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Nyakonda CN, Wedderburn CJ, Williams SR, Stein DJ, Donald KA. Understanding the impact of congenital infections and perinatal viral exposures on the developing brain using white matter magnetic resonance imaging: a scoping review. BMC Med Imaging 2024; 24:119. [PMID: 38783187 PMCID: PMC11119575 DOI: 10.1186/s12880-024-01282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI)-based imaging techniques are useful for assessing white matter (WM) structural and microstructural integrity in the context of infection and inflammation. The purpose of this scoping review was to assess the range of work on the use of WM neuroimaging approaches to understand the impact of congenital and perinatal viral infections or exposures on the developing brain. METHODS This scoping review was conducted according to the Arksey and O' Malley framework. A literature search was performed in Web of Science, Scopus and PubMed for primary research articles published from database conception up to January 2022. Studies evaluating the use of MRI-based WM imaging techniques in congenital and perinatal viral infections or exposures were included. Results were grouped by age and infection. RESULTS A total of 826 articles were identified for screening and 28 final articles were included. Congenital and perinatal infections represented in the included studies were cytomegalovirus (CMV) infection (n = 12), human immunodeficiency virus (HIV) infection (n = 11) or exposure (n = 2) or combined (n = 2), and herpes simplex virus (HSV) infection (n = 1). The represented MRI-based WM imaging methods included structural MRI and diffusion-weighted and diffusion tensor MRI (DWI/ DTI). Regions with the most frequently reported diffusion metric group differences included the cerebellar region, corticospinal tract and association fibre WM tracts in both children with HIV infection and children who are HIV-exposed uninfected. In qualitative imaging studies, WM hyperintensities were the most frequently reported brain abnormality in children with CMV infection and children with HSV infection. CONCLUSION There was evidence that WM imaging techniques can play a role as diagnostic and evaluation tools assessing the impact of congenital infections and perinatal viral exposures on the developing brain. The high sensitivity for identifying WM hyperintensities suggests structural brain MRI is a useful neurodiagnostic modality in assessing children with congenital CMV infection, while the DTI changes associated with HIV suggest metrics such as fractional anisotropy have the potential to be specific markers of subtle impairment or WM damage in neuroHIV.
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Affiliation(s)
- Charmaine Natasha Nyakonda
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Capetown, South Africa.
| | - Catherine J Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Neuroscience Institute, University of Cape Town, Capetown, South Africa
| | - Simone R Williams
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Capetown, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- MRC Unit of Risk and Resilience, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Capetown, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Capetown, South Africa.
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Heany SJ, Levine AJ, Lesosky M, Phillips N, Fouche JP, Myer L, Zar HJ, Stein DJ, Horvath S, Hoare J. Persistent accelerated epigenetic ageing in a longitudinal cohort of vertically infected HIV-positive adolescents. J Neurovirol 2023; 29:272-282. [PMID: 37179258 PMCID: PMC10404174 DOI: 10.1007/s13365-023-01130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/24/2022] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
We have previously shown accelerated ageing in adolescents perinatally infected with HIV (PHIV +), based on discrepancies between epigenetic and chronological age. The current study examines follow-up longitudinal patterns of epigenetic ageing and the association of epigenetic ageing with cognition as well as whole brain structure changes in PHIV + and healthy controls enrolled in the Cape Town Adolescent Antiretroviral Cohort Study (CTAAC). The Illumina EPIC array was used to generate blood DNA methylation data from 60 PHIV + adolescents and 36 age-matched controls aged 9-12 years old at baseline and again at a 36-month follow-up. Epigenetic clock software estimated two measures of epigenetic age acceleration: extrinsic epigenetic accelerated ageing (EEAA) and age acceleration difference (AAD) at both time points. At follow-up, each participant completed neuropsychological testing, structural magnetic resonance imaging, and diffusion tensor imaging. At follow-up, PHIV infection remains associated with increased EEAA and AAD. Accelerated epigenetic ageing remained positively associated with viral load and negatively associated with CD4 ratio. EEAA was positively associated with whole brain grey matter volume and alterations in whole brain white matter integrity. AAD and EEAA were not associated with cognitive function within the PHIV + group. Measures of epigenetic ageing, as detected in DNA methylation patterns, remain increased in PHIV + adolescents across a 36-month period. Associations between epigenetic ageing measures, viral biomarkers, and alterations in brain micro- and macrostructure also persist at 36-month follow-up. Further study should determine if epigenetic age acceleration is associated with cognitive functional changes due to brain alterations in later life.
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Affiliation(s)
- Sarah J Heany
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Andrew J Levine
- Department of Neurology, David Geffen School of Medicineat the , University of California, Los Angeles, Los Angeles, CA, USA
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicole Phillips
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouche
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Centre for Infectious Disease Epidemiology and Research, Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Medical Research Council Unit On Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline Hoare
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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3
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van Genderen JG, Chia C, Van den Hof M, Mutsaerts HJMM, Reneman L, Pajkrt D, Schrantee A. Brain Differences in Adolescents Living With Perinatally Acquired HIV Compared With Adoption Status Matched Controls: A Cross-sectional Study. Neurology 2022; 99:e1676-e1684. [PMID: 35940898 PMCID: PMC9559945 DOI: 10.1212/wnl.0000000000200946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite effective combination antiretroviral therapy (cART), adolescents with perinatally acquired HIV (PHIV) exhibit cognitive impairment, of which structural changes could be the underlying pathophysiologic mechanism. Prior MRI studies found lower brain volumes, higher white matter (WM) hyperintensity (WMH) volume, lower WM integrity, and differences in cerebral blood flow (CBF). However, these findings may be confounded by adoption status, as a large portion of adolescents with PHIV have been adopted. Adoption has been associated with malnutrition and neglect, which, in turn, may have affected brain development. We investigated the long-term effects of PHIV on the brain, while minimizing the confounding effect of adoption status. METHODS We determined whole-brain gray matter (GM) and WM volume with 3D T1-weighted scans; total WMH volume with fluid-attenuated inversion recovery; CBF in the following regions of interest (ROIs): WM, GM, and subcortical GM with arterial spin labeling; and whole-brain WM microstructural markers: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) with diffusion tensor imaging in cART-treated adolescents with PHIV visiting our outpatient clinic in Amsterdam and controls matched for age, sex, ethnic origin, socioeconomic status, and adoption status. We assessed differences in neuroimaging parameters between adolescents with PHIV and controls using linear regression models adjusted for age and sex and applied multiple comparison correction. RESULTS Thirty-five adolescents with PHIV and 38 controls were included with a median age of 14.9 (interquartile range [IQR]: 10.7-18.5) and 15.6 (IQR: 11.1-17.6) years, respectively, with a similar rate of adoption. We found a lower overall FA (beta = -0.012; p < 0.014, -2.4%), a higher MD (beta = 0.014, p = 0.014, 1.3%), and a higher RD (beta = 0.02, p = 0.014, 3.3%) in adolescents with PHIV vs adoption-matched controls, but no differences in AD. We found comparable GM, WM, and WMH volume and CBF in ROIs between adolescents with PHIV and controls. We did not find an association between cognitive profiles and WM microstructural markers in adolescents with PHIV. DISCUSSION Irrespective of adoption status, adolescents with PHIV exhibited subtle lower WM integrity. Our findings may point toward early-acquired WM microstructural alterations associated with HIV.
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Affiliation(s)
- Jason G van Genderen
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands.
| | - Cecilia Chia
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Malon Van den Hof
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Henk J M M Mutsaerts
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Liesbeth Reneman
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Dasja Pajkrt
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Anouk Schrantee
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
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Khobo IL, Jankiewicz M, Holmes MJ, Little F, Cotton MF, Laughton B, van der Kouwe AJW, Moreau A, Nwosu E, Meintjes EM, Robertson FC. Multimodal magnetic resonance neuroimaging measures characteristic of early cART-treated pediatric HIV: A feature selection approach. Hum Brain Mapp 2022; 43:4128-4144. [PMID: 35575438 PMCID: PMC9374890 DOI: 10.1002/hbm.25907] [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: 11/07/2021] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 11/09/2022] Open
Abstract
Children with perinatally acquired HIV (CPHIV) have poor cognitive outcomes despite early combination antiretroviral therapy (cART). While CPHIV-related brain alterations can be investigated separately using proton magnetic resonance spectroscopy (1 H-MRS), structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and functional MRI (fMRI), a set of multimodal MRI measures characteristic of children on cART has not been previously identified. We used the embedded feature selection of a logistic elastic-net (EN) regularization to select neuroimaging measures that distinguish CPHIV from controls and measured their classification performance via the area under the receiver operating characteristic curve (AUC) using repeated cross validation. We also wished to establish whether combining MRI modalities improved the models. In single modality analysis, sMRI volumes performed best followed by DTI, whereas individual EN models on spectroscopic, gyrification, and cortical thickness measures showed no class discrimination capability. Adding DTI and 1 H-MRS in basal measures to sMRI volumes produced the highest classification performancevalidation accuracy = 85 % AUC = 0.80 . The best multimodal MRI set consisted of 22 DTI and sMRI volume features, which included reduced volumes of the bilateral globus pallidus and amygdala, as well as increased mean diffusivity (MD) and radial diffusivity (RD) in the right corticospinal tract in cART-treated CPHIV. Consistent with previous studies of CPHIV, select subcortical volumes obtained from sMRI provide reasonable discrimination between CPHIV and controls. This may give insight into neuroimaging measures that are relevant in understanding the effects of HIV on the brain, thereby providing a starting point for evaluating their link with cognitive performance in CPHIV.
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Affiliation(s)
- Isaac L. Khobo
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Marcin Jankiewicz
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Martha J. Holmes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Francesca Little
- Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mark F. Cotton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Barbara Laughton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Andre J. W. van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- A.A. Martinos Centre for Biomedical ImagingMassachusetts General HospitalBostonMassachusettsUSA
- Department of RadiologyHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Emmanuel Nwosu
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
| | - Ernesta M. Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Frances C. Robertson
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
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5
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George G, Murphy DC, Hogg HDJ, Boniface JB, Urasa S, Rwiza J, Uwemeye L, Bristow C, Hillsmith G, Rainey E, Walker R, Gray WK, Maria-Paddick S. Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population. Sci Rep 2022; 12:1434. [PMID: 35082308 PMCID: PMC8791939 DOI: 10.1038/s41598-022-04989-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/06/2021] [Indexed: 12/20/2022] Open
Abstract
Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Our aim was to evaluate clinical utility of retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Of 129 individuals assessed, 69.8% were visually impaired. Thirteen had retinopathy. HAND prevalence was 66.7%. Retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of retinopathy for HAND was poor (AUROC 0.545-0.617) but specificity and positive predictive value were high. We conclude that ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.
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Affiliation(s)
- Grace George
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Declan C Murphy
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - H D Jeffry Hogg
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Justus Rwiza
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Livin Uwemeye
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Clare Bristow
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Grace Hillsmith
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Emma Rainey
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Richard Walker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Stella Maria-Paddick
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Bensham Hospital, Fontwell Drive, Gateshead, Tyne and Wear, UK.
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Hoare J, Fouche JP, Phillips N, Heany SJ, Myer L, Zar HJ, Stein DJ. Alcohol use is associated with mental health problems and brain structural alterations in adolescents with perinatally acquired HIV infection on ART. Alcohol 2021; 97:59-66. [PMID: 34536544 DOI: 10.1016/j.alcohol.2021.09.006] [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: 07/14/2020] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Alcohol use, presents unique challenges for HIV-1 treatment in adolescents with perinatally acquired infection. The effects of alcohol on host-virus interaction in the brain and the immune system remains understudied in this population. Adolescents with perinatally acquired HIV infection (PHIV) well established on ART, from the Cape Town Adolescent Antiretroviral Cohort who self-reported alcohol use (PHIV + alcohol) (n = 26) were compared to age matched 26 PHIV (PHIV-alcohol) and 26 healthy controls (HC) who reported no use of alcohol. Participants completed clinical investigations including highly-sensitive CRP (hs-CRP), a comprehensive neurocognitive test battery and mental health measures. In addition, we investigated the relationship between alcohol use in PHIV and diffusion tensor imaging (DTI) and structural brain magnetic resonance imaging (MRI) to determine fractional anisotropy (FA), mean diffusivity (MD), grey and white matter volumes and cortical thickness. PHIV (mean age 12,5 years; mean age of ART initiation 3.15 years) reported an occasional weekend drinking pattern of alcohol use. hs-CRP was significantly different between groups, with PHIV + alcohol higher than PHIV-alcohol and HC. General intelligence, attention, working memory, processing speed and executive function were more impaired in the PHIV + alcohol than PHIV alone, with HC having the highest scores. In addition, self-concept was significantly lower in PHIV + alcohol. The Child Behavior Checklist (CBCL) Externalizing behaviour, internalising behaviour and CBCL Total problems were significantly higher in PHIV + alcohol. FA of the superior corona radiata, superior fronto-occipital fasciculus and corpus callosum was significantly lower in PHIV + alcohol compared to PHIV-alcohol and MD of the corona radiata was significantly increased in PHIV + alcohol. The cortical thickness of the lateral orbitofrontal, middle frontal and precentral gyri were significantly lower in PHIV + alcohol compared to PHIV-alcohol and HC. In conclusion PHIV associated impairments in systemic inflammation, cognitive function, mental health and changes in brain structure may be exacerbated by alcohol use, even if only occasional use. However, the study is cross-sectional, which is not able to distinguish between cause and effect.
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7
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Haddad A, Voth B, Brooks J, Swang M, Carryl H, Algarzae N, Taylor S, Parker C, Van Rompay KKA, De Paris K, Burke MW. Reduced neuronal population in the dorsolateral prefrontal cortex in infant macaques infected with simian immunodeficiency virus (SIV). J Neurovirol 2021; 27:923-935. [PMID: 34554407 PMCID: PMC8901521 DOI: 10.1007/s13365-021-01019-2] [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: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
Pediatric HIV infection remains a global health crisis with an estimated 150,000 new mother-to-child (MTCT) infections each year. Antiretroviral therapy (ART) has improved childhood survival, but only an estimated 53% of children worldwide have access to treatment. Adding to the health crisis is the neurological impact of HIV on the developing brain, in particular cognitive and executive function, which persists even when ART is available. Imaging studies suggest structural, connectivity, and functional alterations in perinatally HIV-infected youth. However, the paucity of histological data limits our ability to identify specific cortical regions that may underlie the clinical manifestations. Utilizing the pediatric simian immunodeficiency virus (SIV) infection model in infant macaques, we have previously shown that early-life SIV infection depletes the neuronal population in the hippocampus. Here, we expand on these previous studies to investigate the dorsolateral prefrontal cortex (dlPFC). A total of 11 ART-naïve infant rhesus macaques (Macaca mulatta) from previous studies were retrospectively analyzed. Infant macaques were either intravenously (IV) inoculated with highly virulent SIVmac251 at ~1 week of age and monitored for 6-10 weeks or orally challenged with SIVmac251 from week 9 of age onwards with a monitoring period of 10-23 weeks post-infection (19-34 weeks of age), and SIV-uninfected controls were euthanized at 16-17 weeks of age. Both SIV-infected groups show a significant loss of neurons along with evidence of ongoing neuronal death. Oral- and IV-infected animals showed a similar neuronal loss which was negatively correlated to chronic viremia levels as assessed by an area under the curve (AUC) analysis. The loss of dlPFC neurons may contribute to the rapid neurocognitive decline associated with pediatric HIV infection.
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Affiliation(s)
- Alexandra Haddad
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Brittany Voth
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Janiya Brooks
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Melanie Swang
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Heather Carryl
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Norah Algarzae
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
- King Saudi University, Riyadh, Riyadh, Kingdom of Saudi Arabia
| | - Shane Taylor
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Camryn Parker
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Koen K A Van Rompay
- California National Primate Research Center, University of California Davis, Davis, CA, 95616, USA
| | - Kristina De Paris
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Mark W Burke
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA.
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8
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Finkelstein A, Faiyaz A, Weber MT, Qiu X, Uddin MN, Zhong J, Schifitto G. Fixel-Based Analysis and Free Water Corrected DTI Evaluation of HIV-Associated Neurocognitive Disorders. Front Neurol 2021; 12:725059. [PMID: 34803875 PMCID: PMC8600320 DOI: 10.3389/fneur.2021.725059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background: White matter (WM) damage is a consistent finding in HIV-infected (HIV+) individuals. Previous studies have evaluated WM fiber tract-specific brain regions in HIV-associated neurocognitive disorders (HAND) using diffusion tensor imaging (DTI). However, DTI might lack an accurate biological interpretation, and the technique suffers from several limitations. Fixel-based analysis (FBA) and free water corrected DTI (fwcDTI) have recently emerged as useful techniques to quantify abnormalities in WM. Here, we sought to evaluate FBA and fwcDTI metrics between HIV+ and healthy controls (HIV−) individuals. Using machine learning classifiers, we compared the specificity of both FBA and fwcDTI metrics in their ability to distinguish between individuals with and without cognitive impairment in HIV+ individuals. Methods: Forty-two HIV+ and 52 HIV– participants underwent MRI exam, clinical, and neuropsychological assessments. FBA metrics included fiber density (FD), fiber bundle cross section (FC), and fiber density and cross section (FDC). We also obtained fwcDTI metrics such as fractional anisotropy (FAT) and mean diffusivity (MDT). Tract-based spatial statistics (TBSS) was performed on FAT and MDT. We evaluated the correlations between MRI metrics with cognitive performance and blood markers, such as neurofilament light chain (NfL), and Tau protein. Four different binary classifiers were used to show the specificity of the MRI metrics for classifying cognitive impairment in HIV+ individuals. Results: Whole-brain FBA showed significant reductions (up to 15%) in various fiber bundles, specifically the cerebral peduncle, posterior limb of internal capsule, middle cerebellar peduncle, and superior corona radiata. TBSS of fwcDTI metrics revealed decreased FAT in HIV+ individuals compared to HIV– individuals in areas consistent with those observed in FBA, but these were not significant. Machine learning classifiers were consistently better able to distinguish between cognitively normal patients and those with cognitive impairment when using fixel-based metrics as input features as compared to fwcDTI metrics. Conclusion: Our findings lend support that FBA may serve as a potential in vivo biomarker for evaluating and monitoring axonal degeneration in HIV+ patients at risk for neurocognitive impairment.
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Affiliation(s)
- Alan Finkelstein
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Abrar Faiyaz
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Miriam T Weber
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Md Nasir Uddin
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Jianhui Zhong
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States.,Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States.,Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
| | - Giovanni Schifitto
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States.,Department of Neurology, University of Rochester, Rochester, NY, United States.,Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
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9
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Madzime J, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM, Jankiewicz M. Altered White Matter Tracts in the Somatosensory, Salience, Motor, and Default Mode Networks in 7-Year-Old Children Living with Human Immunodeficiency Virus: A Tractographic Analysis. Brain Connect 2021; 12:302-319. [PMID: 34107770 PMCID: PMC9131360 DOI: 10.1089/brain.2020.0948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Even with the increased access and early initiation of combination antiretroviral therapy, children with perinatally acquired human immunodeficiency virus (CPHIV) continue to demonstrate white matter alterations. Children perinatally HIV-exposed, but uninfected (CHEU) alike show differences in white matter integrity compared with children who are HIV-unexposed and uninfected (CHUU). Objectives: Mapping white matter connections that link gray matter regions that form resting-state (RS) functional networks may demonstrate whether structural and functional connectivity alterations in HIV infection and exposure may be related. We hypothesized reduced structural connectivity in CPHIV within the default mode network (DMN), visual, ventral DMN (vDMN), somatosensory, salience, auditory, motor, executive, basal ganglia, and posterior DMN (pDMN). We also hypothesized that CHEU will have increased structural connectivity compared with CHUU in the vDMN, somatosensory, pDMN, dorsal attention, salience, auditory, motor and basal ganglia. Methods: Study participants were 61 seven-year-old CPHIV and 46 age-matched children who are HIV uninfected (CHU) (19 CHEU). We used diffusion tensor imaging-based tractography to investigate white matter connections that link gray matter regions within RS functional networks. Results: We found altered white matter integrity in the somatosensory, salience, default mode, and motor networks of CPHIV compared with CHU. The superior temporal cortex, superior frontal cortex, and putamen were affected in all four networks and have also been reported to demonstrate morphological alterations in the same cohort. In CHEU, white matter integrity was higher in the visual network, pDMN, and motor network compared with CHUU. Conclusion: Our results suggest that altered white matter integrity may influence gray matter morphology and functional network alterations. Impact statement The long-term effects of human immunodeficiency virus (HIV) and exposure on the developing brain in the combination antiretroviral therapy era are still not well known. We use diffusion tensor imaging-based tractography to explore these effects on white matter connections that link gray matter regions within functional networks. Our findings provide a context for HIV-associated white matter and connectivity abnormalities.
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Affiliation(s)
- Joanah Madzime
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Pediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Andre J W van der Kouwe
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Ernesta M Meintjes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Marcin Jankiewicz
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
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10
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Sarma MK, Pal A, Keller MA, Welikson T, Ventura J, Michalik DE, Nielsen-Saines K, Deville J, Kovacs A, Operskalski E, Church JA, Macey PM, Biswal B, Thomas MA. White matter of perinatally HIV infected older youths shows low frequency fluctuations that may reflect glial cycling. Sci Rep 2021; 11:3086. [PMID: 33542389 PMCID: PMC7862588 DOI: 10.1038/s41598-021-82587-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
In perinatally HIV-infected (PHIV) children, neurodevelopment occurs in the presence of HIV-infection, and even with combination antiretroviral therapy (cART) the brain can be a reservoir for latent HIV. Consequently, patients often demonstrate long-term cognitive deficits and developmental delay, which may be reflected in altered functional brain activity. Our objective was to examine brain function in PHIV on cART by quantifying the amplitude of low frequency fluctuations (ALFF) and regional homogeneity (ReHo). Further, we studied ALFF and ReHo changes with neuropsychological performance and measures of immune health including CD4 count and viral loads in the HIV-infected youths. We found higher ALFF and ReHo in cerebral white matter in the medial orbital lobe for PHIV (N = 11, age mean ± sd = 22.5 ± 2.9 years) compared to controls (N = 16, age = 22.5 ± 3.0 years), with age and gender as co-variates. Bilateral cerebral white matter showed increased spontaneous regional activity in PHIV compared to healthy controls. No brain regions showed lower ALFF or ReHo in PHIV compared to controls. Higher log10 viral load was associated with higher ALFF and ReHo in PHIV in bilateral cerebral white matter and right cerebral white matter respectively after masking the outcomes intrinsic to the brain regions that showed significantly higher ALFF and ReHo in the PHIV compared to the control. Reductions in social cognition and abstract thinking in PHIV were correlated with higher ALFF at the left cerebral white matter in the left medial orbital gyrus and higher ReHo at the right cerebral white matter in the PHIV patients. Although neuroinflammation and associated neuro repair were not directly measured, the findings support their potential role in PHIV impacting neurodevelopment and cognition.
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Affiliation(s)
- Manoj K Sarma
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA
| | - Amrita Pal
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Margaret A Keller
- Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tamara Welikson
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Ventura
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David E Michalik
- Infectious Diseases-Pediatrics, Miller Children's Hospital of Long Beach, Long Beach, CA, USA
| | | | - Jaime Deville
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrea Kovacs
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.,Los Angeles+USC Medical Center, Los Angeles, CA, USA
| | - Eva Operskalski
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.,Los Angeles+USC Medical Center, Los Angeles, CA, USA
| | - Joseph A Church
- Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bharat Biswal
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - M Albert Thomas
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA.
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11
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Zhao T, Chen J, Fang H, Fu D, Su D, Zhang W. Diffusion tensor magnetic resonance imaging of white matter integrity in patients with HIV-associated neurocognitive disorders. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1314. [PMID: 33209894 PMCID: PMC7661883 DOI: 10.21037/atm-20-6342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background This study investigated the efficacy and neurotoxicity of highly active antiretroviral therapy (HAART) by evaluating white matter (WM) injury using diffusion tensor magnetic resonance imaging (DTI) in patients with human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND). Methods Forty-six patients with HAND underwent DTI before and every six months during HAART treatment. DTI data, including fractional anisotropy (FA) and mean diffusivity (MD) values of structural WM before and after HAART, were compared. The relationship between DTI values and plasma viral loads was tested. MD was more sensitive than FA for evaluating WM injury in HAND-positive patients. Results Following 12 months of HAART, increased MD values (compared to 6 months of HAART) were observed in the right temporal lobe, right parietal lobe, right occipital lobe, right anterior limb of the internal capsule, right lenticular nucleus, the right cerebral peduncle, left caudate nucleus, left dorsal thalamus, and left posterior limb of the internal capsule. MD values in the left genu of the internal capsule (r=0.350, P=0.017) and left corona radiata (r=0.338, P=0.021) were positively correlated with plasma viral loads. Conclusions DTI may be useful for assessing the efficacy and neurotoxicity of HAART in HAND-positive patients. Starting HAART may halt WM injury; however, prolonged HAART could worsen WM injury, highlighting the importance of optimal HAART duration.
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Affiliation(s)
| | | | - Hang Fang
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Danhui Fu
- Guangxi Medical University, Nanning, China
| | - Danke Su
- Guangxi Medical University, Nanning, China
| | - Wei Zhang
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, China
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12
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Abstract
Human immunodeficiency virus (HIV) is a neurotropic virus that has a detrimental impact on the developing central nervous system (CNS) of children growing up with perinatal HIV (PHIV) due to a combination of pathophysiological processes related to direct viral cytopathic effects and immune activation. This leads to a spectrum of neurocognitive impairment ranging from severe encephalopathy to subtle domain-specific cognitive impairments, as well as psychological disorders that are compounded by HIV-related stigma and sociodemographic factors that disproportionately affect PHIV children. Early commencement and consistent use of combination antiretroviral therapy (cART) has resulted in a dramatic improvement in neuropsychological outcomes for PHIV children; however, they remain vulnerable to cognitive impairment and psychological disorders, as evidenced by imaging findings, randomised clinical trials and observational studies. An optimal neuroprotective cART regimen remains elusive in children, but systemic viral suppression, regular neurocognitive and psychological screening and ready access to neuropsychological management strategies are key components for optimising neuropsychological outcomes. However, a lack of standardised and validated screening tools, particularly in resource-limited settings, hinders a precise understanding of the nature, prevalence and associations between neuropsychological symptomatology and HIV health. This article reviews the natural history, cellular pathophysiology and structural and functional imaging findings for children growing up with HIV, as well as summarising management strategies related to antiretroviral therapy, screening tools and specific interventions for neurocognitive impairments and psychological disorders.
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13
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Frigati LJ, Ameyan W, Cotton MF, Gregson CL, Hoare J, Jao J, Majonga ED, Myer L, Penazzato M, Rukuni R, Rowland-Jones S, Zar HJ, Ferrand RA. Chronic comorbidities in children and adolescents with perinatally acquired HIV infection in sub-Saharan Africa in the era of antiretroviral therapy. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:688-698. [PMID: 32359507 DOI: 10.1016/s2352-4642(20)30037-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
Abstract
Globally, 1·7 million children are living with HIV, of which 90% are in sub-Saharan Africa. The remarkable scale-up of combination antiretroviral therapy has resulted in increasing numbers of children with HIV surviving to adolescence. Unfortunately, in sub-Saharan Africa, HIV diagnosis is often delayed with children starting antiretroviral therapy late in childhood. There have been increasing reports from low-income settings of children with HIV who have multisystem chronic comorbidities despite antiretroviral therapy. Many of these chronic conditions show clinical phenotypes distinct from those in adults with HIV, and result in disability and reduced quality of life. In this Review, we discuss the spectrum and pathogenesis of comorbidities in children with HIV in sub-Saharan Africa. Prompt diagnosis and treatment of perinatally acquired HIV infection is a priority. Additionally, there is a need for increased awareness of the burden of chronic comorbidities. Diagnostic and therapeutic strategies need to be collectively developed if children with HIV are to achieve their full potential.
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Affiliation(s)
- Lisa J Frigati
- SA-MRC Unit on Child and Adolescent Health, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Wole Ameyan
- Department of HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Mark F Cotton
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Celia L Gregson
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edith D Majonga
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Martina Penazzato
- Department of HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Ruramayi Rukuni
- Biomedical Research and Training Institute, Harare, Zimbabwe; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heather J Zar
- SA-MRC Unit on Child and Adolescent Health, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
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14
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Machine-learning classification of neurocognitive performance in children with perinatal HIV initiating de novo antiretroviral therapy. AIDS 2020; 34:737-748. [PMID: 31895148 DOI: 10.1097/qad.0000000000002471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To develop a predictive model of neurocognitive trajectories in children with perinatal HIV (pHIV). DESIGN Machine learning analysis of baseline and longitudinal predictors derived from clinical measures utilized in pediatric HIV. METHODS Two hundred and eighty-five children (ages 2-14 years at baseline; Mage = 6.4 years) with pHIV in Southeast Asia underwent neurocognitive assessment at study enrollment and twice annually thereafter for an average of 5.4 years. Neurocognitive slopes were modeled to establish two subgroups [above (n = 145) and below average (n = 140) trajectories). Gradient-boosted multivariate regressions (GBM) with five-fold cross validation were conducted to examine baseline (pre-ART) and longitudinal predictive features derived from demographic, HIV disease, immune, mental health, and physical health indices (i.e. complete blood count [CBC]). RESULTS The baseline GBM established a classifier of neurocognitive group designation with an average AUC of 79% built from HIV disease severity and immune markers. GBM analysis of longitudinal predictors with and without interactions improved the average AUC to 87 and 90%, respectively. Mental health problems and hematocrit levels also emerged as salient features in the longitudinal models, with novel interactions between mental health problems and both CD4 cell count and hematocrit levels. Average AUCs derived from each GBM model were higher than results obtained using logistic regression. CONCLUSION Our findings support the feasibility of machine learning to identify children with pHIV at risk for suboptimal neurocognitive development. Results also suggest that interactions between HIV disease and mental health problems are early antecedents to neurocognitive difficulties in later childhood among youth with pHIV.
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15
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Systemic and intrathecal immune activation in association with cerebral and cognitive outcomes in paediatric HIV. Sci Rep 2019; 9:8004. [PMID: 31142789 PMCID: PMC6541601 DOI: 10.1038/s41598-019-44198-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/24/2019] [Indexed: 01/23/2023] Open
Abstract
Despite treatment, immune activation is thought to contribute to cerebral injury in children perinatally infected with human immunodeficiency virus (HIV). We aimed to characterize immune activation in relation to neuroimaging and cognitive outcomes. We therefore measured immunological, coagulation, and neuronal biomarkers in plasma and cerebrospinal fluid (CSF) samples of 34 perinatally HIV-infected children aged 8–18 years, and in plasma samples of 37 controls of comparable age, sex, ethnicity, and socio-economic status. We then compared plasma biomarker levels between groups, and explored associations between plasma/CSF biomarkers and neuroimaging and cognitive outcomes using network analysis. HIV-infected children showed higher plasma levels of C-reactive protein, interferon-gamma, interferon-gamma-inducible protein-10, and monocyte chemoattractant protein-1 than controls. In HIV-infected participants, plasma soluble CD14 was positively associated with microstructural white matter (WM) damage, and plasma D-dimer was negatively associated with WM blood flow. In CSF, IL-6 was negatively associated with WM volume, and neurofilament heavy-chain (NFH) was negatively associated with intelligence quotient and working memory. These markers of ongoing inflammation, immune activation, coagulation, and neuronal damage could be used to further evaluate the pathophysiology and clinical course of cerebral and cognitive deficits in perinatally acquired HIV.
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16
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Van den Hof M, Ter Haar AM, Caan MWA, Spijker R, van der Lee JH, Pajkrt D. Brain structure of perinatally HIV-infected patients on long-term treatment: A systematic review. Neurol Clin Pract 2019; 9:433-442. [PMID: 31750029 DOI: 10.1212/cpj.0000000000000637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
Abstract
Objective We aim to give an overview of the available evidence on brain structure and function in PHIV-infected patients (PHIV+) using long-term combination antiretroviral therapy (cART) and how differences change over time. Methods We conducted an electronic search using MEDLINE, Embase, and PsycINFO. We used the following selection criteria: cohort and cross-sectional studies that reported on brain imaging differences between PHIV+ of all ages who used cART for at least six months before neuroimaging and HIV-negative controls. Two reviewers independently selected studies, performed data extraction, and assessed quality of studies. Results After screening 1500 abstracts and 343 full-text articles, we identified 19 eligible articles. All included studies had a cross-sectional design and used MRI with different modalities: structural MRI (n = 7), diffusion tensor imaging (DTI) (n = 6), magnetic resonance spectroscopy (n = 5), arterial spin labeling (n = 1), and resting-state functional neuroimaging (n = 1). Studies showed considerable methodological limitations and heterogeneity, preventing us to perform meta-analyses. DTI data on white matter microstructure suggested poorer directional diffusion in cART-treated PHIV+ compared with controls. Other modalities were inconclusive. Conclusion Evidence may suggest brain structure and function differences in the population of PHIV+ on long-term cART compared with the HIV-negative population. Because of a small study population, and considerable heterogeneity and methodological limitations, the extent of brain structure and function differences on neuroimaging between groups remains unknown.
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Affiliation(s)
- Malon Van den Hof
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Anne Marleen Ter Haar
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Matthan W A Caan
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Rene Spijker
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Johanna H van der Lee
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Dasja Pajkrt
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
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17
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Wade BSC, Valcour VG, Puthanakit T, Saremi A, Gutman BA, Nir TM, Watson C, Aurpibul L, Kosalaraksa P, Ounchanum P, Kerr S, Dumrongpisutikul N, Visrutaratna P, Srinakarin J, Pothisri M, Narr KL, Thompson PM, Ananworanich J, Paul RH, Jahanshad N. Mapping abnormal subcortical neurodevelopment in a cohort of Thai children with HIV. NEUROIMAGE-CLINICAL 2019; 23:101810. [PMID: 31029050 PMCID: PMC6482384 DOI: 10.1016/j.nicl.2019.101810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
Alterations in subcortical brain structures have been reported in adults with HIV and, to a lesser extent, pediatric cohorts. The extent of longitudinal structural abnormalities in children with perinatal HIV infection (PaHIV) remains unclear. We modeled subcortical morphometry from whole brain structural magnetic resonance imaging (1.5 T) scans of 43 Thai children with PaHIV (baseline age = 11.09±2.36 years) and 50 HIV- children (11.26±2.80 years) using volumetric and surface-based shape analyses. The PaHIV sample were randomized to initiate combination antiretroviral treatment (cART) when CD4 counts were 15-24% (immediate: n = 22) or when CD4 < 15% (deferred: n = 21). Follow-up scans were acquired approximately 52 weeks after baseline. Volumetric and shape descriptors capturing local thickness and surface area dilation were defined for the bilateral accumbens, amygdala, putamen, pallidum, thalamus, caudate, and hippocampus. Regression models adjusting for clinical and demographic variables examined between and within group differences in morphometry associated with HIV. We assessed whether baseline CD4 count and cART status or timing associated with brain maturation within the PaHIV group. All models were adjusted for multiple comparisons using the false discovery rate. A pallidal subregion was significantly thinner in children with PaHIV. Regional thickness, surface area, and volume of the pallidum was associated with CD4 count in children with PaHIV. Longitudinal morphometry was not associated with HIV or cART status or timing, however, the trajectory of the left pallidum volume was positively associated with baseline CD4 count. Our findings corroborate reports in adult cohorts demonstrating a high predilection for HIV-mediated abnormalities in the basal ganglia, but suggest the effect of stable PaHIV infection on morphological aspects of brain development may be subtle.
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Affiliation(s)
- Benjamin S C Wade
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA; Ahmanson-Lovelace Brain Mapping Center University of California, Los Angeles, Los Angeles, CA, USA; Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, USA
| | - Victor G Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Arvin Saremi
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Boris A Gutman
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Talia M Nir
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Christa Watson
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Pope Kosalaraksa
- Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | | | - Stephen Kerr
- HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Jiraporn Srinakarin
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Monthana Pothisri
- Department of Radiology, Chulalongkorn University Medical Center, Bangkok, Thailand
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Jintanat Ananworanich
- HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, MD, USA; Department of Global Health, University of Amsterdam, Amsterdam, the Netherlands; Henry M. Jackson Foundation for the Advancement of Military Medicine, MD, USA
| | - Robert H Paul
- Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA.
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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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Hoare J, Heany SJ, Fouche JP, Phillips N, Joska JA, Myer L, Zar HJ, Stein DJ. Initiation of antiretroviral therapy after the critical neuronal developmental period of the second postnatal year affects white matter microstructure in adolescents living with HIV. J Neurovirol 2019; 25:254-262. [PMID: 30617850 DOI: 10.1007/s13365-018-0712-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
Rapid maturation of major white matter pathways occurs in the first 2 years of life, indicating a critical neuronal developmental period. The impact of initiating antiretroviral therapy (ART) in children perinatally infected with HIV-1, after the age of 2 years on neurocognitive functioning and white matter development in adolescence has not been studied. Forty-six adolescents who initiated ART during the first 2 years of life (< 2 years) and 79 adolescents who initiated ART after 2 years of age (> 2 years), with perinatally acquired HIV were enrolled in the Cape Town Adolescent Antiretroviral Cohort. Adolescents completed a comprehensive neurocognitive battery testing a number of cognitive domains. Diffusion tensor imaging (DTI) was done to determine fractional anisotropy (FA), mean diffusivity (MD), axial diffusion (AD), and radial diffusion (RD) in a region of interest analysis. Neurocognitive performance was similar between adolescents who initiated ART < 2 years or > 2 years. There was a trend towards attention (p = .07) and working memory (p = .05) being poorer in the group who initiated ART > 2 years. FA was lower in the > 2-year group in the superior corona radiata (p = .03), and the external capsule (p = .04). MD was higher in the > 2-year group in the cerebral peduncle (p = .02), the superior corona radiata (p = .01), and the superior fronto-occipital fasciculus (p = .03). RD was higher in the > 2-year group in the superior corona radiata (p = .02), the cerebral peduncle (p = .01), and the superior fronto-occipital fasciculus (p = .01). However, the higher AD in the > 2-year group in the superior corona radiata was not in the expected direction (p = .01). Initiation of ART after the neuronal development period of the second postnatal year is associated with white matter alterations on neuroimaging.
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Affiliation(s)
- Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.
| | - Sarah J Heany
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Nicole Phillips
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, UCT, Cape Town, South Africa.,SA Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.,Medical Research Council Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
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Sarma MK, Keller MA, Macey PM, Michalik DE, Hayes J, Nielsen-Saines K, Deville J, Church JA, Walot I, Albert Thomas M. White matter microstructure among perinatally HIV-infected youth: a diffusion tensor imaging study. J Neurovirol 2019; 25:313-323. [PMID: 30610741 DOI: 10.1007/s13365-018-0714-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
We evaluated white matter microstructure integrity in perinatally HIV-infected (PHIV) youths receiving cART compared to age- and gender-matched healthy youths through DTI metrics using voxel-based morphometry (VBM). We investigated 14 perinatally HIV-infected patients (age 17.9 ± 2.5 years) on cART and 17 healthy youths (HC) (age 18.0 ± 3.0 years) using a 3T MRI scanner. Four DTI-derived metrics were fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Statistical analysis was done with voxel-based analysis of covariance (ANCOVA), with age and gender as covariates. Region-of-interest secondary analyses in statistically significant regions were also performed. Regional increases in FA in the PHIV youths were found in left middle frontal gyrus, right precuneus, right lingual gyrus, and left supramarginal gyrus. Increased MD was found in the right precentral gyrus while decreased MD was found in the white matter of the right superior parietal lobule and right inferior temporal gyrus/fusiform gyrus. Regions of increased/decreased RD overlapped with regions of increased/decreased MD. Both increased and decreased AD were found in three to four regions respectively. The regional FA, MD, RD, and AD values were consistent with the voxel-based analysis findings. The findings are mostly consistent with previous literature, but increased FA has not been previously reported for perinatally HIV-infected youths. Potentially early and prolonged therapy in our population may have contributed to this new finding. Both toxicity of antiretroviral therapy and indolent infection must be considered as causative factors in the DTI metric changes that we have observed.
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Affiliation(s)
- Manoj K Sarma
- Radiological Sciences, David Geffen School of Medicine, UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA
| | - Margaret A Keller
- Pediatrics, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA.,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Paul M Macey
- Brain Research Institute, UCLA School of Medicine, Los Angeles, CA, USA.,UCLA School of Nursing, Los Angeles, CA, USA
| | - David E Michalik
- Infectious Diseases-Pediatrics, Miller Children's Hospital of Long Beach, Long Beach, CA, USA
| | - Judy Hayes
- Pediatrics, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Jaime Deville
- Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph A Church
- Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Irwin Walot
- Radiology, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - M Albert Thomas
- Radiological Sciences, David Geffen School of Medicine, UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA.
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21
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Hoare J, Fouche JP, Phillips N, Joska JA, Myer L, Zar HJ, Stein DJ. Structural brain changes in perinatally HIV-infected young adolescents in South Africa. AIDS 2018; 32:2707-2718. [PMID: 30234601 DOI: 10.1097/qad.0000000000002024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe the structural brain changes, neurocognitive and mental health associations in adolescents perinatally infected with HIV-1 infection. DESIGN Cross-sectional. METHODS Two hundred and four adolescents with perinatally acquired HIV and 44 uninfected frequency-matched controls aged 9-11 years were enrolled within the Cape Town Adolescent Antiretroviral Cohort. Diffusion tensor imaging and structural brain MRI was done to determine fractional anisotropy, mean diffusivity, grey and white matter volumes, cortical thickness and cortical surfractional anisotropy area. Correlation coefficients were calculated between total grey and white matter volume, cortical surface area, cortical thickness, whole brain fractional anisotropy and whole brain mean diffusivity and clinical and laboratory parameters including general intellectual functioning, Becks Youth Inventory, Child Motivation Scale and Child Behaviour Checklist. RESULTS HIV-infected adolescents performed worse than controls on the Wechsler Abbreviated Scale of Intelligence (WASI; P < 0.01). HIV-infected adolescents had significant fractional anisotropy decreases, mean diffusivity increases and decreases in cerebral grey matter volumes, cortical surface area and decreased gyrification. Whole-brain mean fractional anisotropy was significantly reduced in the HIV-infected group (P = 0.031). There were significant correlation coefficients between greater total grey (P = 0.008) and white matter volume (P = 0.004) with the WASI and the Becks self-concept subscale (P = 0.038). Lower whole brain fractional anisotropy was associated with higher scores on the Becks anger (P = 0.018) and disruptive behaviour subscales (P = 0.031). Higher whole brain mean diffusivity was associated with apathy (P = 0.046). CONCLUSION The pattern of increased risk of white matter microstructure alterations, smaller grey matter volumes, reduced cortical surface area and decreased gyrification, suggests abnormal neurodevelopment in perinatally infected younger adolescents.
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Abrams EJ, Mellins CA, Bucek A, Dolezal C, Raymond J, Wiznia A, Jurgrau A, Bamji M, Leu CS, Ng YKW. Behavioral Health and Adult Milestones in Young Adults With Perinatal HIV Infection or Exposure. Pediatrics 2018; 142:peds.2018-0938. [PMID: 30097528 PMCID: PMC6317560 DOI: 10.1542/peds.2018-0938] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Young adults living with perinatally acquired HIV infection (PHIVYAs) are at risk for poor biomedical and behavioral health outcomes. Few studies offer a comprehensive overview of the functioning of this population in young adulthood and the role of HIV. METHODS Data come from the Child and Adolescent Self-Awareness and Health Study, a longitudinal behavioral health cohort study of PHIVYAs and perinatally HIV-exposed but uninfected young adults (PHEUYAs) who are compared on psychiatric and neurocognitive functioning, sexual and substance use behaviors, health and reproductive outcomes, and young adult milestones. RESULTS Overall, 27% of participants met criteria for a psychiatric disorder, including mood (11%), anxiety (22%), and substance use (28%), with no HIV status differences. PHIVYAs performed worse on 2 neurocognitive tests. There were no HIV status differences in condomless sex (41%) or pregnancies (41% women; 38% men). Both groups exhibited similar adult milestones: 67% graduated high school or an equivalent, 19% were in college, and 42% were employed. However, 38% were neither in school or working, 12% reported incarceration, and 16% were ever homeless. Among PHIVYAs, 36% were viremic (>200 copies per mL), and 15% were severely immunocompromised (CD4+ cell count <100 cells per mm3). CONCLUSIONS Many PHIVYAs achieve adult milestones related to school, employment, sexual relationships, and starting families. However, they and PHEUYAs have high rates of psychiatric and substance use disorders and behavioral risks, which can jeopardize long-term health and adult functioning, particularly in the context of HIV. These findings underscore an urgent need to escalate interventions.
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Affiliation(s)
- Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health,,Vagelos College of Physicians and Surgeons, and
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Amelia Bucek
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Jeannette Raymond
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Jurgrau
- New York–Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
| | | | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Yiu Kee Warren Ng
- New York–Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
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23
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Abrams EJ, Ananworanich J, Archary M, Ngongondo M, Brouwers P. Propelling the Pediatric HIV Therapeutic Agenda With Science, Innovation, and Collaboration. J Acquir Immune Defic Syndr 2018; 78 Suppl 1:S32-S39. [PMID: 29994918 PMCID: PMC6044456 DOI: 10.1097/qai.0000000000001747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND A number of well-described obstacles to the pediatric therapeutic agenda have resulted in substantial delays in the introduction of new medications, formulations, strategies, and approaches to treat infants, children, and adolescents living with HIV. SETTING Global landscape. METHODS The authors will provide a summary of current and emerging initiatives to accelerate the pediatric therapeutic agenda including illustrative case studies of innovations and scientific discovery in diagnosis and treatment of very young children with HIV infection. RESULTS The challenges posed by rapid physiologic and developmental changes that characterize the trajectory of childhood as well as the complex regulatory and fiscal milieu of HIV therapeutics have hampered pediatric HIV therapeutic research. Recent efforts to accelerate this agenda include prioritizing agents and formulations, defining dosing by weight bands, applying innovative study designs, synergizing work across research networks to achieve common goals, and the establishment of a global prioritized research agenda. A case study of initiatives to diagnose and effectively treat newborns and infants will illustrate the critical role of basic science research and novel approaches to study design and implementation that are informing global efforts to end AIDS. CONCLUSIONS A pediatric therapeutic agenda informed by basic science and achieved through innovation and global cooperation is essential to achieve an AIDS-free generation.
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Affiliation(s)
- Elaine J. Abrams
- ICAP at Columbia, Mailman School of Public Health, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Global Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Moherndran Archary
- Paediatric Infectious Diseases Unit, King Edward VIII Hospital, University of KwaZulu Natal, Durban, South Africa
| | | | - Pim Brouwers
- Division of AIDS Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
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24
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Horvath S, Stein DJ, Phillips N, Heany SJ, Kobor MS, Lin DTS, Myer L, Zar HJ, Levine AJ, Hoare J. Perinatally acquired HIV infection accelerates epigenetic aging in South African adolescents. AIDS 2018; 32:1465-1474. [PMID: 29746298 PMCID: PMC6026068 DOI: 10.1097/qad.0000000000001854] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Recent studies demonstrate that infection with the HIV-1 is associated with accelerated aging effects in adults according to a highly accurate epigenetic biomarker of aging known as epigenetic clock. However, it is not yet known whether epigenetic age acceleration occurs as early as adolescence in perinatally HIV-infected (PHIV+) youth. DESIGN Observational study of PHIV and HIV-uninfected adolescents enrolled in the Cape Town Adolescent Antiretroviral Cohort Study. METHODS The Illumina EPIC array was used to generate blood DNA methylation data from 204 PHIV and 44 age-matched, uninfected (HIV-) adolescents aged 9-12 years old. The epigenetic clock software and method was used to estimate two measures of epigenetic age acceleration. Each participant completed a comprehensive neuropsychological test battery upon enrollment to Cape Town Adolescent Antiretroviral Cohort. RESULTS HIV is associated with biologically older blood in PHIV+ adolescents according to both measures of epigenetic age acceleration. One of the measures, extrinsic epigenetic age acceleration, is negatively correlated with measures of cognitive functioning (executive functioning, working memory, processing speed). CONCLUSION Overall, our results indicate that epigenetic age acceleration in blood can be observed in PHIV+ adolescents and that these epigenetic changes accompany poorer cognitive functioning.
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Affiliation(s)
- Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Dan J Stein
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Nicole Phillips
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Sarah J Heany
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Michael S Kobor
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - David T S Lin
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Landon Myer
- Centre for Infectious Disease Epidemiology and Research
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital
- SA-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - Andrew J Levine
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Jacqueline Hoare
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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Abstract
BACKGROUND Children with vertically acquired HIV exhibit persistent cognitive impairments, yet the corresponding neuroimaging signature of vertical infection remains unclear. METHODS Fifty healthy control children and 51 vertically infected children were included in the study. The HIV-infected group consisted of survivors who had not received antiretroviral therapy at birth. The HIV-infected group averaged 11.4 (2.5) years of age, with a median CD4 count of 683 cells/mm(3). Most (71%) of the HIV-infected children were on antiretroviral therapy for a median of 34 months (range: 33-42) with HIV RNA <40 copies/mL in 89% of the sample. The HIV-uninfected group averaged 10.6 (2.6) years of age. Magnetic resonance imaging was acquired to determine volumes of the caudate, putamen, thalamus, pallidum, hippocampus, nucleus accumbens, total white matter, total gray matter and cortical gray matter. Correlational analyses examined the degree of shared variance between brain volumes and both cognitive performances and laboratory markers of disease activity (T cells and plasma viral load). RESULTS HIV-infected children exhibited larger volumes of the caudate, nucleus accumbens, total gray matter and cortical gray matter when compared with the controls. Volumetric differences were predominately evident in children under 12 years of age. HIV-infected children performed worse than controls on most neuropsychologic tests, though neither cognitive performances nor laboratory markers corresponded to brain volumes in the HIV-infected children. CONCLUSIONS Outcomes of the present study suggest abnormal brain maturation among HIV-infected pediatric survivors. Longitudinal studies of brain integrity and related resilience factors are needed to determine the impact of neuroimaging abnormalities on psychosocial function in pediatric HIV.
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Axonal chronic injury in treatment-naïve HIV+ adults with asymptomatic neurocognitive impairment and its relationship with clinical variables and cognitive status. BMC Neurol 2018; 18:66. [PMID: 29747571 PMCID: PMC5943991 DOI: 10.1186/s12883-018-1069-5] [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: 02/10/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022] Open
Abstract
Background HIV is a neurotropic virus, and it can bring about neurodegeneration and may even result in cognitive impairments. The precise mechanism of HIV-associated white matter (WM) injury is unknown. The effects of multiple clinical contributors on WM impairments and the relationship between the WM alterations and cognitive performance merit further investigation. Methods Diffusion tensor imaging (DTI) was performed in 20 antiretroviral-naïve HIV-positive asymptomatic neurocognitive impairment (ANI) adults and 20 healthy volunteers. Whole-brain analysis of DTI metrics between groups was conducted by employing tract-based spatial statistics (TBSS), including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). DTI parameters were correlated with clinical variables (age, CD4+ cell count, CD4+/CD8+ ratio, plasma viral load and duration of HIV infection) and multiple cognitive tests by using multilinear regression analyses. Results DTI quantified diffusion alterations in the corpus callosum and corona radiata (MD increased significantly, P < 0.05) and chronic axonal injury in the corpus callosum, corona radiata, internal capsule, external capsule, posterior thalamic radiation, sagittal stratum, and superior longitudinal fasciculus (AD increased significantly, P < 0.05). The impairments in the corona radiata had significant correlations with the current CD4+/CD8+ ratios. Increased MD or AD values in multiple white matter structures showed significant associations with many cognitive domain tests. Conclusions WM impairments are present in neurologically asymptomatic HIV+ adults, periventricular WM (corpus callosum and corona radiata) are preferential occult injuries, which is associated with axonal chronic damage rather than demyelination. Axonopathy may exist before myelin injury. DTI-TBSS is helpful to explore the WM microstructure abnormalities and provide a new perspective for the investigation of the pathomechanism of HIV-associated WM injury.
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Phillips NJ, Hoare J, Stein DJ, Myer L, Zar HJ, Thomas KGF. HIV-associated cognitive disorders in perinatally infected children and adolescents: a novel composite cognitive domains score. AIDS Care 2018; 30:8-16. [PMID: 29681168 DOI: 10.1080/09540121.2018.1466982] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Accurate assessment of HIV-associated cognitive disorders in perinatally infected children and adolescents is challenging. Assessments of general intellectual functioning, or global cognition, may not provide information regarding domain-specific strengths and weaknesses, and may therefore fail to detect, impaired trajectories of development within particular cognitive domains. We compare the efficacy of global cognitive scores to that of composite cognitive domain scores in detecting cognitive disorders in a sample of perinatally HIV-infected children, and a demographically matched HIV negative control group, drawn from the Cape Town Adolescent Antiretroviral Cohort (CTAAC) study. All children were administered a comprehensive neuropsychological test battery. Using data from that test battery, we created ten separate composite cognitive domains: general intellectual functioning, attention, working memory, visual memory, verbal memory, language, visual spatial ability, motor coordination, processing speed and executive function. Within each domain, each test bore a high level of association with each of the other tests in that domain (Cronbach's α ≥ .70 for all domains). We found that composite domain scores calculated on whole-sample data were significantly higher than those calculated using control-sample data. Our comparison of a global cognitive score to composite domain scores suggested that the latter provided more detailed information (regarding strengths, weaknesses, areas of impairment), and when compared to global scores, were more sensitive in detecting HIV-associated cognitive disorders, and were able to distinguish HIV-infected patients from uninfected controls. Hence, we recommend using this method of composite cognitive domains scores, rather than global aggregate scores, when assessing cognitive function in paediatric HIV. This method provides a convenient and relatively accurate assessment that might help with cross-cultural and cross-region comparisons as researchers try to detect cognitive impairment patterns in HIV-infected children and adolescents globally.
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Affiliation(s)
- Nicole J Phillips
- a Department of Psychiatry and Mental Health , University of Cape Town (UCT) , Cape Town , South Africa
| | - Jacqueline Hoare
- a Department of Psychiatry and Mental Health , University of Cape Town (UCT) , Cape Town , South Africa
| | - Dan J Stein
- a Department of Psychiatry and Mental Health , University of Cape Town (UCT) , Cape Town , South Africa.,b South African Medical Research Council Unit on Risk & Resilience in Mental Disorders , Cape Town , South Africa
| | - Landon Myer
- c Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine , University of Cape Town (UCT) , Cape Town , South Africa
| | - Heather J Zar
- d Department of Paediatrics and Child Health, and the South African Medical Research Council Unit on Child and Adolescent Health , Cape Town , South Africa
| | - Kevin G F Thomas
- e ACSENT Laboratory, Department of Psychology , University of Cape Town (UCT) , Cape Town , South Africa
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Fitting S, McLaurin KA, Booze RM, Mactutus CF. Dose-dependent neurocognitive deficits following postnatal day 10 HIV-1 viral protein exposure: Relationship to hippocampal anatomy parameters. Int J Dev Neurosci 2018; 65:66-82. [PMID: 29111178 PMCID: PMC5889695 DOI: 10.1016/j.ijdevneu.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022] Open
Abstract
Despite the availability of antiretroviral prophylactic treatment, pediatric human immunodeficiency virus type 1 (HIV-1) continues to be a significant risk factor in the post-cART era. The time of infection (i.e., during pregnancy, delivery or breastfeeding) may play a role in the development of neurocognitive deficits in pediatric HIV-1. HIV-1 viral protein exposure on postnatal day (P)1, preceding the postnatal brain growth spurt in rats, had deleterious effects on neurocognitive development and anatomical parameters of the hippocampus (Fitting et al., 2008a,b). In the present study, rats were stereotaxically injected with HIV-1 viral proteins, including Tat1-86 and gp120, on P10 to further examine the role of timing on neurocognitive development and anatomical parameters of the hippocampus (Fitting et al., 2010). The dose-dependent virotoxin effects observed across development following P10 Tat1-86 exposure were specific to spatial learning and absent from prepulse inhibition and locomotor activity. A relationship between alterations in spatial learning and/or memory and hippocampal anatomical parameters was noted. Specifically, the estimated number of neurons and astrocytes in the hilus of the dentate gyrus explained 70% of the variance of search behavior in Morris water maze acquisition training for adolescents and 65% of the variance for adults; a brain-behavior relationship consistent with observations following P1 viral protein exposure. Collectively, late viral protein exposure (P10) results in selective alterations in neurocognitive development without modifying measures of somatic growth, preattentive processing, or locomotor activity, as characterized by early viral protein exposure (P1). Thus, timing may be a critical factor in disease progression, with children infected with HIV earlier in life being more vulnerable to CNS disease.
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Affiliation(s)
- Sylvia Fitting
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA; University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Kristen A McLaurin
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA
| | - Rosemarie M Booze
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA
| | - Charles F Mactutus
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA.
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Nwosu EC, Robertson FC, Holmes MJ, Cotton MF, Dobbels E, Little F, Laughton B, van der Kouwe A, Meintjes EM. Altered brain morphometry in 7-year old HIV-infected children on early ART. Metab Brain Dis 2018; 33:523-535. [PMID: 29209922 PMCID: PMC5866746 DOI: 10.1007/s11011-017-0162-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
Abstract
Even with the increased roll out of combination antiretroviral therapy (cART), paediatric HIV infection is associated with neurodevelopmental delays and neurocognitive deficits that may be accompanied by alterations in brain structure. Few neuroimaging studies have been done in children initiating ART before 2 years of age, and even fewer in children within the critical stage of brain development between 5 and 11 years. We hypothesized that early ART would limit HIV-related brain morphometric deficits at age 7. Study participants were 7-year old HIV-infected (HIV+) children from the Children with HIV Early Antiretroviral Therapy (CHER) trial whose viral loads were supressed at a young age, and age-matched uninfected controls. We used structural magnetic resonance imaging (MRI) and FreeSurfer ( http://www.freesurfer.net/ ) software to investigate effects of HIV and age at ART initiation on cortical thickness, gyrification and regional brain volumes. HIV+ children showed reduced gyrification compared to controls in bilateral medial parietal regions, as well as reduced volumes of the right putamen, left hippocampus, and global white and gray matter and thicker cortex in small lateral occipital region. Earlier ART initiation was associated with lower gyrification and thicker cortex in medial frontal regions. Although early ART appears to preserve cortical thickness and volumes of certain brain structures, HIV infection is nevertheless associated with reduced gyrification in the parietal cortex, and lower putamen and hippocampus volumes. Our results indicate that in early childhood gyrification is more sensitive than cortical thickness to timing of ART initiation. Future work will clarify the implications of these morphometric effects for neuropsychological function.
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Affiliation(s)
- Emmanuel C Nwosu
- 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.
| | - Frances C Robertson
- 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
| | - 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
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Els Dobbels
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, Faculty of Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- A.A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - 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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Abstract
Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or without a contrast agent). In addition, single-photon emission computed tomography with various tracers (e.g., thallium-201, Tc99-HMPAO) and positron emission tomography with various agents (e.g., [18F]-dexoyglucose, [11C]-PiB, and [11C]-TSPO tracers), were applied to study opportunistic infections or HIV-associated neurocognitive disorders. Neuroimaging provides diagnoses and biomarkers to quantitate the severity of brain injury or to monitor treatment effects, and may yield insights into the pathophysiology of HIV infection. As the majority of antiretroviral-stable HIV+ patients are living longer, age-related comorbid disorders (e.g., additional neuroinflammation, cerebrovascular disorders, or other dementias) will need to be considered. Other highly prevalent conditions, such as substance use disorders, psychiatric illnesses, and the long-term effects of combined antiretroviral therapy, all may lead to additional brain injury. Neuroimaging studies could provide knowledge regarding how these comorbid conditions impact the HIV-infected brain. Lastly, specific molecular imaging agents may be needed to assess the central nervous system viral reservoir.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Medicine and Department of Neurology, John A. Burns School of Medicine, University of Hawaii, Manoa, United States.
| | - Dinesh K Shukla
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning. J Acquir Immune Defic Syndr 2017; 75:455-464. [PMID: 28481783 DOI: 10.1097/qai.0000000000001441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known regarding effects of perinatally acquired HIV infection (PHIV) on longitudinal change in memory and executive functioning (EF) during adolescence despite the importance of these skills for independence in adulthood. METHODS PHIV (n = 144) and perinatally HIV-exposed uninfected youth (PHEU, n = 79), ages 12-17, completed standardized tests of memory and EF at baseline and 2 years later. Changes from baseline for each memory and EF outcome were compared between PHEU and PHIV youth with (PHIV/C, n = 39) and without (PHIV/non-C, n = 105) history of CDC class C (AIDS-defining) diagnoses. Among PHIV youth, associations of baseline and past disease severity with memory and EF performance at follow-up were evaluated using adjusted linear regression models. RESULTS Participants were primarily black (79%); 16% were Hispanic; 55% were female. Mean memory and EF scores at follow-up generally fell in the low-average to average range. Pairwise comparison of adjusted mean change from baseline to follow-up revealed significantly greater change for PHIV/non-C compared with PHEU youth in only one verbal recognition task, with a difference in mean changes for PHIV/non-C versus PHEU of -0.99 (95% CI: -1.80 to -0.19; P = 0.02). Among youth with PHIV, better immunologic status at baseline was positively associated with follow-up measures of verbal recall and recognition and cognitive inhibition/flexibility. Past AIDS-defining diagnoses and higher peak viral load were associated with lower performance across multiple EF tasks at follow-up. CONCLUSIONS Youth with PHIV demonstrated stable memory and EF during a 2-year period of adolescence, allowing cautious optimism regarding long-term outcomes.
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Tang Z, Liu Z, Li R, Yang X, Cui X, Wang S, Yu D, Li H, Dong E, Tian J. Identifying the white matter impairments among ART-naïve HIV patients: a multivariate pattern analysis of DTI data. Eur Radiol 2017; 27:4153-4162. [PMID: 28396994 DOI: 10.1007/s00330-017-4820-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/04/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify the white matter (WM) impairments of the antiretroviral therapy (ART)-naïve HIV patients by conducting a multivariate pattern analysis (MVPA) of Diffusion Tensor Imaging (DTI) data METHODS: We enrolled 33 ART-naïve HIV patients and 32 Normal controls in the current study. Firstly, the DTI metrics in whole brain WM tracts were extracted for each subject and feed into the Least Absolute Shrinkage and Selection Operators procedure (LASSO)-Logistic regression model to identify the impaired WM tracts. Then, Support Vector Machines (SVM) model was constructed based on the DTI metrics in the impaired WM tracts to make HIV-control group classification. Pearson correlations between the WM impairments and HIV clinical statics were also investigated. RESULTS Extensive HIV-related impairments were observed in the WM tracts associated with motor function, the corpus callosum (CC) and the frontal WM. With leave-one-out cross validation, accuracy of 83.08% (P=0.002) and the area under the Receiver Operating Characteristic curve of 0.9110 were obtained in the SVM classification model. The impairments of the CC were significantly correlated with the HIV clinic statics. CONCLUSION The MVPA was sensitive to detect the HIV-related WM changes. Our findings indicated that the MVPA had considerable potential in exploring the HIV-related WM impairments. KEY POINTS • WM impairments along motor pathway were detected among the ART-naïve HIV patients • Prominent HIV-related WM impairments were observed in CC and frontal WM • The impairments of CC were significantly related to the HIV clinic statics • The CC might be susceptible to immune dysfunction and HIV replication • Multivariate pattern analysis had potential for studying the HIV-related white matter impairments.
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Affiliation(s)
- Zhenchao Tang
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, Shandong Province, 264209, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Ruili Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Xin Yang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Xingwei Cui
- Cooperative Innovation Center of Internet Healthcare, Zhengzhou University, Zhengzhou, China, 450052
| | - Shuo Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Dongdong Yu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China.
| | - Enqing Dong
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, Shandong Province, 264209, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China.
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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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Ackermann C, Andronikou S, Saleh MG, Laughton B, Alhamud AA, van der Kouwe A, Kidd M, Cotton MF, Meintjes EM. Early Antiretroviral Therapy in HIV-Infected Children Is Associated with Diffuse White Matter Structural Abnormality and Corpus Callosum Sparing. AJNR Am J Neuroradiol 2016; 37:2363-2369. [PMID: 27538904 DOI: 10.3174/ajnr.a4921] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/04/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Fractional anisotropy in the frontal white matter, corpus callosum, and internal capsule is abnormal in human immunodeficiency virus-positive (HIV+) adults. We describe the distribution and nature of white matter abnormalities in a cohort of children who started antiretroviral therapy within the first year of life and the benefit of early treatment by using DTI measures (fractional anisotropy and mean, axial, and radial diffusion). MATERIALS AND METHODS DTI was performed on children in a neurodevelopmental substudy from the Children with HIV Early Antiretroviral trial. Voxel-based group comparisons were obtained to determine regions where fractional anisotropy and mean diffusion differed between HIV+ and uninfected children. Associations of DTI parameters with the timing of antiretroviral therapy initiation were examined. RESULTS Thirty-nine HIV+ children (15 boys; mean age, 5.4 years) and 13 controls (5 boys; mean age, 5.7 years) were scanned. Two clusters with lower fractional anisotropy and 7 clusters with increased mean diffusion were identified in the HIV+ group, with symmetric distribution predominantly due to increased radial diffusion, suggestive of decreased myelination. Corticospinal tracts rather than the corpus callosum were predominantly involved. Children on early-interrupted antiretroviral therapy had lower fractional anisotropy compared with those receiving continuous treatment. CONCLUSIONS HIV+ children at 5 years of age have white matter abnormalities measured by fractional anisotropy, despite early antiretroviral therapy, suggesting that early antiretroviral therapy does not fully protect the white matter from either peripartum or in utero infection. In contrast to adults, the corticospinal tracts are predominantly involved rather than the corpus callosum, possibly due to early antiretroviral therapy. Continuous early antiretroviral therapy can limit white matter damage.
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Affiliation(s)
- C Ackermann
- From the Departments of Radiodiagnosis (C.A.)
| | - S Andronikou
- Clinical Research and Imaging Centre, Bristol (S.A.), University of Bristol, Bristol, UK
- Department of Paediatric Radiology (S.A.), Bristol Royal Hospital for Children, Bristol, UK
| | - M G Saleh
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
| | - B Laughton
- Paediatrics and Child Health (B.L., M.F.C.), Faculty of Medicine and Health Sciences
| | - A A Alhamud
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
| | - A van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging (A.v.d.K.), Massachusetts General Hospital, Charlestown, Massachusetts
| | - M Kidd
- Centre for Statistical Consultation (M.K.), Stellenbosch University, Tygerberg, South Africa
| | - M F Cotton
- Paediatrics and Child Health (B.L., M.F.C.), Faculty of Medicine and Health Sciences
| | - E M Meintjes
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
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Phillips N, Amos T, Kuo C, Hoare J, Ipser J, Thomas KGF, Stein DJ. HIV-Associated Cognitive Impairment in Perinatally Infected Children: A Meta-analysis. Pediatrics 2016; 138:peds.2016-0893. [PMID: 27940772 PMCID: PMC5079077 DOI: 10.1542/peds.2016-0893] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Research shows, conclusively, that perinatal HIV infection has negative effects on cognitive functioning of children and adolescents. However, the extent of these cognitive impairments is unknown. Current literature does not document specific cognitive domains most affected in HIV-infected children and adolescents. OBJECTIVE To systematically review and meta-analyze the degree of cognitive impairment, and the specific cognitive domains affected, in children and adolescents with perinatally acquired HIV infection. DATA SOURCES We systematically searched 5 electronic bibliographic databases, namely: PubMed, PsychINFO, Academic Search Premier, Scopus, and WorldCat, by using a search protocol specifically designed for this study. STUDY SELECTION Studies were selected on the basis of set a priori eligibility criteria. Titles, abstracts, and full texts were assessed by 2 independent reviewers. DATA EXTRACTION Data from included studies were extracted into Microsoft Excel by 2 independent reviewers. RESULTS Twenty-two studies were identified for inclusion in the systematic review and of this, 6 studies were included in the meta-analysis. Results from the meta-analysis indicated that working memory and executive function were the domains most affected by the HIV virus. LIMITATIONS Only 27% of the included studies were suitable to enter into the meta-analysis. There was significant geographic bias in published studies, with only 32% (7/22) of included studies from sub-Saharan Africa. CONCLUSIONS The evidence supports an association between HIV infection in children and adolescents and cognitive impairment in the domains of working memory, executive function and processing speed, with effect size estimates also providing some support for deficits in visual memory and visual-spatial ability.
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Affiliation(s)
| | - Taryn Amos
- Department of Psychiatry and Mental Health and
| | - Caroline Kuo
- Department of Psychiatry and Mental Health and,Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island; and
| | | | | | - Kevin G. F. Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and,South African Medical Research Council Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
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Proceedings from the NIMH symposium on "NeuroAIDS in Africa: neurological and neuropsychiatric complications of HIV". J Neurovirol 2016; 22:699-702. [PMID: 27473196 DOI: 10.1007/s13365-016-0467-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/22/2016] [Accepted: 06/30/2016] [Indexed: 12/24/2022]
Abstract
Despite major advances in HIV-1 treatment, the prevalence of HIV-associated neurocognitive disorders (HAND) remains a problem, particularly as individuals on suppressive treatment continue to live longer. To facilitate discussion on emerging and future directions in HAND research, a meeting was held in Durban, South Africa in March 2015 as part of the Society of Neuroscientists of Africa (SONA) conference. The objective of the meeting was to assess the impact of HIV subtype diversity on HAND and immunological dysfunction. The meeting brought together international leaders in the area of neurological complications of HIV-1 infection with special focus on the African population. Research presentations indicated that HAND was highly prevalent and that inflammatory cytokines and immune-activation played important roles in progression of neurocognitive impairment. Furthermore, children on antiretroviral therapy were also at risk for developing neurocognitive impairment. With respect to the effect of HIV-1 subtype diversity, analyses of HIV-1 clade C infection among South Africans revealed that clade C infection induced cognitive impairment that was independent of the substitution in HIV-1 Trans-Activator of Transcription (Tat; C31S). At the cellular level, a Zambian study showed that clade C infection resulted in reduced brain cell death compared with clade B infection suggesting clade specific variations in mediating brain cell injury. Furthermore, ex vivo Tat protein from clade CRF02_AG, prevalent in West/ Central Africa, exhibited reduced disruption of brain endothelium compared with clade B Tat protein. Discussions shed light on future research directions aimed at understanding biomarkers and disease mechanisms critical for HAND.
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Hoare J, Phillips N, Joska JA, Paul R, Donald KA, Stein DJ, Thomas KGF. Applying the HIV-associated neurocognitive disorder diagnostic criteria to HIV-infected youth. Neurology 2016; 87:86-93. [PMID: 27206720 DOI: 10.1212/wnl.0000000000002669] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/02/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to apply the HIV-associated neurocognitive disorders (HAND) criteria for diagnosing HAND in HIV-infected adults, in a cohort of HIV-infected youth to thus establish whether this system is able to detect a spectrum of neurocognitive disorders (ND) in HIV-infected youth. METHODS We used a comprehensive pediatric neurocognitive battery, an assessment of functional competence, and the American Academy of Neurology system for diagnosing ND in a cross-sectional study of HIV-infected youth (n = 86) and HIV-negative controls (n = 34) to establish whether this system could detect a spectrum of ND in HIV-infected youth (6-16 years). RESULTS Compared to a well-matched control group of HIV-negative youth, HIV-infected youth performed significantly more poorly on tests of Verbal IQ, Full Scale IQ, processing speed, finger tapping, verbal memory, expressive language, cognitive flexibility, and inhibition. HIV-infected youth were also more likely to have impaired total competence on the Child Behavior Checklist. Using the criteria for HAND, we found that 45.35% of the 86 HIV-infected youth could be diagnosed with an ND. Furthermore, youth with HIV encephalopathy (HIVE) were 9.4 times more likely to have a diagnosis of a major ND compared to HIV-infected youth without HIVE. CONCLUSIONS The HAND criterion designed for adults was able to identify youth with important functional cognitive impairments who do not fit criteria for HIVE and would therefore not have been identified otherwise. This has major clinical implications regarding the importance of managing HIV-infected youth.
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Affiliation(s)
- Jacqueline Hoare
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis.
| | - Nicole Phillips
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - John A Joska
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Robert Paul
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Kirsten A Donald
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Dan J Stein
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Kevin G F Thomas
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
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Ances BM, Hoare J. Perinatal HIV in the brain: Mission incomplete despite combination antiretroviral therapy. Neurology 2015; 86:13-4. [PMID: 26561292 DOI: 10.1212/wnl.0000000000002211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Beau M Ances
- From the Department of Neurology (B.M.A.), Washington University in Saint Louis, MO; and the Department of Psychiatry and Mental Health (J.H.), University of Cape Town, South Africa.
| | - Jacqueline Hoare
- From the Department of Neurology (B.M.A.), Washington University in Saint Louis, MO; and the Department of Psychiatry and Mental Health (J.H.), University of Cape Town, South Africa
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Cohen S, Caan MWA, Mutsaerts HJ, Scherpbier HJ, Kuijpers TW, Reiss P, Majoie CBLM, Pajkrt D. Cerebral injury in perinatally HIV-infected children compared to matched healthy controls. Neurology 2015; 86:19-27. [PMID: 26561287 DOI: 10.1212/wnl.0000000000002209] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 07/17/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The current study aims to evaluate the neurologic state of perinatally HIV-infected children on combination antiretroviral therapy and to attain a better insight into the pathogenesis of their persistent neurologic and cognitive deficits. METHODS We included perinatally HIV-infected children between 8 and 18 years and healthy controls matched for age, sex, ethnicity, and socioeconomic status. All participants underwent a 3.0 T MRI with 3D-T1-weighted, 3D-fluid-attenuated inversion recovery, and diffusion-weighted series for the evaluation of cerebral volumes, white matter hyperintensities (WMH), and white matter (WM) diffusion characteristics. Associations with disease-related parameters and cognitive performance were explored using linear regression models. RESULTS We included 35 cases (median age 13.8 years) and 37 controls (median age 12.1 years). A lower gray matter and WM volume, more WMH, and a higher WM diffusivity were observed in the cases. Within the HIV-infected children, a poorer clinical, immunologic, and virologic state were negatively associated with volumetric, WMH, and diffusivity markers. CONCLUSIONS In children with HIV, even when long-term clinically and virologically controlled, we found lower brain volumes, a higher WMH load, and poorer WM integrity compared to matched controls. These differences occur in the context of a poor cognitive performance in the HIV-infected group, and larger, longitudinal studies are needed to increase our understanding of the pathogenesis of cerebral injury in perinatally HIV-infected children.
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Affiliation(s)
- Sophie Cohen
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands.
| | - Matthan W A Caan
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands
| | - Henk-Jan Mutsaerts
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands
| | - Henriette J Scherpbier
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands
| | - Taco W Kuijpers
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands
| | - Peter Reiss
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands
| | - Charles B L M Majoie
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands
| | - Dasja Pajkrt
- From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands
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An Updated Systematic Review of Neuroimaging Studies of Children and Adolescents with Perinatally Acquired HIV. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2015. [DOI: 10.1007/s40817-015-0009-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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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