1
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Minosse S, Picchi E, Conti A, di Giuliano F, di Ciò F, Sarmati L, Teti E, de Santis S, Andreoni M, Floris R, Guerrisi M, Garaci F, Toschi N. Multishell diffusion MRI reveals whole-brain white matter changes in HIV. Hum Brain Mapp 2023; 44:5113-5124. [PMID: 37647214 PMCID: PMC10502617 DOI: 10.1002/hbm.26448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 07/15/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023] Open
Abstract
Diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) have been previously used to explore white matter related to human immunodeficiency virus (HIV) infection. While DTI and DKI suffer from low specificity, the Combined Hindered and Restricted Model of Diffusion (CHARMED) provides additional microstructural specificity. We used these three models to evaluate microstructural differences between 35 HIV-positive patients without neurological impairment and 20 healthy controls who underwent diffusion-weighted imaging using three b-values. While significant group effects were found in all diffusion metrics, CHARMED and DKI analyses uncovered wider involvement (80% vs. 20%) of all white matter tracts in HIV infection compared with DTI. In restricted fraction (FR) analysis, we found significant differences in the left corticospinal tract, middle cerebellar peduncle, right inferior cerebellar peduncle, right corticospinal tract, splenium of the corpus callosum, left superior cerebellar peduncle, left superior cerebellar peduncle, pontine crossing tract, left posterior limb of the internal capsule, and left/right medial lemniscus. These are involved in language, motor, equilibrium, behavior, and proprioception, supporting the functional integration that is frequently impaired in HIV-positivity. Additionally, we employed a machine learning algorithm (XGBoost) to discriminate HIV-positive patients from healthy controls using DTI and CHARMED metrics on an ROIwise basis, and unique contributions to this discrimination were examined using Shapley Explanation values. The CHARMED and DKI estimates produced the best performance. Our results suggest that biophysical multishell imaging, combining additional sensitivity and built-in specificity, provides further information about the brain microstructural changes in multimodal areas involved in attentive, emotional and memory networks often impaired in HIV patients.
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Affiliation(s)
- Silvia Minosse
- Diagnostic Imaging UnitUniversity Hospital Rome Tor VergataRomeItaly
| | - Eliseo Picchi
- Diagnostic Imaging UnitUniversity Hospital Rome Tor VergataRomeItaly
- Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Allegra Conti
- Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Francesca di Giuliano
- Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
- Neuroradiology UnitUniversity Hospital of Rome Tor VergataRomeItaly
| | - Francesco di Ciò
- Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Loredana Sarmati
- Clinical Infectious Diseases UnitUniversity Hospital of Rome Tor VergataRomeItaly
- Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Elisabetta Teti
- Clinical Infectious Diseases UnitUniversity Hospital of Rome Tor VergataRomeItaly
| | - Silvia de Santis
- Instituto de NeurocienciasConsejo Superior de Investigaciones Científicas and Universidad Miguel HernándezSant Joan d'AlacantSpain
| | - Massimo Andreoni
- Clinical Infectious Diseases UnitUniversity Hospital of Rome Tor VergataRomeItaly
- Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Roberto Floris
- Diagnostic Imaging UnitUniversity Hospital Rome Tor VergataRomeItaly
- Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Maria Guerrisi
- Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Francesco Garaci
- Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
- Neuroradiology UnitUniversity Hospital of Rome Tor VergataRomeItaly
- IRCSS San Raffaele CassinoFrosinoneItaly
| | - Nicola Toschi
- Neuroradiology UnitUniversity Hospital of Rome Tor VergataRomeItaly
- Athinoula A. Martinos Center for Biomedical ImagingHarvard Medical SchoolBostonMassachusettsUSA
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D'Amico D, Barone R, Di Felice V, Ances B, Prideaux B, Eugenin EA. Chronic brain damage in HIV-infected individuals under antiretroviral therapy is associated with viral reservoirs, sulfatide release, and compromised cell-to-cell communication. Cell Mol Life Sci 2023; 80:116. [PMID: 37016051 PMCID: PMC11071786 DOI: 10.1007/s00018-023-04757-0] [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: 07/01/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 04/06/2023]
Abstract
HIV infection has become a chronic and manageable disease due to the effective use of antiretroviral therapies (ART); however, several chronic aging-related comorbidities, including cognitive impairment, remain a major public health issue. However, these mechanisms are unknown. Here, we identified that glial and myeloid viral reservoirs are associated with local myelin damage and the release of several myelin components, including the lipid sulfatide. Soluble sulfatide compromised gap junctional communication and calcium wave coordination, essential for proper cognition. We propose that soluble sulfatide could be a potential biomarker and contributor to white matter compromise observed in HIV-infected individuals even in the current ART era.
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Affiliation(s)
- Daniela D'Amico
- Department of Neurobiology, The University of Texas Medical Branch (UTMB), Research Building 17, Fifth Floor, 11Th Street, Galveston, TX, 77555, USA
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Rosario Barone
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Valentina Di Felice
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Beau Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brendan Prideaux
- Department of Neurobiology, The University of Texas Medical Branch (UTMB), Research Building 17, Fifth Floor, 11Th Street, Galveston, TX, 77555, USA.
| | - Eliseo A Eugenin
- Department of Neurobiology, The University of Texas Medical Branch (UTMB), Research Building 17, Fifth Floor, 11Th Street, Galveston, TX, 77555, USA.
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3
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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O’Cleirigh C, Thomas KGF, Joska JA. Sex Differences in the Cognitive Performance of a South African Cohort of People With HIV and Comorbid Major Depressive Disorder. J Int Assoc Provid AIDS Care 2023; 22:23259582231203192. [PMID: 37787183 PMCID: PMC10548808 DOI: 10.1177/23259582231203192] [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: 09/15/2022] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
Women with HIV (WWH) may be more vulnerable to cognitive impairment than men with HIV (MWH), which may be explained by the direct effects of HIV or by sociodemographic and psychiatric characteristics. We recruited 105 people with HIV (PWH; 76 women) with incomplete antiretroviral therapy adherence, comorbid major depressive disorder, and socioeconomically disadvantaged backgrounds. Participants completed neuropsychological testing and measures gathering sociodemographic, medical, and psychiatric information. We compared WWH and MWH cognitive performance using unadjusted and adjusted regressions, and within each respective group, we explored predictors of cognitive performance. Results showed no significant between-sex differences in cognitive performance, both globally and within domains. Fewer years of education (β = 0.94), illiteracy (β = 4.55), and greater food insecurity (β = -0.28) predicted lower cognitive performance in WWH but not MWH. We conclude that sex differences in PWH are likely due to sample characteristics representing broader inequalities, rather than true biological differences.
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Affiliation(s)
- Anna J. Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - Jasper S. Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Hetta Gouse
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, , Coral Gables, FL, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - Kevin G. F. Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
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4
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Minosse S, Picchi E, Giuliano FD, di Cio F, Pistolese CA, Sarmati L, Teti E, Andreoni M, Floris R, Guerrisi M, Garaci F, Toschi N. Compartmental models for diffusion weighted MRI reveal widespread brain changes in HIV-infected patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:3834-3837. [PMID: 34892070 DOI: 10.1109/embc46164.2021.9629510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Diffusion tensor imaging (DTI) has been used to explore changes in the brain of subjects with human immunodeficiency virus (HIV) infection. However, DTI notoriously suffers from low specificity. Neurite orientation dispersion and density imaging (NODDI) is a compartmental model able to provide specific microstructural information with additional sensitivity/specificity. In this study we use both the NODDI and the DTI models to evaluate microstructural differences between 35 HIV-positive patients and 20 healthy controls. Diffusion-weighted imaging was acquired using three b-values (0, 1000 and 2500 s/mm2). Both DTI and NODDI models were fitted to the data, obtaining estimates for fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD), neurite density index (NDI) and orientation dispersion index (ODI), after which we performed group comparisons using Tract-based spatial statistics (TBSS). While significant group effects were found in in FA, MD, RD, AD and NDI, NDI analysis uncovered a much wider involvement of brain tissue in HIV infection as compared to DTI. In region-of interest (ROI)-based analysis, NDI estimates from the right corticospinal tract produced excellent performance in discriminating the two groups (AUC = 0.974, sensitivity = 90%; specificity =97%).
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Di Cio F, Minosse S, Picchi E, Di Giuliano F, Sarmati L, Teti E, Andreoni M, Floris R, Guerrisi M, Garaci F, Toschi N. Whole-brain white matter network reorganization in HIV. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:3830-3833. [PMID: 34892069 DOI: 10.1109/embc46164.2021.9629503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The human immunodeficiency virus (HIV) causes an infectious disease with a high viral tropism toward CD4 T-lymphocytes and macrophage. Since the advent of combined antiretroviral therapy (CART), the number of opportunistic infectious disease has diminished, turning HIV into a chronic condition. Nevertheless, HIV-infected patients suffer from several life-long symptoms, including the HIV-associated neurocognitive disorder (HAND), whose biological substrates remain unclear. HAND includes a range of cognitive impairments which have a huge impact on daily patient life. The aim of this study was to examine putative structural brain network changes in HIV-infected patient to test whether diffusion-imaging-related biomarkers could be used to discover and characterize subtle neurological alterations in HIV infection. To this end, we employed multi-shell, multi-tissue constrained spherical deconvolution in conjunction with probabilistic tractography and graph-theoretical analyses. We found several statistically significant effects in both local (right postcentral gyrus, right precuneus, right inferior parietal lobule, right transverse temporal gyrus, right inferior temporal gyrus, right putamen and right pallidum) and global graph-theoretical measures (global clustering coefficient, global efficiency and transitivity). Our study highlights a global and local reorganization of the structural connectome which support the possible application of graph theory to detect subtle alteration of brain regions in HIV patients.Clinical Relevance-Brain measures able to detect subtle alteration in HIV patients could also be used in e.g. evaluating therapeutic responses, hence empowering clinical trials.
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6
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Dreyer AJ, Munsami A, Williams T, Andersen LS, Nightingale S, Gouse H, Joska J, Thomas KGF. Cognitive Differences between Men and Women with HIV: A Systematic Review and Meta-Analysis. Arch Clin Neuropsychol 2021; 37:479-496. [PMID: 34417599 DOI: 10.1093/arclin/acab068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Although many studies report that women with HIV (WWH) are more vulnerable to cognitive impairment than men with HIV (MWH), this trend is not described consistently in the literature. In this systematic review and meta-analysis, we investigated whether the weight of evidence supports the existence of a significant sex difference in cognitive functioning among people with HIV and, if so, whether specific domains are affected. METHOD A systematic literature search retrieved 4,062 unique articles published between January 2000 and June 2019. Eligibility criteria were that studies directly compared adult WWH and MWH using a neuropsychological test battery. After extensive screening, we included 11 studies in the systematic review (N = 3,333) and 6 in the meta-analysis (N = 2,852). RESULTS Six studies included in the systematic review found WWH performed significantly more poorly on measures of cognitive performance than MWH; the other five found no sex differences. Meta-analytic results indicated that WWH performed significantly more poorly than MWH in three cognitive domains (psychomotor coordination, visuospatial learning, and memory), but magnitudes of effect sizes were small (d = -.16, -.43, and - .30, respectively). Analyses detected no sex differences in global cognitive functioning and in the other cognitive domains. CONCLUSIONS Sex differences in cognitive performance are small, and sociodemographic and psychiatric characteristics of WWH and MWH differ between studies. Cognitive differences between WWH and MWH may be explained by sex-based variation in these characteristics, the impact of which seems to outweigh that of HIV-related clinical variables (e.g., CD4 count and viral load).
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Affiliation(s)
- Anna J Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Adele Munsami
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Taryn Williams
- Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kevin G F Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
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7
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Rubin LH, Sundermann EE, Dastgheyb R, Buchholz AS, Pasipanodya E, Heaton RK, Grant I, Ellis R, Moore DJ. Sex Differences in the Patterns and Predictors of Cognitive Function in HIV. Front Neurol 2020; 11:551921. [PMID: 33329301 PMCID: PMC7732436 DOI: 10.3389/fneur.2020.551921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Despite advancements in antiretroviral therapy, mild cognitive deficits persist in nearly half of people with HIV (PWH). The profile of impairment in HIV is highly variable with deficits observed in a range of cognitive domains. Despite evidence of greater cognitive impairment among women with HIV (WWH) vs. men with HIV (MWH), it is unclear how MWH and WWH differ in the type of cognitive impairment and in risk factors associated with cognitive impairment profiles. In a large and well-characterized sample of PWH, we used machine learning to identify profiles of cognitive functioning and their associated factors overall and within sex. Participants included 1,666 PWH (201 WWH; 1,465 MMH) from the HIV Neurobehavioral Research Program who completed a neuropsychological test battery at their baseline visits. Using demographically-adjusted T-scores from 13 test outcomes assessing motor skills, executive functioning, attention/working memory, episodic learning and memory, verbal fluency, and processing speed, we used Kohonen self-organizing maps to identify patterns of high-dimensional data by mapping participants to similar nodes based on T-scores (MCLUST R package). Random forest models were used to determine how sociodemographic (e.g., age, education), clinical (e.g., depressive symptoms, substance use disorder), and biological (e.g., HIV disease characteristics) factors differentially related to membership within a cognitive profile. All analyses were repeated within sex. Three cognitive profiles were identified overall and within each sex. Overall and within MWH, there were unimpaired and global weakness profiles. The third profile in the total sample demonstrated relatively weak auditory attention whereas in MWH showed relative strengths in attention and processing speed. Conversely, there was no unimpaired profile among WWH. Rather, WWH demonstrated separate profiles reflecting weakness in motor skills, a relative weakness in learning and delayed recall, and global weaknesses with spared recognition memory. Despite different cognitive profiles by sex, the most discriminative factors were similar between men and women and included reading level (cognitive reserve), current and nadir CD4 count, plasma HIV viral load, duration of HIV disease, age, depressive symptoms, and race/ethnicity. Findings fill a knowledge gap concerning sex differences in cognitive impairment in PWH and inform personalized risk reduction and therapeutic strategies.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States.,Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Alison S Buchholz
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth Pasipanodya
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Ronald Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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8
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Cilliers K, Muller CJF. Effect of human immunodeficiency virus on the brain: A review. Anat Rec (Hoboken) 2020; 304:1389-1399. [PMID: 33231355 DOI: 10.1002/ar.24573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Thirty million people are infected with human immunodeficiency virus (HIV) worldwide, and HIV-associated neurocognitive disorder (HAND) is one of the most common comorbidities of HIV. However, the effect of HIV on the brain has not been fully investigated. This article aimed to review the changes to the brain due to HIV in terms of atrophy, diffusion changes, and hyperintensities. Studies have observed significant atrophy in subcortical gray matter, as well as in cortical white and gray matter. Moreover, the ventricles enlarge, and the sulci widen. Although HIV causes changes to the white and gray matter of the brain, few diffusion tensor imaging studies have investigated the changes to gray matter integrity. White and gray matter hyperintensities have frequently been observed in HIV-positive individuals, with the subcortical gray matter (caudate nucleus and putamen) and periventricular white matter frequently affected. In conclusion, subcortical gray matter is the first brain region to be affected and is affected most severely. Additionally, this review highlights the gaps in the literature, since the effect of HIV on the brain is not fully known. Future studies should continue to investigate the effect of HIV on the brain in different stages of the disease, and alternate therapies should be developed since highly active antiretroviral therapy is currently ineffective at treating HAND.
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Affiliation(s)
- Karen Cilliers
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Christo J F Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Western Cape, South Africa.,Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
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9
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Greater Sensorimotor Deficits and Abnormally Lower Globus Pallidus Fractional Anisotropy in HIV+ Women than in HIV+ Men. J Neuroimmune Pharmacol 2020; 16:334-345. [PMID: 32323137 DOI: 10.1007/s11481-020-09915-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
AIMS Cognitive impairment may be greater in HIV-positive (HIV+) women than in HIV+ men. Whether sex-specific differences exist in brain microstructure of HIV+ individuals is unknown and was evaluated. METHOD 39 HIV+ (21 men, 18 women) and 45 seronegative (SN, 20 men, 25 women) participants were assessed with brain diffusion tensor imaging and cognitive assessments (7 neuropsychological domains). Fractional anisotropy (FA) and mean diffusivity (MD) were measured with an automated atlas in selected brain regions. Group comparisons were assessed with linear mixed effects models, with sub-regions and hemisphere (left/right) as repeated factors for each region. RESULTS HIV+ women, but not HIV+ men, were slower than sex-matched SN controls on sensorimotor function (Dominant-hand: interaction-p = 0.007; Non-dominant hand: interaction-p = 0.039). Similarly, only HIV+ women had lower FA in the globus pallidus (GP, interaction-p = 0.011). Additionally, regardless of sex, the HIV+ group had poorer Fluency, Speed, and Attention than SN-controls (p = 0.006-0.008), as well as lower FA and higher MD in multiple brain regions (p = <0.001-0.044). Across all participants, performance on Attention was predicted by uncinate-FA (p < 0.001, r = 0.5) and corpus callosum (CC)-FA (p = 0.038, r = 0.23), while the Speed of Information Processing was predicted by CC-FA (p = 0.009, r = 0.3). Furthermore, faster sensorimotor function correlated with higher CC-FA and uncinate-FA in men but not in women (Sex*DTI-interaction-p = 0.03-0.06). CONCLUSIONS The relatively poorer sensorimotor function and abnormally lower GP_FA, suggesting lesser neuronal integrity, in HIV+ women demonstrate sex-specific effects from HIV-infection on these measures. These findings may be related to the greater immune activation and neuroinflammation in HIV+ women compared to HIV+ men. Graphical Abstract.
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10
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Philippi CL, Reyna L, Nedderman L, Chan P, Samboju V, Chang K, Phanuphak N, Ratnaratorn N, Hellmuth J, Benjapornpong K, Dumrongpisutikul N, Pothisri M, Robb ML, Ananworanich J, Spudich S, Valcour V, Paul R. Resting-state neural signatures of depressive symptoms in acute HIV. J Neurovirol 2020; 26:226-240. [PMID: 31989446 PMCID: PMC7261250 DOI: 10.1007/s13365-020-00826-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/23/2019] [Accepted: 01/16/2020] [Indexed: 02/07/2023]
Abstract
Depressive symptoms are often elevated in acute and chronic HIV. Previous neuroimaging research identifies abnormalities in emotion-related brain regions in depression without HIV, including the anterior cingulate cortex (ACC) and amygdala. However, no studies have examined the neural signatures of depressive symptoms in acute HIV infection (AHI). Seed-based voxelwise resting-state functional connectivity (rsFC) for affective seed regions of interest (pregenual ACC, subgenual ACC [sgACC], bilateral amygdala) was computed for 74 Thai males with AHI and 30 Thai HIV-uninfected controls. Group analyses compared rsFC of ACC and amygdala seed regions between AHI and uninfected control groups. Within the AHI group, voxelwise regression analyses investigated the relationship between depressive symptoms and rsFC for these affective seed regions. Group analyses revealed alterations in rsFC of the amygdala in AHI versus uninfected controls. Depressive symptoms associated with decreased rsFC between ACC regions and posterior cingulate/precuneus, medial temporal, and lateral parietal regions in AHI. Symptoms of depression also correlated to increased rsFC between ACC regions and lateral prefrontal cortex, sgACC, and cerebellum in AHI. Similar to the ACC, depressive symptoms associated with decreased rsFC between amygdala and precuneus. Of blood biomarkers, only HIV RNA inversely correlated with rsFC between posterior sgACC and left uncus. We found that depressive symptoms in AHI associate with altered rsFC of ACC and amygdala regions previously implicated in depression. Longitudinal research in this cohort will be necessary to determine whether these early alterations in rsFC of affective network regions are related to persistent depressive symptoms after combination antiretroviral therapy.
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Affiliation(s)
- Carissa L Philippi
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
| | - Leah Reyna
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Laura Nedderman
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Phillip Chan
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Vishal Samboju
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kevin Chang
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | | | - Joanna Hellmuth
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | | | - Mantana Pothisri
- Department of Radiology, Chulalongkorn University Medical Center, Bangkok, Thailand
| | - Merlin L Robb
- U.S. Military HIV Research Program, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jintanat Ananworanich
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- U.S. Military HIV Research Program, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Department of Global Health, The University of Amsterdam, Amsterdam, The Netherlands
| | - Serena Spudich
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
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Rubin LH, Neigh GN, Sundermann EE, Xu Y, Scully EP, Maki PM. Sex Differences in Neurocognitive Function in Adults with HIV: Patterns, Predictors, and Mechanisms. Curr Psychiatry Rep 2019; 21:94. [PMID: 31522330 PMCID: PMC7673651 DOI: 10.1007/s11920-019-1089-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Sex differences in cognitive function are well documented yet few studies had adequate numbers of women and men living with HIV (WLWH; MLWH) to identify sex differences in neurocognitive impairment (NCI) and the factors contributing to NCI. Here, we review evidence that WLWH may be at greater risk for NCI. RECENT FINDINGS We conducted a systematic review of recent studies of NCI in WLWH versus MLWH. A power analysis showed that few HIV studies have sufficient power to address male/female differences in NCI but studies with adequate power find evidence of greater NCI in WLWH, particularly in the domains of memory, speed of information processing, and motor function. Sex is an important determinant of NCI in HIV, and may relate to male/female differences in cognitive reserve, comorbidities (mental health and substance use disorders), and biological factors (e.g., inflammation, hormonal, genetic).
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Affiliation(s)
- Leah H. Rubin
- Department of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Gretchen N. Neigh
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | | | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD,Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eileen P. Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Pauline M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL,Department of Psychology, University of Illinois at Chicago, Chicago, IL
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Webel AR, Schreiner N, Salata RA, Friedman J, Jack AI, Sattar A, Fresco DM, Rodriguez M, Moore S. The Effect of an HIV Self-Management Intervention on Neurocognitive Behavioral Processing. West J Nurs Res 2019; 41:990-1008. [PMID: 30654713 PMCID: PMC6570548 DOI: 10.1177/0193945918823347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People living with HIV (PLHIV) are increasingly diagnosed with comorbidities which require increasing self-management. We examined the effect of a self-management intervention on neurocognitive behavioral processing. Twenty-nine PLHIV completed a two-group, 3-month randomized clinical trial testing a self-management intervention to improve physical activity and dietary intake. At baseline and 3 months later, everyone completed validated assessments of physical, diet, and neurocognitive processing (functional magnetic resonance imaging [fMRI]-derived network analyses). We used linear mixed effects modeling with a random intercept to examine the effect of the intervention. The intervention improved healthy eating (p = .08) but did not improve other self-management behaviors. There was a significant effect of the intervention on several aspects of neurocognitive processing including in the task positive network (TPN) differentiation (p = .047) and an increase in the default mode network (DMN) differentiation (p = .10). Self-management interventions may influence neurocognitive processing in PLHIV, but those changes were not associated with positive changes in self-management behavior.
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Affiliation(s)
- Allison R Webel
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Nathaniel Schreiner
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Robert A Salata
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
- 2 University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, USA
| | - Jared Friedman
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Anthony I Jack
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Abdus Sattar
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Margaret Rodriguez
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Shirley Moore
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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13
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Qiao X, Lin H, Chen X, Ning C, Wang K, Shen W, Xu X, Xu X, Liu X, He N, Ding Y. Sex differences in neurocognitive screening among adults living with HIV in China. J Neurovirol 2019; 25:363-371. [PMID: 30758812 DOI: 10.1007/s13365-019-00727-0] [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: 10/03/2018] [Revised: 01/04/2019] [Accepted: 01/16/2019] [Indexed: 01/22/2023]
Abstract
HIV-infected (HIV+) women may be more vulnerable to neurocognitive impairment (NCI) due to psychological and physiological factors but previous studies show mixed findings. We investigated the neurocognitive performances in HIV+ versus HIV- women and men. This cross-sectional analysis included 669 HIV+ patients (223 women) and 1338 HIV-uninfected (HIV-) controls (446 women) which were frequency matched on sex, education, and 5-year age categories. NCI was screened using the Mini-mental State Examination. Psychomotor speed was assessed using timed alternating hand sequence test. Prevalence of NCI was higher among women versus men in the HIV+ group (16.1% vs 10.5%) but not the HIV- group (4.3% vs 3.5%). HIV+ women performed worse compared to men on psychomotor speed, orientation, attention, and calculation, whereas HIV- women performed worse compared to men on attention and calculation. Adjusted interaction effects of HIV status × sex (women vs men) were significant on orientation, attention, and calculation, and marginally significant on psychomotor speed (p = 0.053). In multivariable models, among both HIV+ women and men, less years of education and depressive symptoms were associated with NCI. Waist-to-hip ratio above the cut-off was strongly associated with NCI among HIV+ women. HIV+ women perform worse on cognitive measures compared to HIV+ men. The association of central obesity with NCI in HIV+ women should be noted.
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Affiliation(s)
- Xiaotong Qiao
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Haijiang Lin
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - Chenxi Ning
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Keran Wang
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - Xiaohui Xu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Xiaoyi Xu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289,138 Yi Xue Yuan Road, Shanghai, 200032, China. .,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
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14
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Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci 2019; 50:175-191. [PMID: 31396894 DOI: 10.1007/7854_2019_101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Although sex differences in brain function and brain disorders are well documented, very few studies have had adequate number of women to address sex-related factors contributing to HIV-associated brain dysfunction. Compared to men living with HIV (MLWH), women living with HIV (WLWH) may be at greater risk for cognitive dysfunction and decline due to biological factors (e.g., hormonal, immunologic) and issues common in underserved communities including poverty, low literacy levels, mental health and substance abuse, barriers to health-care services, and environmental exposures. To address this issue, we review relevant cross-sectional and longitudinal findings from the Women's Interagency HIV Study (WIHS), the largest study of the natural and treated history of WLWH, as well as other studies focusing on cognitive complications of HIV in women. We provide evidence that WLWH are more cognitively vulnerable than MLWH and that there are differences in the pattern of cognitive impairment. We next discuss factors that contribute to these differences, including biological factors (e.g., inflammation, hormonal, genetic) as well as common comorbidities (mental health, substance use, vascular and metabolic risk factors, coinfections and liver function, non-antiretroviral medications, and genetic markers). These findings demonstrate the importance of considering sex as a biological factor in studies of cognitive dysfunction and suggest avenues for future research.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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Sundermann EE, Heaton RK, Pasipanodya E, Moore RC, Paolillo EW, Rubin LH, Ellis R, Moore DJ. Sex differences in HIV-associated cognitive impairment. AIDS 2018; 32:2719-2726. [PMID: 30407251 PMCID: PMC6396274 DOI: 10.1097/qad.0000000000002012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We determined whether there are sex differences in the prevalence and profile of HIV-associated neurocognitive impairment, and whether sex moderates the effect of HIV-serostatus on neurocognitive impairment among HIV-positive and HIV-negative individuals. Secondarily, we assessed whether differences were explained by greater biopsychosocial risk factors in HIV-positive women. DESIGN An observational cohort study. METHODS Analyses included 1361 HIV-positive (204 women) and 702 HIV-negative (214 women) (ages = 18-79 years) participants from the UCSD HIV Neurobehavioral Research Program. Demographically corrected standardized T-scores from 15 neuropsychological tests were used to calculate domain-specific and global deficit scores (GDS). GDS at least 0.5 defined neurocognitive impairment. Biopsychosocial risk factors included low education, low reading level (education quality), lifetime substance use disorders, depressed mood (clinically significant depressive symptoms and/or current major depressive disorder) and a cumulative syndemic count (sum of biopsychosocial risk factors, range = 0-4). Race-stratified analyses were conducted. Analyses were adjusted for relevant demographic and clinical factors. RESULTS HIV-associated neurocognitive impairment was more prevalent in women versus men; however, the difference was eliminated after adjustment for reading level. In sex-stratified logistic regressions, the association between HIV-seropositivity and higher likelihood of neurocognitive impairment was stronger in women versus men; however, the association was attenuated in women, but not men, after adjusting for reading level. These results in the overall sample were specific to blacks. Sex differences in the profile of HIV-associated neurocognitive impairment varied by race. CONCLUSION Women, particularly black women, were most at-risk for HIV-associated neurocognitive impairment. Higher rates of HIV-associated neurocognitive impairment in women versus men may reflect differences in educational quality.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla
| | | | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, California
| | - Emily W Paolillo
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Ronald Ellis
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla
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16
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Paul RH, Cooley SA, Garcia-Egan PM, Ances BM. Cognitive Performance and Frailty in Older HIV-Positive Adults. J Acquir Immune Defic Syndr 2018; 79:375-380. [PMID: 29957675 PMCID: PMC10733865 DOI: 10.1097/qai.0000000000001790] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined the relative contribution of cognitive status to frailty among older individuals infected with HIV+. DESIGN Participants included 122 HIV+ individuals [mean age = 57.5 (6.6)] with a median CD4 cell count of 546. Undetectable viral load (<50 copies per mL) was observed in 94% of the sample. The sample was defined as frail (n = 21) and nonfrail (n = 101) according to the Fried phenotype criteria. Cognitive tests included measures of executive function, motor/psychomotor, language, learning, and memory. Performances were converted to standardized scores and averaged to calculate individual domain scores and a global index of cognitive function. METHODS Logistic and hierarchical regressions were completed to separately determine the associations between clinical, demographic, and cognitive variables with regards to frailty status. RESULTS Results of the logistic regressions revealed that lower executive function, female sex, and higher symptoms of depression were associated with frailty. The hierarchical analysis revealed no significant contribution of executive function to frailty status after accounting for female sex and symptoms of depression (Nagelkerke R = 0.15). CONCLUSIONS These results emphasize the importance of sex distribution and mental health in explanatory models of frailty in HIV. Further, interventions targeting symptoms of depression may increase resilience in older HIV+ individuals.
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Affiliation(s)
- Robert H. Paul
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO
- Department of Psychological Sciences, Missouri Institute of Mental Health, St. Louis, MO
| | - Sarah A. Cooley
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Paola M. Garcia-Egan
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO
| | - Beau M. Ances
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
- Department of Radiology, Washington University in St. Louis, St. Louis, MO
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
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17
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Effects of HIV Infection, methamphetamine dependence and age on cortical thickness, area and volume. NEUROIMAGE-CLINICAL 2018; 20:1044-1052. [PMID: 30342393 PMCID: PMC6197439 DOI: 10.1016/j.nicl.2018.09.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study examined the effects of HIV infection, methamphetamine dependence and their interaction on cortical thickness, area and volume, as well as the potential interactive effects on cortical morphometry of HIV and methamphetamine with age. METHOD T1-weighted structural images were obtained on a 3.0T General Electric MR750 scanner. Freesurfer v5.3.0 was used to derive cortical thickness, area and volume measures in thirty-four regions based on Desikan-Killiany atlas labels. RESULTS Following correction for multiple statistical tests, HIV diagnosis was not significantly related to cortical thickness or area in any ROI, although smaller global cortical area and volume were seen in those with lower nadir CD4 count. HIV diagnosis, nevertheless, was associated with smaller mean cortical volumes in rostral middle frontal gyrus and in the inferior and superior parietal lobes. Methamphetamine dependence was significantly associated with thinner cortex especially in posterior cingulate gyrus, but was not associated with cortical area or volume following correction for multiple statistical tests. We found little evidence that methamphetamine dependence moderated differences in cortical area, volume or thickness for any ROI in the HIV seropositive group. Interactions with age revealed that HIV diagnosis attenuated the degree of age-related cortical thinning seen in non-infected individuals; intercepts indicated that young HIV seropositive individuals had thinner cortex than non-infected peers. CONCLUSIONS Methamphetamine dependence does not appear to potentiate a reduction of cortical area, volume or thickness in HIV seropositive individuals. The finding of thinner cortex in young HIV seropositive individuals and the association between CD4 nadir and global cortical area and volume argue for prioritizing early antiretroviral treatment.
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18
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Maki PM, Rubin LH, Springer G, Seaberg EC, Sacktor N, Miller EN, Valcour V, Young MA, Becker JT, Martin EM. Differences in Cognitive Function Between Women and Men With HIV. J Acquir Immune Defic Syndr 2018; 79:101-107. [PMID: 29847476 PMCID: PMC6092201 DOI: 10.1097/qai.0000000000001764] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women may be more vulnerable to HIV-related cognitive dysfunction compared with men because of sociodemographic, lifestyle, mental health, and biological factors. However, studies to date have yielded inconsistent findings on the existence, magnitude, and pattern of sex differences. We examined these issues using longitudinal data from 2 large, prospective, multisite, observational studies of US women and men with and without HIV. SETTING The Women's Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS). METHODS HIV-infected (HIV+) and uninfected (HIV-) participants in the Women's Interagency HIV Study and Multicenter AIDS Cohort Study completed tests of psychomotor speed, executive function, and fine motor skills. Groups were matched on HIV status, sex, age, education, and black race. Generalized linear mixed models were used to examine group differences on continuous and categorical demographically corrected T-scores. Results were adjusted for other confounding factors. RESULTS The sample (n = 1420) included 710 women (429 HIV+) and 710 men (429 HIV+) (67% non-Hispanic black; 53% high school or less). For continuous T-scores, sex by HIV serostatus interactions were observed on the Trail Making Test parts A & B, Grooved Pegboard, and Symbol Digit Modalities Test. For these tests, HIV+ women scored lower than HIV+ men, with no sex differences in HIV- individuals. In analyses of categorical scores, particularly the Trail Making Test part A and Grooved Pegboard nondominant, HIV+ women also had a higher odds of impairment compared with HIV+ men. Sex differences were constant over time. CONCLUSIONS Although sex differences are generally understudied, HIV+ women vs men show cognitive disadvantages. Elucidating the mechanisms underlying these differences is critical for tailoring cognitive interventions.
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Affiliation(s)
- Pauline M. Maki
- Department of Psychiatry, University of Illinois at Chicago College of Medicine
- Department of Psychology, University of Illinois at Chicago College of Medicine
| | - Leah H. Rubin
- Department of Psychiatry, University of Illinois at Chicago College of Medicine
- Department of Neurology, Johns Hopkins University School of Medicine
- Johns Hopkins Bloomberg School of Public Health
| | | | | | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Eric N. Miller
- Departments of Psychiatry & Behavioral Sciences, University of California Los Angeles
| | - Victor Valcour
- Department of Neurology, University of California San Francisco
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19
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Rubin LH, Radtke KK, Eum S, Tamraz B, Kumanan KN, Springer G, Maki PM, Anastos K, Merenstein D, Karim R, Weber KM, Gustafson D, Greenblatt RM, Bishop JR. Cognitive Burden of Common Non-antiretroviral Medications in HIV-Infected Women. J Acquir Immune Defic Syndr 2018; 79:83-91. [PMID: 29781879 PMCID: PMC6092212 DOI: 10.1097/qai.0000000000001755] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aging HIV population has increased comorbidity burden and consequently non-antiretroviral medication utilization. Many non-antiretroviral medications have known neurocognitive-adverse effects ("NC-AE medications"). We assessed the cognitive effects of NC-AE medications in HIV+ and HIV- women. METHODS One thousand five hundred fifty-eight participants (1037 HIV+; mean age 46) from the Women's Interagency HIV Study completed a neuropsychological test battery between 2009 and 2011. The total number of NC-AE medications and subgroups (eg, anticholinergics) were calculated based on self-report. Generalized linear models for non-normal data were used to examine the cognitive burden of medications and factors that exacerbate these effects. RESULTS HIV+ women reported taking more NC-AE medications vs. HIV- women (P < 0.05). NC-AE medication use altogether was not associated with cognitive performance. However, among NC-AE medication subgroups, anticholinergic-acting medications, but not opioids or anxiolytics/anticonvulsants, were negatively associated with performance. HIV status moderated the association between these NC-AE medication subgroups and performance (P's < 0.05). HIV-serostatus differences (HIV- < HIV+) in global, learning, fluency, and motor function were greatest among women taking >1 anticholinergic medications. HIV-serostatus differences in performance on learning and psychomotor speed were also greatest among women taking 1 or more anxiolytics/anticonvulsants and 1 or more opioids, respectively. CONCLUSIONS HIV+ women have increased cognitive vulnerabilities to anticholinergic, anxiolytic/anticonvulsant, and opioid medications. Potential synergy between these medications and HIV may explain some HIV-related cognitive impairments. It may be important clinically to consider these specific types of medications as a contributor to impaired cognitive performance in HIV+ women and assess the cost/benefit of treatment dosage for underlying conditions.
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Affiliation(s)
- Leah H. Rubin
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kendra K. Radtke
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Seenae Eum
- Deparments of Experimental and Clinical Pharmacology and Psychiatry, University of Minnesota, Minneapolis, MN
| | - Bani Tamraz
- Deparments of Experimental and Clinical Pharmacology and Psychiatry, University of Minnesota, Minneapolis, MN
| | - Krithika N. Kumanan
- Department of Epidemiology and Biostatistics, School of Public Health, Univeristy of Illinois at Chicago, Chicago, IL
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Pauline M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
| | - Kathryn Anastos
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Roksana Karim
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kathleen M. Weber
- Cook County Health & Hospital System/Hektoen Institute of Medicine, Chicago, IL
| | - Deborah Gustafson
- Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, NY
| | - Ruth M. Greenblatt
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Jeffrey R. Bishop
- Deparments of Experimental and Clinical Pharmacology and Psychiatry, University of Minnesota, Minneapolis, MN
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20
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Resting-state connectivity and spontaneous activity of ventromedial prefrontal cortex predict depressive symptomology and peripheral inflammation in HIV. J Neurovirol 2018; 24:616-628. [PMID: 30022427 DOI: 10.1007/s13365-018-0658-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/16/2018] [Accepted: 06/11/2018] [Indexed: 02/05/2023]
Abstract
Depression and chronic inflammation are common in persons infected with the human immunodeficiency virus (HIV+). Although depression and response to inflammatory challenge are shown to reflect activity in common neural networks, little is known regarding sub-clinical presentation in persons chronically infected with HIV. The relationship of resting-state functional connectivity (rsFC) between the subgenual anterior cingulate cortex (sgACC) and bilateral amygdala to Beck Depression Inventory-1 (BDI) scores were compared within a group of 23 HIV+ and 23 HIV-negative comparison adults. An interaction was found wherein lower rsFC between the sgACC and both right and left amygdala was associated with higher BDI scores in HIV+ individuals. Total BDI scores and plasma levels of IL-6, IL-8, TNF-α, and IL-10 made available from 10 of the HIV+ patients were regressed upon an index of spontaneous whole-brain activity at rest; i.e., the amplitude of low-frequency fluctuations (ALFFs). Elevated levels of depression and IL-6 were associated with increased ALFF in a cluster of voxels on the medial portion of the ventral surface of the frontal lobe (Brodmann Area 11). Within this sample of HIV+ individuals lower rsFC of the sgACC with subcortical limbic regions predicts greater burden of depressive symptomology whereas elevated activity in the adjacent BA 11 may reflect sickness, indexed by elevated IL-6, and associated depressive behaviors.
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21
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Verbal and spatial working memory among drug-using HIV-infected men and women. J Neurovirol 2018; 24:488-497. [PMID: 29687402 DOI: 10.1007/s13365-018-0639-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 01/14/2023]
Abstract
Working memory (WM) is a critical component of many neurocognitive functions. The literature has demonstrated consistently that WM impairment is more frequent and severe among substance-dependent individuals (SDIs) infected with HIV compared with uninfected SDIs; however, the SDIs who participated in these previous studies were primarily male. There are few published data on WM performance among HIV+ women with or without substance use disorders, and essentially no direct comparisons of WM performance between HIV+ men and women, regardless of substance use. We investigated potential sex and serostatus effects on WM among a sample of 360 SDIs (114 with HIV; 66% female) verified abstinent from alcohol and drugs of abuse at testing and generally comparable on substance use and comorbid characteristics. Participants were tested with the n-back task, a well-established WM measure that is sensitive to HIV-associated cognitive impairment. HIV+ men and women performed spatial and verbal versions of the n-back significantly less accurately compared with HIV- participants. Women showed slower response times compared with men on both versions, regardless of HIV serostatus. Individuals dependent on cocaine showed faster RTs compared with non-dependent users, but this effect was not apparent among opioid- or alcohol-dependent groups. Findings on n-back accuracy are consistent with our previous proposal that WM impairment represents a signature deficit among HIV+ SDIs; however, WM impairment appears less common among HIV+ women without a substance use history. The pattern of sex differences in response speed but serostatus effects on response accuracy is comparable to a recent report by our group of sex differences in learning speed but serostatus effects on delayed recall.
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22
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Clark US, Sweet LH, Morgello S, Philip NS, Cohen RA. High early life stress and aberrant amygdala activity: risk factors for elevated neuropsychiatric symptoms in HIV+ adults. Brain Imaging Behav 2018; 11:649-665. [PMID: 27011015 DOI: 10.1007/s11682-016-9542-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Relative to HIV-negative adults, HIV+ adults report elevated levels of early life stress (ELS). In non-HIV samples, high ELS has been linked to abnormalities in brain structure and function, as well as increased risk of neuropsychiatric symptoms. Yet, little is known about the neural effects of high ELS, and their relation to elevated neuropsychiatric symptoms, in HIV+ adults. Recent studies have revealed combined effects of HIV and high ELS on amygdala morphometry. Aberrant amygdala activity is prominently implicated in studies of neuropsychiatric symptomology in non-HIV samples. Hence, this preliminary study examined: 1) the combined effects of HIV and high ELS on amygdala activity, and 2) the relation between amygdala activity and neuropsychiatric symptoms in HIV+ adults. We included 28 HIV+ adults and 25 demographically-matched HIV-negative control (HC) adults. ELS exposure was quantified using a retrospective ELS questionnaire, which defined four groups: HIV+ Low-ELS (N = 15); HIV+ High-ELS (N = 13); HC Low-ELS (N = 16); and HC High-ELS (N = 9). Participants completed a battery of neuropsychiatric measures. BOLD fMRI assessed amygdala reactivity during explicit observation of fearful/angry faces. High-ELS participants demonstrated reduced levels of amygdala reactivity relative to Low-ELS participants. HIV+ High-ELS participants reported higher levels of neuropsychiatric symptoms than all other groups. In the HIV+ group, lower amygdala responses were associated with higher neuropsychiatric symptoms, particularly depression, anxiety, and alexithymia. Collectively, these results suggest that high ELS exposure is a significant risk factor for neuropsychiatric symptoms in HIV+ adults. Furthermore, our results implicate ELS-related abnormalities in amygdala activity in the etiology of neuropsychiatric symptoms in HIV+ adults.
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Affiliation(s)
- Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA.
| | - Lawrence H Sweet
- Department of Psychology, University of Georgia, Athens, GA, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Noah S Philip
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Providence VA Medical Center, Providence, RI, USA
| | - Ronald A Cohen
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Departments of Aging and Geriatric Research, Neurology, and Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
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Vance DE, Rubin LH, Valcour V, Waldrop-Valverde D, Maki PM. Aging and Neurocognitive Functioning in HIV-Infected Women: a Review of the Literature Involving the Women's Interagency HIV Study. Curr HIV/AIDS Rep 2017; 13:399-411. [PMID: 27730446 DOI: 10.1007/s11904-016-0340-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV-infected women may be particularly vulnerable to certain types of neurocognitive impairments which may be exacerbated by aging and other predictors. Within the context of cognitive reserve, this article examines issues surrounding women as they age with HIV. For this, a review of 12 recent studies (2013-2016) using data from the Women's Interagency HIV Study (WIHS), the largest cohort study comparing HIV-infected and demographically matched uninfected women, is presented that specifically examines neurocognition. In general, HIV-infected women are more vulnerable to developing neurocognitive impairments than uninfected women; other factors that may contribute to these neurocognitive impairments include recent illicit drug use, reading level (educational quality/cognitive reserve), stress, PTSD, insulin resistance, liver fibrosis, and age. Surprisingly, when examined in some analyses, age × HIV interactions were not observed to impact neurocognitive performance, findings largely consistent in the literature; however, longitudinal analyses of these data have yet to be performed which may yield future insights of how cognitive reserve may be compromised over time. Yet, with insulin resistance, liver fibrosis, stress, and other known predictors of poorer neurocognition also occurring more with advanced age, in time, the synergistic effect of age and HIV may be more robust and observable as this population ages.
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Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham (UAB), Room 2M026, 1701 University Boulevard, Birmingham, AL, 35294-1210, USA.
| | - Leah H Rubin
- Department of Psychiatry, University of Illinois at Chicago, Room 324, MC 913, Chicago, IL, 60612, USA
| | - Victor Valcour
- Department of Neurology, UCSF School of Medicine, 3333 California Street, San Francisco, CA, 94104, USA
| | - Drenna Waldrop-Valverde
- Center for Neurocognitive Studies, Nell Hodgson Woodruff School of Nursing, Emory University, Room 442, 1520 Clifton Road, NE, Atlanta, GA, 30322-4027, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Room 328, MC 913, Chicago, IL, 60612, USA
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Geary DC. Evolution of Human Sex-Specific Cognitive Vulnerabilities. QUARTERLY REVIEW OF BIOLOGY 2017. [DOI: 10.1086/694934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brief Report: Low-Dose Hydrocortisone Has Acute Enhancing Effects on Verbal Learning in HIV-Infected Men. J Acquir Immune Defic Syndr 2017; 75:e65-e70. [PMID: 28141781 DOI: 10.1097/qai.0000000000001303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Glucocorticoids are released in response to stress and alter cognition and brain function through both rapid nongenomic and slow genomic mechanisms. Administration of glucocorticoids in the form of hydrocortisone enhances aspects of learning and memory in individuals with PTSD but impairs these abilities in healthy individuals. We examine the time-dependent effects of glucocorticoids on cognition in HIV-infected men. METHODS In a double-blind placebo-controlled crossover study, we examined the time-dependent effects of a single low dose of hydrocortisone [10 mg; low-dose hydrocortisone (LDH)] on cognition in 45 HIV-infected men. Participants were randomized to receive either LDH or placebo and one month later, were given the opposite treatment. At each intervention session, cognition was assessed 30 minutes (assessing nongenomic effects) and 4 hours (assessing genomic effects) after pill administration. Self-reported stress/anxiety and cortisol/cytokines in saliva were measured throughout each session. RESULTS Compared with placebo, LDH doubled salivary cortisol levels. Cortisol returned to baseline 4 hours postadministration. At the 30-minute assessment, LDH enhanced verbal learning compared with placebo. Greater increases in cortisol were associated with greater enhancements in verbal learning. LDH did not affect subjective stress/anxiety or any other cognitive outcomes at the 30-minute or 4-hour time point. CONCLUSIONS The rapid effects of LDH on verbal learning suggests a nongenomic mechanism by which glucocorticoids can enhance cognition in HIV-infected men. The nonenduring nature of this enhancement may limit its clinical utility but provides insight into mechanisms underlying the effects of acute glucocorticoids on learning.
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Chronic low-level expression of HIV-1 Tat promotes a neurodegenerative phenotype with aging. Sci Rep 2017; 7:7748. [PMID: 28798382 PMCID: PMC5552766 DOI: 10.1038/s41598-017-07570-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/28/2017] [Indexed: 12/20/2022] Open
Abstract
The widespread use of combinational antiretroviral therapies (cART) in developed countries has changed the course of Human Immunodeficiency Virus (HIV) infection from an almost universally fatal disease to a chronic infection for the majority of individuals. Although cART has reduced the severity of neurological damage in HIV-infected individuals, the likelihood of cognitive impairment increases with age, and duration of infection. As cART does not suppress the expression of HIV non-structural proteins, it has been proposed that a constitutive production of HIV regulatory proteins in infected brain cells may contribute to neurological damage. However, this assumption has never been experimentally tested. Here we take advantage of the leaky tetracycline promoter system in the Tat-transgenic mouse to show that a chronic very low-level expression of Tat is associated with astrocyte activation, inflammatory cytokine expression, ceramide accumulation, reductions in brain volume, synaptic, and axonal damage that occurs over a time frame of 1 year. These data suggest that a chronic low-level production of Tat may contribute to progressive neurological damage in virally suppressed HIV-infected individuals.
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Keutmann MK, Gonzalez R, Maki PM, Rubin LH, Vassileva J, Martin EM. Sex differences in HIV effects on visual memory among substance-dependent individuals. J Clin Exp Neuropsychol 2017; 39:574-586. [PMID: 27841082 PMCID: PMC5395326 DOI: 10.1080/13803395.2016.1250869] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
HIV's effects on episodic memory have not been compared systematically between male and female substance-dependent individuals. We administered the Brief Visuospatial Memory Test-Revised (BVMT-R) to 280 substance-dependent HIV+ and HIV- men and women. Groups were comparable on demographic, substance use, and comorbid characteristics. There were no significant main effects of sex or HIV serostatus on BVMT-R performance, but HIV+ women performed significantly more poorly on delayed recall. This effect was most prominent among cocaine-dependent HIV+ women. Our findings are consistent with recent speculation that memory impairment may be more common among HIV+ women, particularly those with a history of cocaine dependence.
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Affiliation(s)
| | - Raul Gonzalez
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Pauline M. Maki
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - Leah H. Rubin
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - Jasmin Vassileva
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Eileen M. Martin
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
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28
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Vance DE, Rubin LH, Valcour V, Waldrop-Valverde D, Maki PM. Aging and Neurocognitive Functioning in HIV-Infected Women: a Review of the Literature Involving the Women’s Interagency HIV Study. Curr HIV/AIDS Rep 2016. [DOI: https:/doi.10.1007/s11904-016-0340-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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