1
|
Carmona-Cervelló M, León-Gómez BB, Dacosta-Aguayo R, Lamonja-Vicente N, Montero-Alía P, Molist G, Ayet A, Chacón C, Costa-Garrido A, López-Lifante VM, Zamora-Putin V, Liutsko L, García-Sierra R, Fornés A, Moreno-Gabriel E, Massanella M, Muñoz-Moreno JA, Rodríguez-Pérez MC, Mateu L, Prats A, Mataró M, Boigues M, Quirant B, Prado JG, Martínez-Cáceres E, Violán C, Torán-Monserrat P. Long COVID: cognitive, balance, and retina manifestations. Front Med (Lausanne) 2024; 11:1399145. [PMID: 39036098 PMCID: PMC11260168 DOI: 10.3389/fmed.2024.1399145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
Background The neurological symptoms of Long COVID (LC) and the impact of neuropsychological manifestations on people's daily lives have been extensively described. Although a large body of literature describes symptoms, validating this with objective measures is important. This study aims to identify and describe the effects of Long COVID on cognition, balance, and the retinal fundus, and determine whether the duration of symptoms influences cognitive impairment. Methods This cross-sectional study involved LC volunteers with cognitive complaint from public health centers in northern Barcelona who participated between January 2022 and March 2023. This study collected sociodemographic characteristics, information on substance use, comorbidities, and clinical data related to COVID-19. We measured five cognitive domains using a battery of neuropsychological tests. Balance was assessed through posturography and retinal vascular involvement by retinography. Results A total of 166 people with LC and cognitive complaints participated, 80.72% were women and mean age was 49.28 ± 8.39 years. The most common self-reported symptoms were concentration and memory deficit (98.80%), brain fog (82.53%) and insomnia (71.17%). The 68.67% presented cognitive deficit in at least one domain, with executive functions being the most frequent (43.98%). The 51.52% of the participants exhibited a dysfunctional pattern in balance, and 9.2% showed some alteration in the retina. There were no statistically significant differences between cognitive impairment and symptom duration. Conclusion Our findings contribute to a more comprehensive understanding of the pathology associated with Long COVID. They highlight the diversity of self-reported symptoms, the presence of abnormal balance patterns, and some cognitive impairment. These findings underscore the necessity of addressing the clinical management of this condition in primary care through follow-up and the pursuit of multidisciplinary and comprehensive treatment.
Collapse
Affiliation(s)
- Meritxell Carmona-Cervelló
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Brenda Biaani León-Gómez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Rosalia Dacosta-Aguayo
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Noemí Lamonja-Vicente
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Grup de Recerca en Impacte de les Malalties Cròniques i les Seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Pilar Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Gemma Molist
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Faculty of Medicine, University of Vic-Central University of Vic, Barcelona, Spain
| | - Aitana Ayet
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Carla Chacón
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Grup de Recerca en Impacte de les Malalties Cròniques i les Seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Anna Costa-Garrido
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Victor M. López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Palau-Solità Healthcare Centre, Institut Català de la Salut, Palau-Solità Plegamans, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Valeria Zamora-Putin
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Palau-Solità Healthcare Centre, Institut Català de la Salut, Palau-Solità Plegamans, Barcelona, Spain
| | - Liudmila Liutsko
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Rosa García-Sierra
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antònia Fornés
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Department of Social Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Massanella
- IrsiCaixa-AIDS Research Institute, Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Red Española de investigación en Covid Persisitente, Barcelona, Spain
| | - Jose A. Muñoz-Moreno
- Infectious Diseases Department, Fundació Lluita Contra les Infeccions, Germans Trias i Pujol Hospital, Barcelona, Spain
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - M. Carmen Rodríguez-Pérez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Lourdes Mateu
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Red Española de investigación en Covid Persisitente, Barcelona, Spain
- Infectious Diseases Department, Fundació Lluita Contra les Infeccions, Germans Trias i Pujol Hospital, Barcelona, Spain
| | - Anna Prats
- Infectious Diseases Department, Fundació Lluita Contra les Infeccions, Germans Trias i Pujol Hospital, Barcelona, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Marc Boigues
- Immunology Department, FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Barcelona, Spain
- Immunology Division, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Cellular Biology, Physiology and Immunology,Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Bibiana Quirant
- Immunology Department, FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Barcelona, Spain
- Immunology Division, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Cellular Biology, Physiology and Immunology,Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Julia G. Prado
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- IrsiCaixa-AIDS Research Institute, Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Eva Martínez-Cáceres
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Immunology Department, FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Barcelona, Spain
- Immunology Division, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Concepción Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Grup de Recerca en Impacte de les Malalties Cròniques i les Seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Instituto de Salud Carlos III, Madrid, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Department of Medicine, Faculty of Medicine,Universitat de Girona, Girona, Spain
| | | |
Collapse
|
2
|
Dacosta-Aguayo R, Puig J, Lamonja-Vicente N, Carmona-Cervelló M, León-Gómez BB, Monté-Rubio G, López-Linfante VM, Zamora-Putin V, Montero-Alia P, Chacon C, Bielsa J, Moreno-Gabriel E, Garcia-Sierra R, Pachón A, Costa A, Mataró M, Prado JG, Martinez-Cáceres E, Mateu L, Massanella M, Violán C, Torán-Monserrat P. Reduced Cortical Thickness Correlates of Cognitive Dysfunction in Post-COVID-19 Condition: Insights from a Long-Term Follow-up. AJNR Am J Neuroradiol 2024; 45:647-654. [PMID: 38575319 PMCID: PMC11288549 DOI: 10.3174/ajnr.a8167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/03/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND PURPOSE There is a paucity of data on long-term neuroimaging findings from individuals who have developed the post-coronavirus 2019 (COVID-19) condition. Only 2 studies have investigated the correlations between cognitive assessment results and structural MR imaging in this population. This study aimed to elucidate the long-term cognitive outcomes of participants with the post-COVID-19 condition and to correlate these cognitive findings with structural MR imaging data in the post-COVID-19 condition. MATERIALS AND METHODS A cohort of 53 participants with the post-COVID-19 condition underwent 3T brain MR imaging with T1 and FLAIR sequences obtained a median of 1.8 years after Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection. A comprehensive neuropsychological battery was used to assess several cognitive domains in the same individuals. Correlations between cognitive domains and whole-brain voxel-based morphometry were performed. Different ROIs from FreeSurfer were used to perform the same correlations with other neuroimaging features. RESULTS According to the Frascati criteria, more than one-half of the participants had deficits in the attentional (55%, n = 29) and executive (59%, n = 31) domains, while 40% (n = 21) had impairment in the memory domain. Only 1 participant (1.89%) showed problems in the visuospatial and visuoconstructive domains. We observed that reduced cortical thickness in the left parahippocampal region (t(48) = 2.28, P = .03) and the right caudal-middle-frontal region (t(48) = 2.20, P = .03) was positively correlated with the memory domain. CONCLUSIONS Our findings suggest that cognitive impairment in individuals with the post-COVID-19 condition is associated with long-term alterations in the structure of the brain. These macrostructural changes may provide insight into the nature of cognitive symptoms.
Collapse
Affiliation(s)
- Rosalia Dacosta-Aguayo
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Department of Clinical Psychology and Psychobiology (R.D.-A., M.M.), University of Barcelona, Barcelona, Spain. Institut de Neurociències, University of Barcelona, Barcelona, Spain. Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Josep Puig
- Comparative Medicine and Bioimaging Center (J.P., G.M.-R.), Germans Trias i Pujol Research Institute, Badalona, Spain
- Department of Radiology (IDI) (J.P.), IDIBGI Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Noemi Lamonja-Vicente
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Meritxell Carmona-Cervelló
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Brenda Biaani León-Gómez
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Gemma Monté-Rubio
- Comparative Medicine and Bioimaging Center (J.P., G.M.-R.), Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Victor M López-Linfante
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Palau-Solità Healthcare Centre (V.M.L.-L., V.Z.-P.), Palau-Solità Plegamans Institut Català de la Salut, Barcelona, Spain
- Department of Medicine (V.M.L.-L., E.M.-C.), Universitat Autònoma de Barcelona, Cerdanyola de Vallès, Bellaterra, Spain
| | - Valeria Zamora-Putin
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Palau-Solità Healthcare Centre (V.M.L.-L., V.Z.-P.), Palau-Solità Plegamans Institut Català de la Salut, Barcelona, Spain
| | - Pilar Montero-Alia
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Carla Chacon
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (C.C., C.V.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol; Barcelona, Spain. Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Jofre Bielsa
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Eduard Moreno-Gabriel
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Department of Social Psychology (E.M.-G.), Universitat Autònoma de Barcelona, Cerdanyola de Vallès, Bellaterra, Spain
| | - Rosa Garcia-Sierra
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Nursing Department, Faculty of Medicine (R.G.-S.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Pachón
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Anna Costa
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology (R.D.-A., M.M.), University of Barcelona, Barcelona, Spain. Institut de Neurociències, University of Barcelona, Barcelona, Spain. Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Julia G Prado
- IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute (J.G.P., M.M.), Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (J.G.-., L.M., M.M.), Instituto de Salud Carlos III, Madrid, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
| | - Eva Martinez-Cáceres
- Department of Medicine (V.M.L.-L., E.M.-C.), Universitat Autònoma de Barcelona, Cerdanyola de Vallès, Bellaterra, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Immunology Department (E.M.-C.), FOCIS Center of Excellence, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Immunology Division, Laboratori Clinic Metropolitana Nord (E.M.-C.), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lourdes Mateu
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (J.G.-., L.M., M.M.), Instituto de Salud Carlos III, Madrid, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Infectious Diseases Department (L.M.), Fight against AIDS Foundation (FLS), Germans Trias I Pujol Hospital, Can Ruti Campus, Badalona, Spain
- Red Española de Investigación en Covid Persisitente (L.M., M.M.), European Innovation and Collaboration Programme, Badalona, Spain
| | - Marta Massanella
- IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute (J.G.P., M.M.), Can Ruti Campus, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (J.G.-., L.M., M.M.), Instituto de Salud Carlos III, Madrid, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Red Española de Investigación en Covid Persisitente (L.M., M.M.), European Innovation and Collaboration Programme, Badalona, Spain
| | - Concepción Violán
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (C.C., C.V.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol; Barcelona, Spain. Germans Trias i Pujol Research Institute, Badalona, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Red de Investigación en Cronicidad (C.V.), Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autónoma de Barcelona (C.V.), Bellaterra, Spain
| | - Pere Torán-Monserrat
- From the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (R.D.-A., N.L.-V., M.C.-C., B.B.L.-G., V.M.L.-L., V.Z.-P., P.M.-A., C.C., J.B., E.M.-G., R.G.-S., A.P., A.C., C.V., P.T.-M.), Unitat de Suport a la Recerca Metropolitana Nord, Mataró, Spain
- Multidisciplinary Research Group in Health and Society (N.L.-V., V.M.L.-L., P.M.-A., E.M.-G., R.G.-S., P.T.-M.), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Germans Trias i Pujol Research Institute (J.G.P., E.M.-C., L.M., M.M., C.V., P.T.-M.), Can Ruti Campus, Badalona, Spain
- Department of Medicine (P.T.-M.), Faculty of Medicine, Universitat de Girona, Girona, Spain
| |
Collapse
|
3
|
Towe SL, Tang R, Gibson MJ, Zhang AR, Meade CS. Longitudinal changes in neurocognitive performance related to drug use intensity in a sample of persons with and without HIV who use illicit stimulants. Drug Alcohol Depend 2023; 251:110923. [PMID: 37598454 PMCID: PMC10538396 DOI: 10.1016/j.drugalcdep.2023.110923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Illicit stimulant use remains a public health concern that has been associated with multiple adverse outcomes, including cognitive deficits. The effects of stimulant use on cognition may be particularly deleterious in persons with HIV. Stimulant use intensity may be an important factor in the magnitude of observed deficits over time. METHODS We completed neurocognitive testing in a sample of people who use stimulants with (n = 84) and without HIV (n = 123) at baseline and up to 4 follow-up time points over approximately 1 year. Participants reported on substance use at each visit, including frequency of use and stimulant dependence. Mixed effects models examined the relationship between stimulant-related factors and neurocognitive function over time. RESULTS Participants were mostly male (57%), African American (86%), and 47.41 years old on average. All participants actively used stimulants at enrollment and use remained prevalent throughout the follow-up period, with an average of ≥24 days of use in the past 90 days at all time points. Retention was excellent, with 86% completing all 4 follow-up assessments. Mixed effects models showed that stimulant dependence was associated with lower neurocognitive performance independent of HIV status (p = 0.002), whereas frequency of use had a greater negative impact on performance in participants with HIV compared to those without HIV (p = 0.045). CONCLUSIONS Our key finding is that stimulant-related factors are associated with neurocognitive performance over time, but in complex ways. These findings have important implications for harm reduction approaches, particularly those that target cognitive function.
Collapse
Affiliation(s)
- Sheri L Towe
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Durham, NC 27708, USA.
| | - Runshi Tang
- University of Wisconsin-Madison, Department of Statistics, Madison, WI 53706, USA
| | - Matthew J Gibson
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Durham, NC 27708, USA
| | - Anru R Zhang
- Duke University School of Medicine, Department of Biostatistics & Bioinformatics, Durham, NC 27708, USA
| | - Christina S Meade
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Durham, NC 27708, USA
| |
Collapse
|
4
|
Al-Khalil K, Bell RP, Towe SL, Gadde S, Burke E, Meade CS. Cortico-striatal networking deficits associated with advanced HIV disease and cocaine use. J Neurovirol 2023; 29:167-179. [PMID: 36809507 PMCID: PMC10515399 DOI: 10.1007/s13365-023-01120-8] [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: 10/28/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/23/2023]
Abstract
Cocaine use is disproportionately prevalent in people with HIV (PWH) and is known to potentiate HIV neuropathogenesis. As both HIV and cocaine have well-documented cortico-striatal effects, PWH who use cocaine and have a history of immunosuppression may exhibit greater FC deficits compared to PWH without these conditions. However, research investigating the legacy effects of HIV immunosuppression (i.e., a history of AIDS) on cortico-striatal functional connectivity (FC) in adults with and without cocaine use is sparse. Resting-state functional magnetic resonance imaging (fMRI) and neuropsychological assessment data from 273 adults were analyzed to examine FC in relation to HIV disease: HIV-negative (n = 104), HIV-positive with nadir CD4 ≥ 200 (n = 96), HIV-positive with nadir CD4 < 200 (AIDS; n = 73), and cocaine use (83 COC and 190 NON). Using independent component analysis/dual regression, FC was assessed between the basal ganglia network (BGN) and five cortical networks: dorsal attention network (DAN), default mode network, left executive network, right executive network, and salience network. There were significant interaction effects such that AIDS-related BGN-DAN FC deficits emerged in COC but not in NON participants. Independent of HIV, cocaine effects emerged in FC between the BGN and executive networks. Disruption of BGN-DAN FC in AIDS/COC participants is consistent with cocaine potentiation of neuro-inflammation and may be indicative of legacy HIV immunosuppressive effects. The current study bolsters previous findings linking HIV and cocaine use with cortico-striatal networking deficits. Future research should consider the effects of the duration of HIV immunosuppression and early treatment initiation.
Collapse
Affiliation(s)
- Kareem Al-Khalil
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA.
| | - Ryan P Bell
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Sheri L Towe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Syam Gadde
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA
| | - Emma Burke
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Christina S Meade
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| |
Collapse
|
5
|
McIntosh RC, Clark US, Cherner M, Cysique LA, Heaton RK, Levin J, Remien RH, Thames A, Moore DJ, Rubin LH. The Evolution of Assessing Central Nervous System Complications in Human Immunodeficiency Virus: Where Do We Go From Here? J Infect Dis 2023; 227:S30-S37. [PMID: 36930636 PMCID: PMC10022716 DOI: 10.1093/infdis/jiac316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
In this fifth decade of the human immunodeficiency virus (HIV) epidemic, central nervous system (CNS) complications including cognitive impairment and mental health remain a burden for people with HIV (PWH) on antiretroviral therapy. Despite the persistence of these complications, which often co-occur, the underlying pathophysiology remains elusive and consequently treatments remain limited. To continue to grow our understanding of the underlying mechanisms of CNS complications among PWH, there is a need to reexamine our current approaches, which are now more than 2 decades old. At the 2021 National Institutes of Health-sponsored meeting on Biotypes of CNS Complications in PWH, the Neurobehavioral Working Group addressed the following: (1) challenges inherent to determining CNS complications; (2) heterogeneity in CNS complications; and (3) problems and solutions for examining integrated biotypes. The review below provides a summary of the main points presented and discussed by the Neurobehavioral Working Group at the meeting.
Collapse
Affiliation(s)
- Roger C McIntosh
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Lucette A Cysique
- Department of Psychology, University of New South Wales, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jules Levin
- National AIDS Treatment Advocacy Project, New York, New York, USA
| | - Robert H Remien
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Leah H Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, Epidemiology, and Molecular and Comparative Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
6
|
Chu L, Shu Z, Gu X, Wu Y, Yang J, Deng H. The Endocannabinoid System as a Potential Therapeutic Target for HIV-1-Associated Neurocognitive Disorder. Cannabis Cannabinoid Res 2023. [PMID: 36745405 DOI: 10.1089/can.2022.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Despite the successful introduction of combined antiretroviral therapy, the prevalence of mild to moderate forms of HIV-associated neurocognitive disorders (HAND) remains high. It has been demonstrated that neuronal injury caused by HIV is excitotoxic and inflammatory, and it correlates with neurocognitive decline in HAND. Endocannabinoid system (ECS) protects the body from excitotoxicity and neuroinflammation on demand and presents a promising therapeutic target for treating HAND. Here, we firstly discuss the potential pathogenesis of HAND. We secondly discuss the structural and functional changes in the ECS that are currently known among HAND patients. We thirdly discuss current clinical and preclinical findings concerning the neuroprotective and anti-inflammatory properties of the ECS among HAND patients. Fourth, we will discuss the interactions between the ECS and neuroendocrine systems, including the hypothalamic-pituitary-adrenocortical (HPA) and hypothalamic-pituitary-gonadal (HPG) axes under the HAND conditions. Materials and Methods: We have carried out a review of the literature using PubMed to summarize the current state of knowledge on the association between ECS and HAND. Results: The ECS may be ideally suited for modulation of HAND pathophysiology. Direct activation of presynaptic cannabinoid receptor 1 or reduction of cannabinoid metabolism attenuates HAND excitotoxicity. Chronic neuroinflammation associated with HAND can be reduced by activating cannabinoid receptor 2 on immune cells. The sensitivity of the ECS to HIV may be enhanced by increased cannabinoid receptor expression in HAND. In addition, indirect regulation of the ECS through modulation of hormone-related receptors may be a potential strategy to influence the ECS and also alleviate the progression of HAND due to the reciprocal inhibition of the ECS by the HPA and HPG axes. Conclusions: Taken together, targeting the ECS may be a promising strategy to alleviate the inflammation and neurodegeneration caused by HIV-1 infection. Further studies are required to clarify the role of endocannabinoid signaling in HIV neurotoxicity. Strategies promoting endocannabinoid signaling may slow down cognitive decline of HAND are proposed.
Collapse
Affiliation(s)
- Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China.,Department of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Zheng Shu
- Clinical Nutrition Department, The Third Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Xinpei Gu
- Department of Human Anatomy, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yan Wu
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China.,Department of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Jin Yang
- Department of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China.,Department of Child and Adolescent Hygienics, School of Public Health, Southeast University, Nanjing, China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China.,Department of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| |
Collapse
|
7
|
Law-Ye B, de Truchis P, Peyrassou D, Force G, Carlier RY. Elevation of brain ADC (apparent diffusion coefficient) in HIV-associated neurocognitive disorders and evolution after treatment: A pilot study. J Neurol Sci 2022; 442:120446. [PMID: 36265262 DOI: 10.1016/j.jns.2022.120446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thirty to 50% of HIV-infected patients develop HIV-Associated Neurocognitive Disorders (HAND) despite virological control. The previously published Neuro+3 study showed their neurocognitive status can be improved by intensifying antiviral therapy. Our study is a part of the Neuro3+ study and aims to study apparent diffusion coefficient (ADC) as a biomarker for neurological improvement. PATIENTS AND METHODS We prospectively included 31 patients with HAND. They received therapy with better CNS Penetration Effectiveness (CPE) score with two-year follow-up. Cognitive status was assessed at day 0 (D0) and week 96 (W96) using Frascati 3-stage classification and Global Deficit Score (GDS). Brain MRI at D0 and W96 assessed morphological data (white matter hyperintensities, opportunistic infections, ischemic lesions, atrophy) and measured whole brain apparent diffusion coefficient (ADC). We compared their data with a control group of 20 healthy patients with similar ages and sex ratio. RESULTS After ARV intensification, cognitive status was significantly improved: GDS (n = 1,4 vs 1,0 p = 0.01) and Frascati scale (2HAD/22MND/7ANI vs 1HAD/8MND/17ANI p = 0.001). Mean ADC was significantly higher in patients at inclusion than in controls (0.88 × 10-3 mm2/s ± 0.06 vs 0.81 × 10-3 mm2/s ± 0.04, p = 0.0001). ADC decreased after treatment (0.88 × 10-3 mm2/s ± 0.06 vs 0.85 × 10-3 mm2/s ± 0.06 (p = 0,04). In subgroup analysis, ADC significantly decreased in clinically improved patients (0.89 × 10-3 mm2/s ± 0.07 vs 0.85 × 10-3 mm2/s ± 0.07 (p = 0,03)) and did not significantly change in non-clinically improved patients (0.86 × 10-3 mm2/s ± 0.07 vs 0.84 × 10-3 mm2/s ± 0.07 (p = 0,31)). After treatment, there was no significant difference between patients and controls (0.85 × 10-3 mm2/s ± 0.06 vs 0.81 × 10-3 mm2/s ± 0.04, p = 0.17). CONCLUSION Whole-brain ADC is a good biomarker of HIV-associated neurocognitive disorders. It is significantly increased in patients with HAND compared with controls and significantly decreases after treatment. It is all the more important to have a quantitative biomarker as conventional imaging does not contribute to the diagnosis.
Collapse
Affiliation(s)
- Bruno Law-Ye
- Neuroradiology Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France.
| | - Pierre de Truchis
- Infectiology Department, Garches University Hospital, Garches, France; UMR 1179, UVSQ-Paris-Saclay University, France
| | - David Peyrassou
- Radiology Department, DMU Smart Imaging, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Gilles Force
- Infectiology Department, Garches University Hospital, Garches, France
| | - Robert-Yves Carlier
- Radiology Department, DMU Smart Imaging, Raymond Poincaré University Hospital, APHP, Garches, France; APHP-Université Paris-Saclay, Garches, France
| |
Collapse
|
8
|
Abnormal cognitive aging in people with HIV: Evidence from Data Integration between two countries' cohort studies. AIDS 2022; 36:1171-1179. [PMID: 35471252 DOI: 10.1097/qad.0000000000003230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous research has shown inconsistent results on whether cognitive aging is abnormal in people with HIV (PWH) because of low sample size, cross-sectional design, and nonstandard neuropsychological methods. To address these issues, we integrated data from two longitudinal studies: Australian HIV and Brain Ageing Research Program (N = 102) and CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study (N = 924) and determined the effect of abnormal aging on neurocognitive impairment (NCI) among PWH. METHODS Both studies used the same neuropsychological test battery. NCI was defined based on demographically corrected global deficit score (≥0.5 = impaired). Both studies also assessed comorbidities, neuropsychiatric conditions and functional status using similar tools. To determine the cross-sectional and longitudinal effects of age on the risk of NCI, a generalized linear mixed-effect model tested main and interaction effects of age group (young, <50 vs. old, ≥50) and time on NCI adjusting the effects of covariates. RESULTS Older PWH had 83% higher chance of NCI compared with younger PWH [odds ratio (OR) = 1.83 (1.15-2.90), P < 0.05]. Older participants also had a greater risk of increases in NCI over the follow-up [OR = 1.66 (1.05-2.64), P < 0.05] than younger participants. Nonwhite ethnicity (P < 0.05), having a contributing (P < 0.05) or confounding (P < 0.001) comorbidity, greater cognitive symptoms (P < 0.001), and abnormal creatinine level (P < 0.05), plasma viral load greater than 200 copies/ml (P < 0.05), being from the Australian cohort (P < 0.05) were also associated with a higher risk of NCI. CONCLUSION Data integration may serve as a strategy to increase sample size and study power to better assess abnormal cognitive aging effect in PWH, which was significant in the current study.
Collapse
|
9
|
Salahuddin MF, Qrareya AN, Mahdi F, Moss E, Akins NS, Li J, Le HV, Paris JJ. Allopregnanolone and neuroHIV: Potential benefits of neuroendocrine modulation in the era of antiretroviral therapy. J Neuroendocrinol 2022; 34:e13047. [PMID: 34651359 PMCID: PMC8866218 DOI: 10.1111/jne.13047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Abstract
Forty years into the HIV pandemic, approximately 50% of infected individuals still suffer from a constellation of neurological disorders collectively known as 'neuroHIV.' Although combination antiretroviral therapy (cART) has been a tremendous success, in its present form, it cannot eradicate HIV. Reservoirs of virus reside within the central nervous system, serving as sources of HIV virotoxins that damage mitochondria and promote neurotoxicity. Although understudied, there is evidence that HIV or the HIV regulatory protein, trans-activator of transcription (Tat), can dysregulate neurosteroid formation potentially contributing to endocrine dysfunction. People living with HIV commonly suffer from endocrine disorders, including hypercortisolemia accompanied by paradoxical adrenal insufficiency upon stress. Age-related comorbidities often onset sooner and with greater magnitude among people living with HIV and are commonly accompanied by hypogonadism. In the post-cART era, these derangements of the hypothalamic-pituitary-adrenal and -gonadal axes are secondary (i.e., relegated to the brain) and indicative of neuroendocrine dysfunction. We review the clinical and preclinical evidence for neuroendocrine dysfunction in HIV, the capacity for hormone therapeutics to play an ameliorative role and the future steroid-based therapeutics that may have efficacy as novel adjunctives to cART.
Collapse
Affiliation(s)
- Mohammed F. Salahuddin
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Alaa N. Qrareya
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Fakhri Mahdi
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Emaya Moss
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Nicholas S. Akins
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Jing Li
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
- Research Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Hoang V. Le
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
- Research Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Jason J. Paris
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
- Research Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| |
Collapse
|
10
|
Brouillette MJ, Koski L, Forcellino L, Gasparri J, Brew BJ, Fellows LK, Mayo NE, Cysique LA. Predicting occupational outcomes from neuropsychological test performance in older people with HIV. AIDS 2021; 35:1765-1774. [PMID: 33927088 DOI: 10.1097/qad.0000000000002927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The ability to work is amongst the top concerns of people living with well treated HIV. Cognitive impairment has been reported in many otherwise asymptomatic persons living with HIV and even mild impairment is associated with higher rates of occupational difficulties. There are several classification algorithms for HIV-associated neurocognitive disorder (HAND) as well as overall scoring methods available to summarize neuropsychological performance. We asked which method best explained work status and productivity. DESIGN Participants (N = 263) drawn from a longitudinal Canadian cohort underwent neuropsychological testing. METHODS : Several classification algorithms were applied to establish a HAND diagnosis and two summary measures (NPZ and Global Deficit Score) were computed. Self-reported work status and productivity was assessed at each study visit (four visits, 9 months apart). The association of work status with each diagnostic classification and summary measure was estimated using logistic regression. For those working, the value on the productivity scale was regressed within individuals over time, and the slopes were regressed on each neuropsychological outcome. RESULTS The application of different classification algorithms to the neuropsychological data resulted in rates of impairment that ranged from 28.5 to 78.7%. Being classified as impaired by any method was associated with a higher rate of unemployment. None of the diagnostic classifications or summary methods predicted productivity, at time of testing or over the following 36 months. CONCLUSION Neuropsychological diagnostic classifications and summary scores identified participants who were more likely to be unemployed, but none explained productivity. New methods of assessing cognition are required to inform optimal workforce engagement.
Collapse
Affiliation(s)
- Marie-Josée Brouillette
- Department of Psychiatry, McGill University
- Chronic Viral Illness Service, McGill University Health Centre (MUHC)
- Infectious Diseases and Immunity in Global Health Program, MUHC-RI, Montreal, QC
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC
| | - Lisa Koski
- Department of Psychology, McGill University
| | | | - Joséphine Gasparri
- Bachelor of Behavioral Neuroscience, Concordia University, Montreal, QC, Canada
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit
- Faculty of Medicine, University of Notre Dame, and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lesley K Fellows
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC
- Department of Neurology and Neurosurgery
- Montreal Neurological Hospital and Institute
| | - Nancy E Mayo
- Department of Medicine, School of Physical and Occupational Therapy, McGill University
- Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Center for Outcomes Research and Evaluation
- Division of Geriatrics, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Lucette A Cysique
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
11
|
Vance DE, Becker JT. Using HIV neuropsychological classification methods to predict employment status. AIDS 2021; 35:1859-1861. [PMID: 34397484 PMCID: PMC8371715 DOI: 10.1097/qad.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - James T Becker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
12
|
Rates of cognitive impairment in a South African cohort of people with HIV: variation by definitional criteria and lack of association with neuroimaging biomarkers. J Neurovirol 2021; 27:579-594. [PMID: 34241815 DOI: 10.1007/s13365-021-00993-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/14/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
There is wide variation in the reported prevalence of cognitive impairment in people with HIV (PWH). Part of this variation may be attributable to different studies using different methods of combining neuropsychological test scores to classify participants as either cognitively impaired or unimpaired. Our aim was to determine, in a South African cohort of PWH (N = 148), (a) how much variation in reported rates was due to method used to define cognitive impairment and (b) which method correlated best with MRI biomarkers of HIV-related brain pathology. Participants completed detailed neuropsychological assessment and underwent 3 T structural MRI and diffusion tensor imaging (DTI). We used the neuropsychological data to investigate 20 different methods of determining HIV-associated cognitive impairment. We used the neuroimaging data to obtain volumes for cortical and subcortical grey matter and total white matter and DTI metrics for several white matter tracts. Applying each of the 20 methods to the cognitive dataset resulted in a wide variation (20-97%) in estimated rates of impairment. Logistic regression models showed no method was associated with HIV-related neuroimaging abnormalities as measured by structural volumes or DTI metrics. We conclude that for the population from which this sample was drawn, much of the variation in reported rates of cognitive impairment in PWH is due to the method of classification used, and that none of these methods accurately reflects biological effects of HIV in the brain. We suggest that defining HIV-associated cognitive impairment using neuropsychological test performance only is insufficient; pre-morbid functioning, co-morbidities, cognitive symptoms, and functional impairment should always be considered.
Collapse
|
13
|
Force G, Ghout I, Ropers J, Carcelain G, Marigot-Outtandy D, Hahn V, Darchy N, Defferriere H, Bouaziz-Amar E, Carlier R, Dorgham K, Callebert J, Peytavin G, Delaugerre C, de Truchis P. Improvement of HIV-associated neurocognitive disorders after antiretroviral therapy intensification: the Neuro+3 study. J Antimicrob Chemother 2021; 76:743-752. [PMID: 33179033 DOI: 10.1093/jac/dkaa473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/19/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Despite the effectiveness of antiretroviral (ARV) therapy to control HIV infection, HIV-associated neurocognitive disorders (HAND) remain frequent. The Neuro+3 study assessed the cognitive improvement associated with ARV intensification based on increased CNS penetration effectiveness (CPE) scoring ≥+3 and total CPE score ≥9. METHODS Thirty-one patients, aged 18-65 years, with confirmed diagnosis of HAND and effective ARV therapy were included. The cognitive improvement was measured using Frascati three-stage classification and global deficit score (GDS) after 48 and 96 weeks of ARV intensification. Ultrasensitive HIV-RNA, neopterin, soluble CD14, CCL2, CXCL10, IL6, IL8 and NF-L were measured in plasma and cerebrospinal fluid at Day 0 (baseline), Week 48 (W48) and W96. RESULTS The intensified ARV was associated with a median (IQR) CPE score increase from 6 (4-7) at baseline to 10 (9-11). From baseline to W96, the median (IQR) GDS decreased from 1.4 (0.8-2.2) to 1.0 (0.6-2.0) (P = 0.009); HAND classification improved from 2 to 1 HIV-associated dementia, 22 to 8 mild neurocognitive disorders, 7 to 17 asymptomatic neurocognitive impairment and 0 to 5 patients without any neurocognitive alterations (P = 0.001). In multivariable linear regression analysis, GDS improvement at W96 was significantly associated with CPE score ≥9 after intensification (P = 0.014), CD4 lymphocyte increase at W48 (P < 0.001) and plasma CXCL10 decrease at W96 (P = 0.001). CONCLUSIONS In patients with HAND, a significant cognitive improvement was observed after the ARV intensification strategy, with a higher CPE score. Cognitive improvement was more often observed in the case of a switch of two drug classes, arguing for better control of CNS HIV immune activation.
Collapse
Affiliation(s)
- Gilles Force
- French-British Hospital Institute, Levallois-Perret, France
| | - Idir Ghout
- APHP Hospital Ambroise Paré, Versailles Saint Quentin en Yvelines University, Boulogne, France
| | - Jacques Ropers
- APHP Hospital Ambroise Paré, Versailles Saint Quentin en Yvelines University, Boulogne, France
| | | | - Dhiba Marigot-Outtandy
- APHP Hospital Raymond Poincaré, Paris-Saclay University, Garches, France.,Bligny Hospital, Briis sous Forges, France
| | | | - Natacha Darchy
- French-British Hospital Institute, Levallois-Perret, France
| | - Hélène Defferriere
- APHP Hospital Raymond Poincaré, Paris-Saclay University, Garches, France
| | | | - Robert Carlier
- APHP Hospital Raymond Poincaré, Paris-Saclay University, Garches, France
| | - Karim Dorgham
- Sorbonne University, Inserm, Center for Immunology and Microbial Infection, Paris, France
| | | | | | | | - Pierre de Truchis
- APHP Hospital Raymond Poincaré, Paris-Saclay University, Garches, France
| | | |
Collapse
|
14
|
Matt SM, Nickoloff-Bybel EA, Rong Y, Runner K, Johnson H, O'Connor MH, Haddad EK, Gaskill PJ. Dopamine Levels Induced by Substance Abuse Alter Efficacy of Maraviroc and Expression of CCR5 Conformations on Myeloid Cells: Implications for NeuroHIV. Front Immunol 2021; 12:663061. [PMID: 34093554 PMCID: PMC8170305 DOI: 10.3389/fimmu.2021.663061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Despite widespread use of antiretroviral therapy (ART), HIV remains a major public health issue. Even with effective ART many infected individuals still suffer from the constellation of neurological symptoms now known as neuroHIV. These symptoms can be exacerbated by substance abuse, a common comorbidity among HIV-infected individuals. The mechanism(s) by which different types of drugs impact neuroHIV remains unclear, but all drugs of abuse increase central nervous system (CNS) dopamine and elevated dopamine increases HIV infection and inflammation in human myeloid cells including macrophages and microglia, the primary targets for HIV in the brain. Thus, drug-induced increases in CNS dopamine may be a common mechanism by which distinct addictive substances alter neuroHIV. Myeloid cells are generally infected by HIV strains that use the chemokine receptor CCR5 as a co-receptor, and our data indicate that in a subset of individuals, drug-induced levels of dopamine could interfere with the effectiveness of the CCR5 inhibitor Maraviroc. CCR5 can adopt distinct conformations that differentially regulate the efficiency of HIV entry and subsequent replication and using qPCR, flow cytometry, Western blotting and high content fluorescent imaging, we show that dopamine alters the expression of specific CCR5 conformations of CCR5 on the surface of human macrophages. These changes are not affected by association with lipid rafts, but do correlate with dopamine receptor gene expression levels, specifically higher levels of D1-like dopamine receptors. These data also demonstrate that dopamine increases HIV replication and alters CCR5 conformations in human microglia similarly to macrophages. These data support the importance of dopamine in the development of neuroHIV and indicate that dopamine signaling pathways should be examined as a target in antiretroviral therapies specifically tailored to HIV-infected drug abusers. Further, these studies show the potential immunomodulatory role of dopamine, suggesting changes in this neurotransmitter may also affect the progression of other diseases.
Collapse
Affiliation(s)
- Stephanie M Matt
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Emily A Nickoloff-Bybel
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Yi Rong
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Kaitlyn Runner
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Hannah Johnson
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Margaret H O'Connor
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, United States.,Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Elias K Haddad
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, United States.,Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Peter J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| |
Collapse
|
15
|
Towe SL, Hartsock JT, Xu Y, Meade CS. Web-Based Cognitive Training to Improve Working Memory in Persons with Co-Occurring HIV Infection and Cocaine Use Disorder: Outcomes from a Randomized Controlled Trial. AIDS Behav 2021; 25:1542-1551. [PMID: 32749625 DOI: 10.1007/s10461-020-02993-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neurocognitive impairment (NCI) remains a persistent complication of HIV disease that nearly half of persons with HIV experience, and rates are even higher in persons who use substances such as cocaine. Cognitive training is a promising intervention for HIV-associated NCI. In this randomized controlled trial, we examined the feasibility and effectiveness of a web-based cognitive training program to improve working memory in a sample of 58 persons with HIV and cocaine use disorder. Participants were randomly assigned to either the experimental working memory training arm or the attention control training arm and completed up to 48 daily sessions over 10 weeks. Overall, treatment completion (74%) and retention rates (97%) were high, and participant feedback indicated the intervention was acceptable. Our results show that the intervention successfully reduced working memory deficits in the experimental arm relative to the control arm. Our findings support both the feasibility and effectiveness of cognitive training in this population.
Collapse
Affiliation(s)
- Sheri L Towe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA.
| | - Jeremiah T Hartsock
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Yunan Xu
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| |
Collapse
|
16
|
Aung HL, Bloch M, Vincent T, Quan D, Jayewardene A, Liu Z, Gates TM, Brew B, Mao L, Cysique LA. Cognitive ageing is premature among a community sample of optimally treated people living with HIV. HIV Med 2021; 22:151-164. [PMID: 33085207 PMCID: PMC7984032 DOI: 10.1111/hiv.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evidence of premature cognitive ageing amongst people living with HIV (PLHIV) remains controversial due to previous research limitations including underpowered studies, samples with suboptimal antiretroviral access, varying rate of virological control, high rate of AIDS, over-representation of non-community samples, and inclusion of inappropriate controls. The current study addresses these limitations, while also considering mental health and non-HIV comorbidity burden to determine whether PLHIV showed premature cognitive ageing compared with closely comparable HIV-negative controls. METHODS This study enrolled 254 PLHIV [92% on antiretroviral therapy; 84% with HIV RNA < 50 copies/mL; 15% with AIDS) and 72 HIV-negative gay and bisexual men [mean (SD) age = 49 (10.2) years] from a single primary care clinic in Sydney, Australia. Neurocognitive function was evaluated with the Cogstate Computerized Battery (CCB) at baseline and 6 months after. Linear mixed-effects (LME) models examined main and interaction effects of HIV status and chronological age on the CCB demographically uncorrected global neurocognitive z-score (GZS), adjusting for repeated testing, and then adjusting sequentially for HIV disease markers, mental health and comorbidities. RESULTS HIV status and age interacted with a lower GZS (β = -0.43, P < 0.05). Higher level of anxiety symptoms (β = -0.11, P < 0.01), historical AIDS (β = -0.12, P < 0.05) and historical HIV brain involvement (β = -0.12, P < 0.05) were associated with lower GZS. CONCLUSIONS We found a robust medium-sized premature ageing effect on cognition in a community sample with optimal HIV care. Our study supports routine screening of cognitive and mental health among PLHIV aged ≥ 50 years.
Collapse
Affiliation(s)
- HL Aung
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
| | - M Bloch
- Faculty of MedicineUNSWSydneyNSWAustralia
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - T Vincent
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - D Quan
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - A Jayewardene
- Holdsworth House Medical PracticeSydneyNSWAustralia
- Charles Perkins CentreUniversity of SydneySydneyNSWAustralia
| | - Z Liu
- Stats CentralUNSWSydneyNSWAustralia
| | - TM Gates
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
| | - B Brew
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
- Faculty of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - L Mao
- Centre for Social Research in HealthUNSWSydneyNSWAustralia
| | - LA Cysique
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
| |
Collapse
|
17
|
Aung HL, Aghvinian M, Gouse H, Robbins RN, Brew BJ, Mao L, Cysique LA. Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review. AIDS Behav 2021; 25:917-960. [PMID: 33025390 PMCID: PMC7886778 DOI: 10.1007/s10461-020-03053-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
Despite evidence of premature, accentuated and accelerated aging for some age-related conditions such as cardiovascular diseases in people living with HIV (PLHIV), the evidence for these abnormal patterns of aging on neurocognition remains unclear. Further, no systematic review has been dedicated to this issue. Using PRISMA guidelines, we searched standard databases (PubMed, EMBASE, CINAHL and PsycINFO). Articles were included if they analyzed and reported the effect of age on neurocognition among PLHIV as one of their major findings, if they were conducted in the combination anti-retroviral therapy era (after 1996) and published in a peer-reviewed journal in English. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) appraisal tools. To systematically target the abnormal patterns of neurocognitive aging, we define premature cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive test performance covering both the normal and abnormal performance range; accentuated cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive impairment (NCI) rate, thus covering the abnormal performance range only; accelerated cognitive aging as significant interaction effect of HIV status and age on longitudinal neurocognitive test performance or incidence of NCI. Because these definitions require an age-comparable HIV-negative (HIV-) control group, when no controls were included, we determined the range of the age effect on neurocognitive test performance or NCI among PLHIV. A total of 37 studies originating from the US (26), UK (2), Italy (2), Poland (2), China (2), Japan (1), Australia (1), and Brazil (1) were included. Six studies were longitudinal and 14 included HIV- controls. The quality appraisal showed that 12/37 studies neither used an age-matched HIV- controls nor used demographically corrected cognitive scores. A meta-analysis was not possible because study methods and choice of neurocognitive measurement methods and outcomes were heterogeneous imposing a narrative synthesis. In studies with an HIV- control sample, premature neurocognitive aging was found in 45% of the cross-sectional analyses (9/20), while accelerated neurocognitive aging was found in 75% of the longitudinal analyses (3/4). There was no evidence for accentuated aging, but this was tested only in two studies. In studies without an HIV- control sample, the age effect was always present but wide (NCI OR = 1.18-4.8). While large sample size (> 500) was associated with abnormal patterns of cognitive aging, most of the studies were under powered. Other study characteristics such as longitudinal study design and higher proportion of older participants were also associated with the findings of abnormal cognitive aging. There is some support for premature and accelerated cognitive aging among PLHIV in the existing literature especially among large and longitudinal studies and those with higher proportion of older samples. Future HIV and cognitive aging studies need to harmonize neuropsychological measurement methods and outcomes and use a large sample from collaborative multi-sites to generate more robust evidences.
Collapse
Affiliation(s)
- Htein Linn Aung
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Neuroscience Research Australia, Sydney, Australia.
- Faculty of Medicine, UNSW, Sydney, Australia.
| | | | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Lucette A Cysique
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
| |
Collapse
|
18
|
Towe SL, Meade CS, Cloak CC, Bell RP, Baptiste J, Chang L. Reciprocal Influences of HIV and Cannabinoids on the Brain and Cognitive Function. J Neuroimmune Pharmacol 2020; 15:765-779. [PMID: 32445005 PMCID: PMC7680275 DOI: 10.1007/s11481-020-09921-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
Globally, cannabis is the most commonly used illicit drug, with disproportionately high use among persons with HIV. Despite advances in HIV care, nearly half of persons living with HIV continue to experience neurocognitive deficits or impairments that may have negative impacts on their daily function. Chronic cannabis use may play a role in the development or exacerbation of these impairments. Here we present a review summarizing existing research detailing the effect of cannabis use associated with the neuropathogenesis of HIV. We examine evidence for possible additive or synergistic effects of HIV infection and cannabis use on neuroHIV in both the preclinical and adult human literatures, including in vitro studies, animal models, clinical neuroimaging research, and studies examining the cognitive effects of cannabis. We discuss the limitations of existing research, including methodological challenges involved with clinical research with human subjects. We identify gaps in the field and propose critical research questions to advance our understanding of how cannabis use affects neuroHIV. Graphical Abstract.
Collapse
Affiliation(s)
- Sheri L Towe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Christine C Cloak
- Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 670 W. Baltimore Street, HSF III, Room 1161, Baltimore, MD, 21201, USA
| | - Ryan P Bell
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Julian Baptiste
- Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 670 W. Baltimore Street, HSF III, Room 1161, Baltimore, MD, 21201, USA
| | - Linda Chang
- Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 670 W. Baltimore Street, HSF III, Room 1161, Baltimore, MD, 21201, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
- John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, 96813, USA.
| |
Collapse
|
19
|
Dawood G, Klop D, Olivier E, Elliott H, Pillay M, Grimmer K. Nature and extent of hearing loss in HIV-infected children: A scoping review. Int J Pediatr Otorhinolaryngol 2020; 134:110036. [PMID: 32335463 DOI: 10.1016/j.ijporl.2020.110036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Antiretroviral therapy (ART) has had a major impact on life expectancy from HIV as many people now live with it as a chronic disease. Chronic HIV has been associated with a range of comorbid disabilities and health conditions, one of which is hearing loss. Undiagnosed and untreated hearing loss, particularly in children, has been linked to poorer spoken language skills, with subsequent effects on academic performance. METHODS This systematic scoping review aimed to summarize the available peer-reviewed literature on hearing loss in HIV-infected children, specifically to describe its extent and nature. The review followed the framework proposed by Arksey and O'Malley. Key search terms included hearing loss (and synonyms), child (and synonyms), and HIV. Electronic databases (EBSCOhost Research Platform, PubMed, Web of Science and Scopus databases) were searched for any relevant articles published from January 1, 2000 to June 30, 2019. Reference lists of included articles were pearled for additional relevant articles not already identified. Each stage of the selection process was conducted independently by two authors. The results were then collated by a third author who also resolved any discrepancies. Extracted data included sample descriptors, audiologic tests, hearing loss prevalence, hearing loss descripts, and factors associated with hearing loss. RESULTS Seventeen articles were included; 10 from Africa, four from South America, two from North America and the remaining article from Asia. Although most of the articles reported on pure tone audiometry, the samples as well as the cut-off criteria for normal hearing were heterogenous. Prevalence of hearing loss varied across articles (from 6% to 84%). Conductive hearing loss occurred more frequently than sensorineural or mixed hearing loss. ART use and ear infection were reported as significant in three of five articles that reported on significant associates of HIV-related hearing loss. CONCLUSION There was a modest volume of research from a limited number of countries. Heterogeneity in sampling and audiometric methods precluded a clear understanding of potential associations between chronic HIV-related hearing loss and contributing factors.
Collapse
Affiliation(s)
- Gouwa Dawood
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa.
| | - Daleen Klop
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa
| | - Elrietha Olivier
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa
| | - Haley Elliott
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa
| | - Mershen Pillay
- Discipline of Speech-Language Pathology, University of KwaZulu-Natal, Westville, South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| |
Collapse
|
20
|
Zahr NM, Sullivan EV, Pohl KM, Pfefferbaum A, Saranathan M. Sensitivity of ventrolateral posterior thalamic nucleus to back pain in alcoholism and CD4 nadir in HIV. Hum Brain Mapp 2020; 41:1351-1361. [PMID: 31785046 PMCID: PMC7268080 DOI: 10.1002/hbm.24880] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/15/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
Volumes of thalamic nuclei are differentially affected by disease-related processes including alcoholism and human immunodeficiency virus (HIV) infection. This MRI study included 41 individuals diagnosed with alcohol use disorders (AUD, 12 women), 17 individuals infected with HIV (eight women), and 49 healthy controls (24 women) aged 39 to 75 years. A specialized, high-resolution acquisition protocol enabled parcellation of five thalamic nuclei: anterior [anterior ventral (AV)], posterior [pulvinar (Pul)], medial [mediodorsal (MD)], and ventral [including ventral lateral posterior (VLp) and ventral posterior lateral (VPl)]. An omnibus mixed-model approach solving for volume considered the "fixed effects" of nuclei, diagnosis, and their interaction while covarying for hemisphere, sex, age, and supratentorial volume (svol). The volume by diagnosis interaction term was significant; the effects of hemisphere and sex were negligible. Follow-up mixed-model tests thus evaluated the combined (left + right) volume of each nucleus separately for effects of diagnosis while controlling for age and svol. Only the VLp showed diagnoses effects and was smaller in the AUD (p = .04) and HIV (p = .0003) groups relative to the control group. In the AUD group, chronic back pain (p = .008) and impaired deep tendon ankle reflex (p = .0005) were associated with smaller VLp volume. In the HIV group, lower CD4 nadir (p = .008) was associated with smaller VLp volume. These results suggest that the VLp is differentially sensitive to disease processes associated with AUD and HIV.
Collapse
Affiliation(s)
- Natalie M. Zahr
- Neuroscience ProgramSRI InternationalMenlo ParkCalifornia
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
| | - Kilian M. Pohl
- Neuroscience ProgramSRI InternationalMenlo ParkCalifornia
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
| | - Adolf Pfefferbaum
- Neuroscience ProgramSRI InternationalMenlo ParkCalifornia
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineCalifornia
| | | |
Collapse
|
21
|
Cognitive impairment severity in relation to signs of subclinical Wernicke's encephalopathy in HIV and alcoholism comorbidity. AIDS 2020; 34:391-403. [PMID: 31725430 PMCID: PMC7021228 DOI: 10.1097/qad.0000000000002428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The comorbidity of HIV infection and alcoholism (ALC) is prevalent. Wernicke's encephalopathy, a neurological disorder resulting from thiamine depletion, has been generally associated with alcoholism but has also been reported in HIV infection. This study examined whether subclinical Wernicke's encephalopathy signs could contribute to the heterogeneity of cognitive and motor deficits observed in individuals with both disease conditions (HIV+ALC). DESIGN Sixty-one HIV+ALC individuals and 59 controls were assessed on attention and working memory, production, immediate and delayed episodic memory, visuospatial abilities, and upper limb motor function. METHODS Using Caine criteria (dietary deficiency, oculomotor abnormality, cerebellar dysfunction, and altered mental state), HIV+ALC individuals were classified by subclinical Wernicke's encephalopathy risk factors. RESULTS Signs of subclinical Wernicke's encephalopathy were present in 20% of the HIV+ALC participants. For attention/working memory, delayed memory, and upper limb motor function, HIV+ALC Caine 2+ (i.e. meeting two or three criteria) demonstrated the most severe deficits, scoring lower than HIV+ALC Caine 1 (i.e. meeting one criterion), HIV+ALC Caine 0 (i.e. meeting no criteria), and controls. CONCLUSION The high prevalence of subclinical signs of Wernicke's encephalopathy and relevance to performance indicate that this condition should be considered in assessment of HIV-infected individuals, especially when alcoholism comorbidity is known or suspected. Above and beyond clinical factors, such as depression, alcoholism and HIV disease-related variables, AIDS, hepatitis C and drug history known to mediate neuropsychological performance, subclinical Wernicke's encephalopathy signs could partly explain the heterogeneity in patterns and severity of cognitive and motor impairments in HIV-infected individuals with alcoholism comorbidity.
Collapse
|
22
|
Cognitive and Motor Impairment Severity Related to Signs of Subclinical Wernicke's Encephalopathy in HIV Infection. J Acquir Immune Defic Syndr 2020; 81:345-354. [PMID: 30958387 DOI: 10.1097/qai.0000000000002043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wernicke's encephalopathy (WE) is a neurological condition resulting from thiamine deficiency. Although commonly associated with alcoholism, nonalcoholic WE has been described in individuals with HIV infection, but subclinical WE may be underdiagnosed. The current study questioned whether the presence of subclinical WE signs underlies cognitive and motor deficits in HIV individuals as observed in alcoholism. SETTING Fifty-six HIV-positive individuals (HIV+) and 53 HIV-negative controls (HIV-) were assessed on 6 cognitive and motor domains: attention/working memory, production, immediate and delayed episodic memory, visuospatial abilities, and upper-limb motor function. METHODS Based on a rating scheme by Caine et al, HIV+ individuals were categorized by subclinical WE risk factors (dietary deficiency, oculomotor abnormality, cerebellar dysfunction, and altered mental state). Performance was expressed as age- and education-corrected Z-scores standardized on controls. RESULTS Sorting by Caine criteria yielded 20 HIV+ as Caine 0 (ie, meeting no criteria), 22 as Caine 1 (ie, meeting one criterion), and 14 as Caine 2 (ie, meeting 2 criteria). Comparison among HIV+ Caine subgroups revealed a graded effect: Caine 0 performed at control levels, Caine 1 showed mild to moderate deficits on some domains, and Caine 2 showed the most severe deficits on each domain. CONCLUSION This graded severity pattern of performance among Caine subgroups suggests that signs of subclinical WE can partly explain the heterogeneity in HIV-related cognitive and motor impairment. This study highlights the utility of Caine criteria in identifying potential causes of HIV-related neurocognitive disorders and has implications for disease management.
Collapse
|
23
|
Brain PET Imaging: Value for Understanding the Pathophysiology of HIV-associated Neurocognitive Disorder (HAND). Curr HIV/AIDS Rep 2020; 16:66-75. [PMID: 30778853 DOI: 10.1007/s11904-019-00419-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent developments in PET imaging of neuropathologies underlying HIV-associated neurocognitive dysfunction (HAND). We concentrate on the recent post antiretroviral era (ART), highlighting clinical and preclinical brain PET imaging studies. RECENT FINDINGS In the post ART era, PET imaging has been used to better understand perturbations of glucose metabolism, neuroinflammation, the function of neurotransmitter systems, and amyloid/tau protein deposition in the brains of HIV-infected patients and HIV animal models. Preclinical and translational findings from those studies shed a new light on the complex pathophysiology underlying HAND. The molecular imaging capabilities of PET in neuro-HIV are great complements for structural imaging modalities. Recent and future PET imaging studies can improve our understanding of neuro-HIV and provide biomarkers of disease progress that could be used as surrogate endpoints in the evaluation of the effectiveness of potential neuroprotective therapies.
Collapse
|
24
|
Kelschenbach J, He H, Kim BH, Borjabad A, Gu CJ, Chao W, Do M, Sharer LR, Zhang H, Arancio O, Potash MJ, Volsky DJ. Efficient Expression of HIV in Immunocompetent Mouse Brain Reveals a Novel Nonneurotoxic Viral Function in Hippocampal Synaptodendritic Injury and Memory Impairment. mBio 2019; 10:e00591-19. [PMID: 31266862 PMCID: PMC6606797 DOI: 10.1128/mbio.00591-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/29/2019] [Indexed: 01/05/2023] Open
Abstract
HIV causes neurodegeneration and dementia in AIDS patients, but its function in milder cognitive impairments in virologically suppressed patients on antiretroviral therapy is unknown. Such patients are immunocompetent, have low peripheral and brain HIV burdens, and show minimal brain neuropathology. Using the model of HIV-related memory impairment in EcoHIV-infected conventional mice, we investigated the neurobiological and cognitive consequences of efficient EcoHIV expression in the mouse brain after intracerebral infection. HIV integrated and persisted in an expressed state in brain tissue, was detectable in brain monocytic cells, and caused neuroinflammatory responses and lasting spatial, working, and associative memory impairment. Systemic antiretroviral treatment prevented direct brain infection and memory dysfunction indicating the requirement for HIV expression in the brain for disease. Similarly inoculated murine leukemia virus used as a control replicated in mouse brain but not in monocytic cells and was cognitively benign, linking the disease to HIV-specific functions. Memory impairment correlated in real time with hippocampal dysfunction shown by defective long-term potentiation in hippocampal slices ex vivo and with diffuse synaptodendritic injury in the hippocampus reflected in significant reduction in microtubule-associated protein 2 and synapsin II staining. In contrast, there was no evidence of overt neuronal loss in this region as determined by neuron-specific nuclear protein quantification, TUNEL assay, and histological observations. Our results reveal a novel capacity of HIV to induce neuronal dysfunction and memory impairment independent of neurotoxicity, distinct from the neurotoxicity of HIV infection in dementia.IMPORTANCE HIV neuropathogenesis has been attributed in large measure to neurotoxicity of viral proteins and inflammatory factors produced by infected monocytic cells in the brain. We show here that HIV expression in mouse brain causes lasting memory impairment by a mechanism involving injury to hippocampal synaptodendritic arbors and neuronal function but not overt neuronal loss in the region. Our results mirror the observation of minimal neurodegeneration in cognitively impaired HIV patients on antiretroviral therapy and demonstrate that HIV is nonneurotoxic in certain brain abnormalities that it causes. If neurons comprising the cognition-related networks survive HIV insult, at least for some time, there is a window of opportunity for disease treatment.
Collapse
Affiliation(s)
- Jennifer Kelschenbach
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hongxia He
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Boe-Hyun Kim
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alejandra Borjabad
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chao-Jiang Gu
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Wei Chao
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meilan Do
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Leroy R Sharer
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hong Zhang
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Ottavio Arancio
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Mary Jane Potash
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David J Volsky
- Department of Medicine, Infectious Diseases Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
25
|
Cysique LA. Chronic Human Immunodeficiency Virus Infection With and Without Comorbidities Appears to Converge Toward Early Pathological Brain Aging. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 3:820-821. [PMID: 30297029 DOI: 10.1016/j.bpsc.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick; the School of Medical Sciences, University of New South Wales, Sydney; Peter Duncan Neuroscience Research Unit at St. Vincent's Applied Medical Research Centre, Darlinghurst, New South Wales, Australia.
| |
Collapse
|
26
|
Intranasal insulin therapy reverses hippocampal dendritic injury and cognitive impairment in a model of HIV-associated neurocognitive disorders in EcoHIV-infected mice. AIDS 2019; 33:973-984. [PMID: 30946151 PMCID: PMC6457131 DOI: 10.1097/qad.0000000000002150] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Almost half of HIV-positive people on antiretroviral therapy have demonstrable mild neurocognitive impairment (HIV-NCI), even when virologically suppressed. Intranasal insulin therapy improves cognition in Alzheimer's disease and diabetes. Here we tested intranasal insulin therapy in a model of HIV-NCI in EcoHIV-infected conventional mice. DESIGN AND METHODS Insulin pharmacokinetics following intranasal administration to mice was determined by ELISA. Mice were inoculated with EcoHIV to cause NCI; 23 days or 3 months after infection they were treated daily for 9 days with intranasal insulin (2.4 IU/mouse) and examined for NCI in behavioral tests and HIV burdens by quantitative PCR. Some animals were tested for hippocampal neuronal integrity by immunostaining and expression of neuronal function-related genes by real time-quantitative PCR. The effect of insulin treatment discontinuation on cognition and neuropathology was also examined. RESULTS Intranasal insulin administration to mice resulted in μIU/ml levels of insulin in cerebrospinal fluid with a half-life of about 2 h, resembling pharmacokinetic parameters of patients receiving 40 IU. Intranasal insulin treatment starting 23 days or 3 months after infection completely reversed NCI in mice. Murine NCI correlated with reductions in hippocampal dendritic arbors and downregulation of neuronal function genes; intranasal insulin reversed these changes coincident with restoration of cognitive acuity, but they returned within 24 h of treatment cessation. Intranasal insulin treatment reduced brain HIV DNA when started 23 but not 90 days after infection. CONCLUSION Our preclinical studies support the use of intranasal insulin administration for treatment of HIV-NCI and suggest that some dendritic injury in this condition is reversible.
Collapse
|
27
|
Vascular cognitive impairment and HIV-associated neurocognitive disorder: a new paradigm. J Neurovirol 2019; 25:710-721. [DOI: 10.1007/s13365-018-0706-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023]
|
28
|
Cysique LA, Brew BJ. Comorbid depression and apathy in HIV-associated neurocognitive disorders in the era of chronic HIV infection. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:71-82. [PMID: 31727231 DOI: 10.1016/b978-0-444-64012-3.00006-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter provides an overview of the current research on the question of depression and apathy in HIV-associated neurocognitive disorders (HAND) in the era of chronic HIV infection. After presenting the epidemiology of each condition showing that depression and apathy are the two most frequent psychiatric comorbidities of HAND, we review the current research, particularly in relation to the milder forms of HAND that characterize treated HIV cohorts. Doing so, we include findings on depression and apathy in non-HIV aging population and the risk of dementia, findings that are relevant to the aging HIV cohorts carrying a high burden of psychiatric comorbidities. We then present a review of the research pertaining to the differentiation between depression and apathy. A section is dedicated to the question of suicidality in chronic HIV infection, which is underappreciated. An overview of the pharmacologic and psychosocial interventions relevant to depression and apathy in HIV cohorts treated with antiretroviral treatment is provided. The chapter concludes with future directions for the research on apathy and depression with emphasis on the question of aging and the need for longitudinal studies.
Collapse
Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Bruce J Brew
- Neurology and HIV Departments, St. Vincent's Hospital, Sydney, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
| |
Collapse
|
29
|
Cysique LA, Casaletto KB, Heaton RK. Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2019; 50:271-298. [PMID: 31559600 DOI: 10.1007/7854_2019_116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
HIV infection has become a chronic disease managed across the life span. In this context, the cognitive health of HIV infection needs to have methods for monitoring over time, in order to better anticipate HIV-associated neurocognitive disorder (HAND) trajectories in relation to biomarkers, and predict prognosis and especially the risk of dementia as People Living with HIV (PLHIV) age. In this chapter, we critically review several statistical frameworks to quantify cognitive change. We then provide a critical review of naturalistic longitudinal studies and selected randomized clinical trials assessing neurocognitive change as a primary outcome in PLHIV, conducted since the advent of the combined antiretroviral therapy era (censored January 2019). Doing so, we distinguish between PLHIV who were treated early and did not experience AIDS (CDC 1993), versus treated late, after experiencing AIDS and more severe immune compromise. Highlighting strengths and limitations of these studies, we emphasize that issues of reliability pertaining to the use of neuropsychological tests need careful consideration for the robust quantification of cognitive change, including measurement error, practice effect, inter-individual variability, baseline level of functioning, demographic effects, timeframe between testing intervals, normative longitudinal data, and operationalization of clinically meaningful neurocognitive change. In addition, issues pertaining to longitudinal analyses including type, amount and pattern of missing data and/or participant attrition, regression toward the mean, and survivor bias need to be properly addressed. We conclude by proposing future research directions with emphasis on research translation to clinical participants.
Collapse
Affiliation(s)
- Lucette A Cysique
- Faculty of Medicine, Neuroscience Research Australia, School of Medical Sciences, The University of New South Wales, Sydney, Sydney, NSW, Australia.
| | - Kaitlin B Casaletto
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, UCSD School of Medicine, La Jolla, CA, USA
| |
Collapse
|
30
|
Mukherjee T, Sakthivel R, Fong HY, McStea M, Chong ML, Omar SF, Chin AV, Kamaruzzaman S, Kamarulzaman A, Rajasuriar R, Cysique LA. Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia. AIDS Behav 2018; 22:3226-3233. [PMID: 29508103 PMCID: PMC6123290 DOI: 10.1007/s10461-018-2073-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study determines the optimal cut-off scores for the Montreal Cognitive Assessment (MoCA) to detect HIV-associated neurocognitive disorders (HAND) in a multi-ethnic Malaysian HIV-positive cohort by developing demographically corrected normative standards among 283 HIV-negative community-based controls with overlapping demographic characteristics. The norms (corrected for age, sex, education, ethnicity) were applied to 342 HIV-positive virally suppressed individuals on cART. Impairment rates were classified using the Global Deficit Score (GDS ≥ .5) method. The MoCA was also scored according to the recommended cut-off of ≤ 26, and functional decline was applied to both impairment definitions to classify HAND per the Frascati criteria. The ≤ 26 cut-off considerably overestimated cognitive impairment in both samples (59.4% HIV-negative; 69.3% HIV-positive). In contrast, corrected scores yielded impairment rates consistent with what has been reported internationally in virally suppressed cohorts (23.4% with 83.3% mild impairment, 16.7% moderate impairment). A supplemental file allowing the computation of corrected MoCA scores and impairment status is included.
Collapse
Affiliation(s)
- Trena Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rishanantini Sakthivel
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Ho Yen Fong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Megan McStea
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Meng Li Chong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Sharifah Faridah Omar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Vyrn Chin
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia.
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.
| | - Lucette A Cysique
- Neuroscience Research Australia, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
31
|
Bell RP, Barnes LL, Towe SL, Chen NK, Song AW, Meade CS. Structural connectome differences in HIV infection: brain network segregation associated with nadir CD4 cell count. J Neurovirol 2018; 24:454-463. [PMID: 29687404 PMCID: PMC6105458 DOI: 10.1007/s13365-018-0634-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 01/21/2023]
Abstract
This study investigated structural brain organization using diffusion tensor imaging (DTI) in 35 HIV-positive and 35 HIV-negative individuals. We used global and nodal graph theory metrics to investigate whether HIV was associated with differences in brain network organization based on fractional anisotropy (FA) and mean diffusivity (MD). Participants also completed a comprehensive neuropsychological testing battery. For global network metrics, HIV-positive individuals displayed a lower FA clustering coefficient relative to HIV-negative individuals. For nodal network metrics, HIV-positive individuals had less MD nodal degree in the left thalamus. Within HIV-positive individuals, the FA global clustering coefficient was positively correlated with nadir CD4 cell count. Across the sample, cognitive performance was negatively correlated with characteristic path length and positively correlated with global efficiency for FA. These results suggest that, despite management with combination antiretroviral therapy, HIV infection is associated with altered structural brain network segregation and thalamic centrality and that low nadir CD4 cell count may be a risk factor. These graph theory metrics may serve as neural biomarkers to identify individuals at risk for HIV-related neurological complications.
Collapse
Affiliation(s)
- Ryan P Bell
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Laura L Barnes
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Sheri L Towe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Nan-Kuei Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Allen W Song
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA.
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA.
| |
Collapse
|
32
|
Pfefferbaum A, Zahr NM, Sassoon SA, Kwon D, Pohl KM, Sullivan EV. Accelerated and Premature Aging Characterizing Regional Cortical Volume Loss in Human Immunodeficiency Virus Infection: Contributions From Alcohol, Substance Use, and Hepatitis C Coinfection. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:844-859. [PMID: 30093343 DOI: 10.1016/j.bpsc.2018.06.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/16/2018] [Accepted: 06/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Life expectancy of successfully treated human immunodeficiency virus (HIV)-infected individuals is approaching normal longevity. The growing HIV population ≥50 years of age is now at risk of developing HIV-associated neurocognitive disorder, acquiring coinfection with the hepatitis C virus (HCV), and engaging in hazardous drinking or drug consumption that can adversely affect trajectories of the healthy aging of brain structures. METHODS This cross-sectional/longitudinal study quantified regional brain volumes from 1101 magnetic resonance imaging scans collected over 14 years in 549 participants (25 to 75 years of age): 68 HIV-infected individuals without alcohol dependence, 60 HIV-infected individuals with alcohol dependence, 222 alcohol-dependent individuals, and 199 control subjects. We tested 1) whether localized brain regions in HIV-infected individuals exhibited accelerated aging, or alternatively, nonaccelerated premature aging deficits; and 2) the extent to which alcohol or substance dependence or HCV coinfection altered brain aging trajectories. RESULTS The HIV-infected cohort exhibited steeper declining volume trajectories than control subjects, consistently in the frontal cortex. Nonaccelerated volume deficits occurred in the temporal, parietal, insular, and cingulate regions of all three diagnostic groups. Alcohol and drug dependence comorbidities and HCV coinfection exacerbated HIV-related volume deficits. Accelerated age interactions in frontal and posterior parietal volumes endured in HIV-infected individuals free of alcohol or substance dependence and HCV infection comorbidities. Functionally, poorer HIV-associated neurocognitive disorder scores and Veterans Aging Cohort Study indices correlated with smaller regional brain volumes in the HIV-infected individuals without alcohol dependence and alcohol-dependent groups. CONCLUSIONS HIV infection itself may confer a heightened risk of accelerated brain aging, potentially exacerbated by HCV coinfection and substance dependency. Confirmation would require a prospective study with a preinfection baseline.
Collapse
Affiliation(s)
- Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Natalie M Zahr
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Dongjin Kwon
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Kilian M Pohl
- Center for Health Sciences, SRI International, Menlo Park, California
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
33
|
Zahr NM. The Aging Brain With HIV Infection: Effects of Alcoholism or Hepatitis C Comorbidity. Front Aging Neurosci 2018; 10:56. [PMID: 29623036 PMCID: PMC5874324 DOI: 10.3389/fnagi.2018.00056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
As successfully treated individuals with Human Immunodeficiency Virus (HIV)-infected age, cognitive and health challenges of normal aging ensue, burdened by HIV, treatment side effects, and high prevalence comorbidities, notably, Alcohol Use Disorders (AUD) and Hepatitis C virus (HCV) infection. In 2013, people over 55 years old accounted for 26% of the estimated number of people living with HIV (~1.2 million). The aging brain is increasingly vulnerable to endogenous and exogenous insult which, coupled with HIV infection and comorbid risk factors, can lead to additive or synergistic effects on cognitive and motor function. This paper reviews the literature on neuropsychological and in vivo Magnetic Resonance Imaging (MRI) evaluation of the aging HIV brain, while also considering the effects of comorbidity for AUD and HCV.
Collapse
Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| |
Collapse
|
34
|
Kamminga J, Lal L, Wright EJ, Bloch M, Brew BJ, Cysique LA. Monitoring HIV-Associated Neurocognitive Disorder Using Screenings: a Critical Review Including Guidelines for Clinical and Research Use. Curr HIV/AIDS Rep 2017; 14:83-92. [PMID: 28284004 DOI: 10.1007/s11904-017-0349-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Screening tools to identify HIV-associated neurocognitive disorder (HAND) are primarily devised to detect cognitive impairment on a single occasion. With the chronicity of HIV infection and the risk of HAND developing or progressing despite viral control, it may be pertinent to repeat HAND screening at more than one time point. Despite this, there are limited data on longitudinal use of such screening tools, particularly with regard to the role of practice effects. Additionally, no guidelines currently exist on the timeframe between testing intervals, or recommendation of the magnitude of baseline impairment that warrants follow-up testing. The aim of the current paper was to review existing evidence for longitudinal validity of HAND screening tools. Only those HAND screening tools previously found to have high cross-sectional criterion validity were included. Preliminary recommendations for clinical use and future research are proposed including in international settings.
Collapse
Affiliation(s)
- Jody Kamminga
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,Ongoing and Extended Care Services, Hunter New England Local Health District, Armidale Community Health, Armidale, NSW, 2350, Australia
| | - Luxshimi Lal
- The Burnet Institute, Melbourne, VIC, 3004, Australia.,The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Edwina J Wright
- The Burnet Institute, Melbourne, VIC, 3004, Australia.,The Alfred Hospital, Melbourne, VIC, 3004, Australia.,Monash University, Clayton, VIC, 3800, Australia
| | - Mark Bloch
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia.,Holdsworth House Medical Practice, Sydney, NSW, 2000, Australia
| | - Bruce J Brew
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia.,St. Vincent's Hospital Applied Medical Research Center, The Peter Duncan Neuroscience Unit, Darlinghurst, NSW, 2010, Australia.,Neurology and HIV Departments, St. Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Lucette A Cysique
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia. .,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia. .,St. Vincent's Hospital Applied Medical Research Center, The Peter Duncan Neuroscience Unit, Darlinghurst, NSW, 2010, Australia. .,Neurology and HIV Departments, St. Vincent's Hospital, Darlinghurst, NSW, 2010, Australia.
| |
Collapse
|
35
|
Saloner R, Cysique LA. HIV-Associated Neurocognitive Disorders: A Global Perspective. J Int Neuropsychol Soc 2017; 23:860-869. [PMID: 29198283 PMCID: PMC5939823 DOI: 10.1017/s1355617717001102] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 01/17/2023]
Abstract
The present review on HIV-associated neurocognitive disorders (HAND) provides a worldwide overview of studies that have investigated the rate and neuropsychological (NP) profile of HAND research since the inception of the 2007 HAND diagnostic nomenclature. In the first part, the review highlights some of the current controversies around HAND prevalence rates. In the second part, the review critically assesses some solutions to move the field forward. In the third part, we present the cross-sectional NP profile in non-Western HIV+ cohorts and in relation to Western cohorts' findings. The adopted global perspective highlights the successful expansion of NP studies in HIV infection to culturally diverse low- to medium-income countries with high HIV burden. These studies have produced interestingly similar rates of HAND whether patients were naïve or treated and/or virally suppressed compared to the rich income countries where the NP research in NeuroHIV has originated. The perspective also demonstrates that globally, the group which is the most representative of the HIV epidemic, and thus at risk for HAND are persons with chronic HIV infection and survivors of past immunosuppression, while in relative terms, those who have been treated early with long-term viral suppression represent a minority. In the last part, we present a review of the naturalistic longitudinal NP global studies in HIV+cohorts, discuss the role of longitudinal design in solving issues around the question of asymptomatic neurocognitive impairment, and the question of biomarker discovery. Finally, we conclude by calling for greater methods and data harmonization at a global level. (JINS, 2017, 23, 860-869).
Collapse
Affiliation(s)
- Rowan Saloner
- The HIV Neurobehavioral Research Program (HNRP), Department of Psychiatry, University of California, San Diego, San Diego, California
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, California
| | - Lucette A. Cysique
- School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW
- Neuroscience Research Australia, Barker Street, Randwick, NSW
- Neuroscience Program and Peter Duncan Neurosciences Unit St. Vincent’s Hospital Centre for Applied Medical Research Centre, and departments of Neurology and HIV St. Vincent’s Hospital Sydney, NSW
| |
Collapse
|
36
|
Liu J, Xu E, Tu G, Liu H, Luo J, Xiong H. Methamphetamine potentiates HIV-1gp120-induced microglial neurotoxic activity by enhancing microglial outward K + current. Mol Cell Neurosci 2017; 82:167-175. [PMID: 28552341 DOI: 10.1016/j.mcn.2017.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 01/22/2023] Open
Abstract
Methamphetamine (Meth) abuse not only increases the risk of human immunodeficiency virus-1 (HIV-1) infection, but exacerbates HIV-1-associated neurocognitive disorders (HAND) as well. The mechanisms underlying the co-morbid effect are not fully understood. Meth and HIV-1 each alone interacts with microglia and microglia express voltage-gated potassium (KV) channel KV1.3. To understand whether KV1.3 functions an intersecting point for Meth and HIV-1, we studied the augment effect of Meth on HIV-1 glycoprotein 120 (gp120)-induced neurotoxic activity in cultured rat microglial cells. While Meth and gp120 each alone at low (subtoxic) concentrations failed to trigger microglial neurotoxic activity, Meth potentiated gp120-induced microglial neurotoxicity when applied in combination. Meth enhances gp120 effect on microglia by enhancing microglial KV1.3 protein expression and KV1.3 current, leading to an increase of neurotoxin production and resultant neuronal injury. Pretreatment of microglia with a specific KV1.3 antagonist 5-(4-Phenoxybutoxy)psoralen (PAP) or a broad spectrum KV channel blocker 4-aminopyridine (4-AP) significantly attenuated Meth/gp120-treated microglial production of neurotoxins and resultant neuronal injury, indicating an involvement of KV1.3 in Meth/gp120-induced microglial neurotoxic activity. Meth/gp120 activated caspase-3 and increased caspase-3/7 activity in microglia and inhibition of caspase-3 by its specific inhibitor significantly decreased microglial production of TNF-α and iNOS and attenuated microglia-associated neurotoxic activity. Moreover, blockage of KV1.3 by specific blockers attenuated Meth/gp120 enhancement of caspase-3/7 activity. Taking together, these results suggest an involvement of microglial KV1.3 in the mediation of Meth/gp120 co-morbid effect on microglial neurotoxic activity via caspase-3 signaling.
Collapse
Affiliation(s)
- Jianuo Liu
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, United States.
| | - Enquan Xu
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, United States
| | - Guihua Tu
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, United States
| | - Han Liu
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, United States
| | - Jiangtao Luo
- Department of Biostatistics, College of Public Health, University Nebraska Medical Center, Omaha, NE 68198-4375, United States
| | - Huangui Xiong
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, United States.
| |
Collapse
|
37
|
Gott C, Gates T, Dermody N, Brew BJ, Cysique LA. Cognitive change trajectories in virally suppressed HIV-infected individuals indicate high prevalence of disease activity. PLoS One 2017; 12:e0171887. [PMID: 28264037 PMCID: PMC5338778 DOI: 10.1371/journal.pone.0171887] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/29/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The longitudinal rate and profile of cognitive decline in persons with stable, treated, and virally suppressed HIV infection is not established. To address this question, the current study quantifies the rate of cognitive decline in a cohort of virally suppressed HIV+ persons using clinically relevant definitions of decline, and determine cognitive trajectories taking into account historical and baseline HAND status. METHODS Ninety-six HIV+ (clinically stable and virally undetectable) and 44 demographically comparable HIV- participants underwent standard neuropsychological testing at baseline and 18-months follow-up. We described clinically relevant cognitive trajectories based on standard definitions of historical and baseline HAND status and cognitive decline. Historical, moderate to severe HAND was formally diagnosed at the start of the cART era in 15/96 participants based on clinical neurological and neuropsychological assessment. The same standard of care has been applied to all participants at St. Vincent's Hospital Infectious Disease Department for the duration of their HIV infection (median of 20 years). RESULTS Relative to HIV- controls (4.5%), 14% of HIV+ participants declined (p = .11), they also scored significantly lower on the global change score (p = .03), processing speed (p = .02), and mental flexibility/inhibition (p = .02) domains. Having HAND at baseline significantly predicted cognitive decline at follow up (p = .005). We determined seven clinically relevant cognitive trajectories taking into account whether participant has a history of HAND prior to study entry (yes/no); their results on the baseline assessment (baseline impairment: yes/no) and their results on the 18-month follow up (decline or stable) which in order of prevalence were: 1) No HAND history, no baseline impairment, 18-month follow-up stable (39%), 2) No HAND history, baseline impairment, 18-month follow-up stable (35%), 3) History of HAND; baseline impairment, 18-month follow-up stable (9%) 4) No history of HAND, baseline impairment, 18-month follow-up decline (7%), 5) History of HAND, no baseline impairment, 18-month follow-up stable (3%), 6) No HAND history, no baseline impairment, 18-month follow-up decline (3%) 7) History of HAND, baseline impairment, 18-month follow-up decline (3%). There was no relationship between cognitive decline (taking into account historical and baseline HAND) and traditional HIV disease biomarkers. CONCLUSIONS Despite long-term viral suppression, we found mostly subclinical levels of decline in psychomotor speed and executive functioning (mental flexibility and cognitive inhibition); well-established markers of HAND progression. Moreover, 57% of our cohort is undergoing slow evolution of their disease, challenging the notion of prevalent neurocognitive stability in virally suppressed HIV infection.
Collapse
Affiliation(s)
- Chloe Gott
- Psychology Department, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Thomas Gates
- Departments of HIV and Neurology St Vincent’s Hospital and Peter Duncan Neurosciences Unit St Vincent’s Centre for Applied Medical Research Centre, Darlinghurst, NSW, Australia
| | - Nadene Dermody
- Psychology Department, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bruce J. Brew
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Departments of HIV and Neurology St Vincent’s Hospital and Peter Duncan Neurosciences Unit St Vincent’s Centre for Applied Medical Research Centre, Darlinghurst, NSW, Australia
| | - Lucette A. Cysique
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Departments of HIV and Neurology St Vincent’s Hospital and Peter Duncan Neurosciences Unit St Vincent’s Centre for Applied Medical Research Centre, Darlinghurst, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- * E-mail:
| |
Collapse
|
38
|
Liu L, Yu J, Li L, Zhang B, Liu L, Wu CH, Jong A, Mao DA, Huang SH. Alpha7 nicotinic acetylcholine receptor is required for amyloid pathology in brain endothelial cells induced by Glycoprotein 120, methamphetamine and nicotine. Sci Rep 2017; 7:40467. [PMID: 28074940 PMCID: PMC5225415 DOI: 10.1038/srep40467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/06/2016] [Indexed: 01/12/2023] Open
Abstract
One of the most challenging issues in HIV-associated neurocognitive disorders (HAND) caused by HIV-1 virotoxins and drug abuse is the lack of understanding the underlying mechanisms that are commonly associated with disorders of the blood-brain barrier (BBB), which mainly consists of brain microvascular endothelial cells (BMEC). Here, we hypothesized that Glycoprotein 120 (gp120), methamphetamine (METH) and nicotine (NT) can enhance amyloid-beta (Aβ) accumulation in BMEC through Alpha7 nicotinic acetylcholine receptor (α7 nAChR). Both in vitro (human BMEC) (HBMEC) and in vivo (mice) models of BBB were used to dissect the role of α7 nAChR in up-regulation of Aβ induced by gp120, METH and NT. Aβ release from and transport across HBMEC were significantly increased by these factors. Methyllycaconitine (MLA), an antagonist of α7 nAChR, could efficiently block these pathogenic effects. Furthermore, our animal data showed that these factors could significantly increase the levels of Aβ, Tau and Ubiquitin C-Terminal Hydrolase L1 (UCHL1) in mouse cerebrospinal fluid (CSF) and Aβ in the mouse brains. These pathogenicities were significantly reduced by MLA, suggesting that α7 nAChR may play an important role in neuropathology caused by gp120, METH and NT, which are the major pathogenic factors contributing to the pathogenesis of HAND.
Collapse
Affiliation(s)
- Liqun Liu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Saban Research Institute, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA90027, USA
| | - Jingyi Yu
- Saban Research Institute, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA90027, USA.,School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Li Li
- School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Clinical Laboratory, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan 650034, China
| | - Bao Zhang
- Saban Research Institute, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA90027, USA.,School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Lingjuan Liu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Chun-Hua Wu
- Saban Research Institute, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA90027, USA
| | - Ambrose Jong
- Saban Research Institute, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA90027, USA
| | - Ding-An Mao
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Sheng-He Huang
- Saban Research Institute, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA90027, USA.,School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
| |
Collapse
|
39
|
HIV-1 Glycoprotein 120 Enhancement of N-Methyl-D-Aspartate NMDA Receptor-Mediated Excitatory Postsynaptic Currents: Implications for HIV-1-Associated Neural Injury. J Neuroimmune Pharmacol 2016; 12:314-326. [PMID: 28005232 DOI: 10.1007/s11481-016-9719-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/28/2016] [Indexed: 01/21/2023]
Abstract
It is widely accepted that human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein 120 (gp120) plays an important role in HIV-1-induced neural injury and pathogenesis of HIV-1-associated dementia (HAND). Multiple pathways have been proposed for gp120-induced neurotoxicity, amongst is the activation of N-Methyl-D-Aspartate receptors (NMDARs). It has been shown that gp120 causes neuronal injury or death and gp120 transgenic mice exhibit neurological similarity to that of HAND, all of which can be blocked or attenuated by NMDAR antagonists. Several lines of evidence indicate the subtype and location of activated NMDARs are key determinants of the nature of NMDAR physiology. To examine the subtype and the location of NMDARs affected by gp120, we studied gp120 on subtype NMDAR-mediated EPSCs in the CA1 region of rat hippocampal slices through "blind" whole-cell patch recordings. Our results showed bath application of gp120 increased both NR2A- and NR2B-mediated EPSCs possibly via a presynaptic mechanism, with much stronger effect on NR2B-mediated EPSCs. In contrast, gp120 failed on enhancing AMPA receptor-mediated EPSCs. Ca2+ imaging studies revealed that gp120 potentiated glutamate-induced increase of intracellular Ca2+ concentration in rat hippocampal neuronal cultures which were blocked by a NMDAR antagonist, but not by an AMPA receptor antagonist, indicating gp120 induces Ca2+ influx through NMDARs. Further investigations demonstrated that gp120 increased the EPSCs mediated by extrasynaptic NR2BRs. Taken together, these results demonstrate that gp120 interacts with both NR2A and NR2B subtypes of NMDARs with a predominant action on the extrasynaptic NR2B, implicating a role NR2B may play in HIV-1-associated neuropathology.
Collapse
|
40
|
Liu H, Xu E, Liu J, Xiong H. Oligodendrocyte Injury and Pathogenesis of HIV-1-Associated Neurocognitive Disorders. Brain Sci 2016; 6:brainsci6030023. [PMID: 27455335 PMCID: PMC5039452 DOI: 10.3390/brainsci6030023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/12/2016] [Accepted: 07/20/2016] [Indexed: 02/07/2023] Open
Abstract
Oligodendrocytes wrap neuronal axons to form myelin, an insulating sheath which is essential for nervous impulse conduction along axons. Axonal myelination is highly regulated by neuronal and astrocytic signals and the maintenance of myelin sheaths is a very complex process. Oligodendrocyte damage can cause axonal demyelination and neuronal injury, leading to neurological disorders. Demyelination in the cerebrum may produce cognitive impairment in a variety of neurological disorders, including human immunodeficiency virus type one (HIV-1)-associated neurocognitive disorders (HAND). Although the combined antiretroviral therapy has markedly reduced the incidence of HIV-1-associated dementia, a severe form of HAND, milder forms of HAND remain prevalent even when the peripheral viral load is well controlled. HAND manifests as a subcortical dementia with damage in the brain white matter (e.g., corpus callosum), which consists of myelinated axonal fibers. How HIV-1 brain infection causes myelin injury and resultant white matter damage is an interesting area of current HIV research. In this review, we tentatively address recent progress on oligodendrocyte dysregulation and HAND pathogenesis.
Collapse
Affiliation(s)
- Han Liu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
| | - Enquan Xu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
| | - Jianuo Liu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
| | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
| |
Collapse
|
41
|
Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis 2016; 63:687-693. [PMID: 27325690 DOI: 10.1093/cid/ciw399] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are not routinely assessed due to the lack of an adequate screening strategy. We aimed to develop a clinically relevant screening procedure for symptomatic HAND, validated against a gold standard neuropsychological (NP) test battery. METHODS Representative HIV-infected (HIV+) and demographically matched HIV-uninfected (HIV-) participants in an observational study completed a standard evaluation for mood, drug and/or alcohol use, and activities of daily living and a newly designed 20-minute computerized CogState battery that assessed 5 cognitive domains. A subset completed standard NP assessment for 8 cognitive domains. HAND definition on screening and gold standard NP was determined using demographically corrected z scores and the global deficit score (≥ 0.5), applying the Frascati criteria. Participants were blinded to screening results, and the NP examiner was blinded to screening and HIV status. RESULTS A total of 254 HIV+ participants were enrolled-mean age, 48.9 ± 10.2 years; median nadir CD4, 270 cells/mL; tertiary educated, 54%; and HIV- controls, 72. HIV+ HAND screening prevalence was 30.7% (HIV-associated dementia, 3.2%; mild neurocognitive disorder, 12.6%; and asymptomatic neurocognitive disorder, 15.0%; HIV- group: 13.9%; P = .004). Of the 75 participants who completed the NP battery, the HAND rate in the HIV+ group was 50.9% vs 43.4% by screening (P > .50). HAND screening vs gold standard NP sensitivity was 76% and specificity was 71%. Clinically relevant HIV-associated dementia and mild neurocognitive disorder sensitivity was 100% and specificity was 98% (positive predictive value 0.92). CONCLUSIONS Symptomatic HAND warranting neurological review was accurately predicted using a CogState-based screening procedure.
Collapse
Affiliation(s)
- Mark Bloch
- Holdsworth House Medical Practice.,Faculty of Medicine, University of New South Wales
| | | | - Avindra Jayewardene
- Holdsworth House Medical Practice.,Charles Perkins Centre, University of Sydney, New South Wales
| | | | - Angela Carberry
- Holdsworth House Medical Practice.,Charles Perkins Centre, University of Sydney, New South Wales
| | | | | | - Paul Maruff
- Psychology Department Melbourne University, Victoria
| | - Bruce Brew
- Faculty of Medicine, University of New South Wales.,St Vincent's Hospital.,St Vincent's Applied Medical Research Centre
| | - Lucette A Cysique
- Faculty of Medicine, University of New South Wales.,St Vincent's Hospital.,St Vincent's Applied Medical Research Centre.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| |
Collapse
|