of HIV-serostatus (p < 0.001), suggest adequate pain treatment would lead to better quality of life in all participants.
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Affiliation(s)
- Deborrah Castillo
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
| | - Thomas Ernst
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA
| | - Eric Cunningham
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA
| | - Linda Chang
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA.
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA.
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18
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Abstract
PURPOSE OF REVIEW HIV-sensory neuropathy (HIV-SN) remains a common complication of HIV infection and may be associated with significant morbidity due to neuropathic pain. The overall purpose of this review is to discuss trends in the changing epidemiology in HIV-SN, new data regarding the pathophysiology of the condition, and discuss approaches to management. RECENT FINDINGS While HIV-SN has been historically considered the most common neurological complication of HIV infection, improved accessibility to effective combination antiretroviral therapy (cART), use of less neurotoxic antiretroviral medication regimens, and trends towards earlier introduction of treatment have impacted the condition: overall incident HIV-SN is likely decreased compared to prior rates and patients afflicted by HIV-SN may more frequently have asymptomatic or subclinical disease. Traditional predictors of HIV-SN have also changed, as traditional indices of severe immune deficiency such as low CD4 count and high viral load no longer predict HIV-SN. Emerging evidence supports the contention that both peripheral and central mechanisms underlying the generation as well as persistence of neuropathic pain in HIV-SN exist. It is important to recognize that even mild neuropathic pain in this clinical population is associated with meaningful impairment in quality of life and function, which emphasizes the clinical importance of recognizing and treating the condition. The general approach to management of neuropathic pain in HIV-SN is the introduction of symptomatic analgesic therapy. There exist, however, few evidence-based analgesic options for HIV-SN based on available clinical data. Symptomatic treatment trials are increasingly recognized to have been potentially confounded by more robust placebo response than that observed in other neuropathic pain conditions. In the authors' experience, use of analgesic therapies with proven efficacy in other neuropathic pain conditions is appropriate, bearing in consideration potential pharmacokinetic interactions with the cART regimen. Combination analgesic regimens may also achieve meaningful analgesic responses, particularly when drugs with differing mechanisms of action are utilized. It is paramount that the patient is appropriately counseled regarding expectations and the anticipated benefit of analgesic therapy, as pain relief is often incomplete but clinically meaningful improvement in pain and function can be achieved.
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Affiliation(s)
| | - Taylor B Harrison
- Department of Neurology, Emory University, Atlanta, GA, USA. .,Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, 80 Jesse Hill Jr., Drive Box 036, Atlanta, GA, 30303, USA.
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19
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Abstract
In much of the developed world, the HIV epidemic has largely been controlled by antiretroviral treatment. Even so, there is growing concern that HIV-infected individuals may be at risk for accelerated brain aging and a range of cognitive impairments. What promotes or resists these changes is largely unknown. There is also interest in discovering factors that promote resilience to HIV and combat its adverse effects in children. Here, we review recent developments in brain imaging that reveal how the virus affects the brain. We relate these brain changes to changes in blood markers, cognitive function, and other patient outcomes or symptoms, such as apathy or neuropathic pain. We focus on new and emerging techniques, including new variants of brain MRI. Diffusion tensor imaging, for example, can map the brain's structural connections, while fMRI can uncover functional connections. Finally, we suggest how large-scale global research alliances, such as ENIGMA, may resolve controversies over effects where evidence is now lacking. These efforts pool scans from tens of thousands of individuals and offer a source of power not previously imaginable for brain imaging studies.
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Affiliation(s)
- Paul Thompson
- Dept. of Neurology, Keck USC School of Medicine, Imaging Genetics Center, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA 90292, Phone: (323) 44-BRAIN Fax: (323) 442-0137
| | - Neda Jahanshad
- Dept. of Neurology, Keck USC School of Medicine, Imaging Genetics Center, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA 90292, Phone: (323) 44-BRAIN Fax: (323) 442-0137
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20
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Tavernier S, Coenye T. Quantification of Pseudomonas aeruginosa in multispecies biofilms using PMA-qPCR. PeerJ 2015; 3:e787. [PMID: 25755923 PMCID: PMC4349053 DOI: 10.7717/peerj.787] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/04/2015] [Indexed: 11/20/2022] Open
Abstract
Multispecies biofilms are an important healthcare problem and may lead to persistent infections. These infections are difficult to treat, as cells in a biofilm are highly resistant to antimicrobial agents. While increasingly being recognized as important, the properties of multispecies biofilms remain poorly studied. In order to do so, the quantification of the individual species is needed. The current cultivation-based approaches can lead to an underestimation of the actual cell number and are time-consuming. In the present study we set up a culture-independent approach based on propidium monoazide qPCR (PMA-qPCR) to quantify Pseudomonas aeruginosa in a multispecies biofilm. As a proof of concept, we explored the influence of the combined presence of Staphylococcus aureus, Streptococcus anginosus and Burkholderia cenocepacia on the antimicrobial susceptibility of P. aeruginosa using this PMA-qPCR approach.
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Affiliation(s)
- Sarah Tavernier
- Laboratory of Pharmaceutical Microbiology, Ghent University , Ghent , Belgium
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University , Ghent , Belgium
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21
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Understanding the etiology and management of HIV-associated peripheral neuropathy. Curr HIV/AIDS Rep 2015; 11:195-201. [PMID: 24969360 DOI: 10.1007/s11904-014-0211-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
HIV may cause several forms of peripheral neuropathy, the most common of which is distal symmetric polyneuropathy (DSP) characterized by pain and sensory deficits in a stocking-glove distribution. The pathophysiology of DSP remains largely unknown but is thought to be related both to the neurotoxicity of HIV-through indirect immunomodulatory mechanisms-and to the neurotoxic effects of anti-retroviral therapies, most notably the dideoxynucleoside reverse transcription inhibitors or so-called d-drugs. Determining whether symptoms arise from the virus or the treatment poses a challenge to the clinician who must decide if a patient's HAART regimen should be altered. Treatment of symptoms related to HIV-DSP is a difficult task and there is no evidence that the traditional agents used in chronic neuropathic pain are efficacious in the HIV-DSP population. Indeed few pharmacologic agents have proven efficacy in HIV-DSP - these include cannabis and the capsaicin 8 % dermal patch. As such, alternative, non-pharmacologic therapies are being investigated. More research is needed to further elucidate the complex pathophysiology of HIV-DSP which may yield additional therapies for these patients.
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22
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Kallianpur AR, Jia P, Ellis RJ, Zhao Z, Bloss C, Wen W, Marra CM, Hulgan T, Simpson DM, Morgello S, McArthur JC, Clifford DB, Collier AC, Gelman BB, McCutchan JA, Franklin D, Samuels DC, Rosario D, Holzinger E, Murdock DG, Letendre S, Grant I. Genetic variation in iron metabolism is associated with neuropathic pain and pain severity in HIV-infected patients on antiretroviral therapy. PLoS One 2014; 9:e103123. [PMID: 25144566 PMCID: PMC4140681 DOI: 10.1371/journal.pone.0103123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
HIV sensory neuropathy and distal neuropathic pain (DNP) are common, disabling complications associated with combination antiretroviral therapy (cART). We previously associated iron-regulatory genetic polymorphisms with a reduced risk of HIV sensory neuropathy during more neurotoxic types of cART. We here evaluated the impact of polymorphisms in 19 iron-regulatory genes on DNP in 560 HIV-infected subjects from a prospective, observational study, who underwent neurological examinations to ascertain peripheral neuropathy and structured interviews to ascertain DNP. Genotype-DNP associations were explored by logistic regression and permutation-based analytical methods. Among 559 evaluable subjects, 331 (59%) developed HIV-SN, and 168 (30%) reported DNP. Fifteen polymorphisms in 8 genes (p<0.05) and 5 variants in 4 genes (p<0.01) were nominally associated with DNP: polymorphisms in TF, TFRC, BMP6, ACO1, SLC11A2, and FXN conferred reduced risk (adjusted odds ratios [ORs] ranging from 0.2 to 0.7, all p<0.05); other variants in TF, CP, ACO1, BMP6, and B2M conferred increased risk (ORs ranging from 1.3 to 3.1, all p<0.05). Risks associated with some variants were statistically significant either in black or white subgroups but were consistent in direction. ACO1 rs2026739 remained significantly associated with DNP in whites (permutation p<0.0001) after correction for multiple tests. Several of the same iron-regulatory-gene polymorphisms, including ACO1 rs2026739, were also associated with severity of DNP (all p<0.05). Common polymorphisms in iron-management genes are associated with DNP and with DNP severity in HIV-infected persons receiving cART. Consistent risk estimates across population subgroups and persistence of the ACO1 rs2026739 association after adjustment for multiple testing suggest that genetic variation in iron-regulation and transport modulates susceptibility to DNP.
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Affiliation(s)
- Asha R. Kallianpur
- Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Peilin Jia
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Ronald J. Ellis
- Department of Neurology, University of California San Diego, San Diego, California, United States of America
| | - Zhongming Zhao
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Cinnamon Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute, and Scripps Health, La Jolla, California, United States of America
| | - Wanqing Wen
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Christina M. Marra
- Department of Neurology, University of Washington, Seattle, Washington, United States of America
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - David M. Simpson
- Department of Neurology, Icahn School of Medicine of Mt. Sinai, New York, New York, United States of America
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine of Mt. Sinai, New York, New York, United States of America
| | - Justin C. McArthur
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - David B. Clifford
- Department of Neurology, Washington University, St. Louis, Missouri, United States of America
| | - Ann C. Collier
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Benjamin B. Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - J. Allen McCutchan
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Donald Franklin
- HIV Neurobehavioral Research Center & CHARTER Center, University of California San Diego, San Diego, California, United States of America
| | - David C. Samuels
- Department of Molecular Physiology and Biophysics and Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Debralee Rosario
- HIV Neurobehavioral Research Center & CHARTER Center, University of California San Diego, San Diego, California, United States of America
| | - Emily Holzinger
- Department of Molecular Physiology and Biophysics and Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Deborah G. Murdock
- Department of Molecular Physiology and Biophysics and Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Scott Letendre
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
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