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Tamargo JA, Meade CS, Campa A, Martinez SS, Li T, Sherman KE, Baum MK. Food Insecurity and Cognitive Impairment in the Miami Adult Studies on HIV (MASH) Cohort. J Nutr 2021; 151:979-986. [PMID: 33561209 PMCID: PMC8030697 DOI: 10.1093/jn/nxaa416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Food insecurity is a social determinant of health associated with cognitive impairments in older adults and people living with HIV (PLWH). Few studies have examined this relation longitudinally, and no studies have explored how the frequency of food insecurity over time may impact cognitive impairment. OBJECTIVE This study aimed to examine the impact of food insecurity on cognitive impairment over a 2-y follow-up period in a cohort of people living with and without HIV. METHODS This was a 2-y longitudinal analysis of primarily economically disadvantaged, middle-aged, Black, and Hispanic participants from the Miami Adult Studies on HIV (MASH) cohort. Food insecurity was assessed with the USDA Household Food Security Module at baseline and 12- and 24-mo follow-ups. Food insecurity in all 3 assessments was considered persistent food insecurity. Cognitive impairment was assessed with the Mini-Mental State Examination. Statistical analyses consisted of logistic regressions. RESULTS A total of 394 participants (247 HIV positive) with 2-y follow-up data were included in this analysis. At baseline, 104 (26.4%) were food-insecure and 58 (14.7%) had cognitive impairment. Very low food security was associated with cognitive impairment at baseline (OR: 3.23; 95% CI: 1.08, 9.65). PLWH not virally suppressed had higher risk for cognitive impairment compared with HIV-uninfected participants (OR: 2.87; 95% CI: 1.15, 7.18). Additionally, baseline food insecurity (OR: 2.28; 95% CI: 1.08, 4.81) and the frequency of food insecurity over time (OR: 1.50 per year; 95% CI: 1.08, 2.10), particularly persistent food insecurity (OR: 3.69; 95% CI: 1.15, 11.83), were associated with cognitive impairment at 2-y follow-up; the results were consistent after excluding cognitively impaired participants at baseline. CONCLUSIONS Food insecurity is a significant risk factor for cognitive impairment, particularly among individuals who experience food insecurity frequently or persistently. Screening for food insecurity and interventions to secure access to sufficient, nutritious foods may help delay cognitive decline among socioeconomically disadvantaged individuals.
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Affiliation(s)
- Javier A Tamargo
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Adriana Campa
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Sabrina S Martinez
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Kenneth E Sherman
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
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Britton MK, Porges EC, Bryant V, Cohen RA. Neuroimaging and Cognitive Evidence for Combined HIV-Alcohol Effects on the Central Nervous System: A Review. Alcohol Clin Exp Res 2020; 45:290-306. [PMID: 33296091 DOI: 10.1111/acer.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) among people living with HIV (PLWH) is a significant public health concern. Despite the advent of effective antiretroviral therapy, up to 50% of PLWH still experience worsened neurocognition, which comorbid AUD exacerbates. We report converging lines of neuroimaging and neuropsychological evidence linking comorbid HIV/AUD to dysfunction in brain regions linked to executive function, learning and memory, processing speed, and motor control, and consequently to impairment in daily life. The brain shrinkage, functional network alterations, and brain metabolite disruption seen in individuals with HIV/AUD have been attributed to several interacting pathways: viral proteins and EtOH are directly neurotoxic and exacerbate each other's neurotoxic effects; EtOH reduces antiretroviral adherence and increases viral replication; AUD and HIV both increase gut microbial translocation, promoting systemic inflammation and HIV transport into the brain by immune cells; and HIV may compound alcohol's damaging effects on the liver, further increasing inflammation. We additionally review the neurocognitive effects of aging, Hepatitis C coinfection, obesity, and cardiovascular disease, tobacco use, and nutritional deficiencies, all of which have been shown to compound cognitive changes in HIV, AUD, and in their comorbidity. Finally, we examine emerging questions in HIV/AUD research, including genetic and cognitive protective factors, the role of binge drinking in HIV/AUD-linked cognitive decline, and whether neurocognitive and brain functions normalize after drinking cessation.
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Affiliation(s)
- Mark K Britton
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Vaughn Bryant
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, (VB), University of Florida, Gainesville, Florida, USA
| | - Ronald A Cohen
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
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Delle Donne V, Ciccarelli N, Massaroni V, Borghetti A, Dusina A, Farinacci D, Visconti E, Tamburrini E, Fabbiani M, Di Giambenedetto S. The University of California San Diego performance-based skills assessment: a useful tool to detect mild everyday functioning difficulties in HIV-infected patients with very good immunological condition. J Neurovirol 2020; 26:899-907. [PMID: 32839950 PMCID: PMC7716816 DOI: 10.1007/s13365-020-00891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
Abstract
Everyday functioning (EF) impairment is frequent in people living with HIV (PLWH). Our aim was to better explore EF and its association with PLWH cognition, by administering both the IADL scale, the most common functional scale, and a new and ecologic multi-domain (communication and financial skills) tool to measure EF as the University of California San Diego (UCSD) Performance-Based Skills Assessment-Brief Version (UPSA-B). Eighty-five PLWH on cART with very good immunological condition and 23 age- and education-matched healthy controls (HC) were enrolled. PLWH underwent a standardized neuropsychological battery plus IADL, and cognitive impairment was defined according to Frascati criteria. Both groups underwent the UPSA-B. Only 6 subjects (7%) were affected by cognitive impairment (asymptomatic profile). While IADL score was at ceiling for all patients, the UPSA-B total score was significantly worse in PLWH when compared with HC [mean 82.1 (SD 9.3) vs 89.2 (SD 6.2); p < 0.001]. At communication subtest, PLWH group and HC were significantly different (p = 0.002), while no difference emerged at financial skills (p = 0.096). Higher score at UPSA-B was independently associated with better global cognitive performance (composite Z-score) (β 7.79; p < 0.001). Also considering each single cognitive domain, UPSA-B performance (both total and at subtests) confirmed the association with neurocognitive performance. In conclusion, UPSA-B seems to better discriminate EF impairment than IADL in PLWH, and it was associated with cognitive functions, also in the absence of symptomatic cognitive impairment. Thus, it appears a promising tool in the context of HIV infection to avoid misdiagnosis and to better detect also mild EF.
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Affiliation(s)
- Valentina Delle Donne
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Nicoletta Ciccarelli
- Department of Psychology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 1, 20123, Milan, Italy.
| | - Valentina Massaroni
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Dusina
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Damiano Farinacci
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Tamburrini
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy.,UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimiliano Fabbiani
- Tropical and Infectious Diseases Unit, Department of Specialized and Internal Medicine, University Hospital of Siena, Siena, Italy
| | - Simona Di Giambenedetto
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy.,UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Fabbiani M, Ciccarelli N, Castelli V, Soria A, Borghetti A, Colella E, Moschese D, Valsecchi M, Emiliozzi A, Gori A, De Luca A, Bandera A, Di Giambenedetto S. Hepatitis C virus-related factors associated WITH cognitive performance in HIV-HCV-coinfected patients. J Neurovirol 2019; 25:866-873. [PMID: 31281946 DOI: 10.1007/s13365-019-00780-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023]
Abstract
The contribution of HCV-related variables to cognitive impairment in HIV-HCV-coinfected patients has been poorly investigated. We selected HIV-HCV-coinfected patients undergoing cognitive examination (exploring memory, language, speed of mental processing and fine motor function) at three clinical centres. Cognitive performance was evaluated using Z-transformed scores. Logistic regression analysis was used to investigate variables associated to cognitive impairment (defined as a composite Z-score ≤ - 1). Overall, 146 HIV-HCV-coinfected patients were enrolled. Median HCV-RNA was 6.2logU/mL. HCV genotype 1a/b was the most represented (53.4%). Liver fibrosis was mild (Fib4 ≤ 1.45) in the majority of patients (44.5%). Global cognitive impairment was diagnosed in 35 (24%) subjects. Exploring each domain, a higher proportion of impairment was observed for memory (37%) followed by speed of mental processing (32.2%), fine motor functioning (24%) and language (18.5%). Among HCV-related variables, the duration of HCV infection was independently associated with global cognitive impairment (aOR 1.13 per +1 year, p = 0.016) and abnormal speed of mental processing (aOR 1.16 per +1 year, p = 0.001), while higher HCV-RNA was independently associated to fine motor functioning impairment (aOR 1.98 per +1log, p = 0.037). HCV genotype, fibrosis stage, transaminases or bilirubin levels were not related to cognitive performance. Of note, integrase inhibitor (InSTI) use was independently associated to a pathological performance in fine motor functioning (aOR 3.34, p = 0.035) and memory (aOR 3.70, p = 0.014). In conclusion, the duration of HCV infection and HCV-RNA load showed an association with cognitive impairment, suggesting a role of hepatitis-related factors in the development of cognitive disorders in HIV-HCV-coinfected patients. The association between InSTI use and altered cognitive performance should prompt investigations about potential neurotoxicity of these drugs.
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Affiliation(s)
- Massimiliano Fabbiani
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, viale Golgi 19, 27100, Pavia, Italy.
| | - Nicoletta Ciccarelli
- Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy
| | - Valeria Castelli
- Infectious Diseases Unit, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Alessandro Soria
- Infectious Diseases Unit, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Alberto Borghetti
- Institute of Clinical Infectious Diseases, Fondazione Gemelli, IRCCS, Catholic University, Largo Gemelli 8, 00168, Rome, Italy
| | - Elisa Colella
- Infectious Diseases Unit, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Davide Moschese
- Institute of Clinical Infectious Diseases, Fondazione Gemelli, IRCCS, Catholic University, Largo Gemelli 8, 00168, Rome, Italy
| | - Manuela Valsecchi
- Infectious Diseases Unit, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Arianna Emiliozzi
- Institute of Clinical Infectious Diseases, Fondazione Gemelli, IRCCS, Catholic University, Largo Gemelli 8, 00168, Rome, Italy
| | - Andrea Gori
- Infectious Diseases Unit, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Andrea De Luca
- Department of Medical Biotechnologies, University of Siena, viale Bracci 16, 53100, Siena, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Fondazione Gemelli, IRCCS, Catholic University, Largo Gemelli 8, 00168, Rome, Italy
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