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Moschopoulos CD, Stanitsa E, Protopapas K, Kavatha D, Papageorgiou SG, Antoniadou A, Papadopoulos A. Multimodal Approach to Neurocognitive Function in People Living with HIV in the cART Era: A Comprehensive Review. Life (Basel) 2024; 14:508. [PMID: 38672778 PMCID: PMC11050956 DOI: 10.3390/life14040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Combination antiretroviral treatment (cART) has revolutionized the management of human immunodeficiency virus (HIV) and has markedly improved the disease burden and life expectancy of people living with HIV. HIV enters the central nervous system (CNS) early in the course of infection, establishes latency, and produces a pro-inflammatory milieu that may affect cognitive functions, even in the cART era. Whereas severe forms of neurocognitive impairment (NCI) such as HIV-associated dementia have declined over the last decades, milder forms have become more prevalent, are commonly multifactorial, and are associated with comorbidity burdens, mental health, cART neurotoxicity, and ageing. Since 2007, the Frascati criteria have been used to characterize and classify HIV-associated neurocognitive disorders (HAND) into three stages, namely asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). These criteria are based on a comprehensive neuropsychological assessment that presupposes the availability of validated, demographically adjusted, and normative population data. Novel neuroimaging modalities and biomarkers have been proposed in order to complement NCI assessments, elucidate neuropathogenic mechanisms, and support HIV-associated NCI diagnosis, monitoring, and prognosis. By integrating neuropsychological assessments with biomarkers and neuroimaging into a holistic care approach, clinicians can enhance diagnostic accuracy, prognosis, and patient outcomes. This review interrogates the value of these modes of assessment and proposes a unified approach to NCI diagnosis.
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Affiliation(s)
- Charalampos D. Moschopoulos
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Evangelia Stanitsa
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.S.); (S.G.P.)
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Dimitra Kavatha
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.S.); (S.G.P.)
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
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Zhan Y, Cai DC, Liu Y, Song F, Shan F, Song P, Chen G, Zhang Y, Wang H, Shi Y. Altered metabolism in right basal ganglia associated with asymptomatic neurocognitive impairment in HIV-infected individuals. Heliyon 2024; 10:e23342. [PMID: 38169709 PMCID: PMC10758793 DOI: 10.1016/j.heliyon.2023.e23342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/02/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Background Only few studies have focused on the metabolite differences between asymptomatic neurocognitive impairment (ANI) and cognitively normal people living with HIV (PLWH). The current study aims to examine whether brain metabolisms in basal ganglia (BG) by magnetic resonance spectroscopy (MRS) were potential to discriminate ANI from cognitively normal PLWH. Methods According to neuropsychological (NP) test, 80 PLWH (37.4 ± 10.2 years) were divided into ANI group (HIV-ANI, n = 31) and NP normal group (HIV-normal, n = 49). Brain metabolisms by MRS from right BG were compared between groups, including N-acetylaspartate and N-acetyl aspartylglutamate (tNAA), creatine and phosphocreatine (tCr), and choline-containing compounds (tCho). A total value of three metabolites were introduced. All brain metabolisms were evaluated as its percentage of total. Furthermore, correlations between MRS and NP and clinical measures were evaluated. A logistic regression model was applied, and the AUC values for the model and the continuous factors were compared using receiver operating curve (ROC) analysis. Results Compared to HIV-normal group, tNAA/total was lower and tCr/total was higher in the HIV-ANI group (P < 0.05). Both tNAA/total and tCr/total values were correlated with NP score (P < 0.05), especially in verbal fluency, speed of information processing, learning, and recall (P < 0.05). The logistic model included BG-tCr/total, current CD4 and infection years of PLWH. The AUC value for the BG-tCr/total was 0.696 and was not significantly lower than that for logistic model (P < 0.01). Conclusion The altered brain metabolites in the right BG were found in the ANI group compared to PLWH with normal cognition, and further associated with NP deficits. The current findings indicated that brain metabolites assessed by MRS has the potential to discriminate ANI from cognitively normal PLWH.
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Affiliation(s)
- Yi Zhan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dan-Chao Cai
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ying Liu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Pengrui Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Guochao Chen
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yijun Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Deist M, Suliman S, Kidd M, Franklin D, Cherner M, Heaton RK, Spies G, Seedat S. Neuropsychological Test Norms for the Assessment of HIV-Associated Neurocognitive Impairment Among South African Adults. AIDS Behav 2023; 27:3080-3097. [PMID: 36918465 PMCID: PMC10386947 DOI: 10.1007/s10461-023-04029-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
Reliable and valid neurocognitive (NC) test batteries that assess multiple domains of cognitive functioning are vital tools in the early detection of HIV-associated NC impairment. The HIV Neurobehavioral Research Center's International Neurobehavioral Battery (HNRC Battery) is one such diagnostic tool and has shown cultural validity in several international neuroHIV studies. However, no published norms are currently available for the full HNRC Battery in South Africa. To accurately interpret NC test results, appropriate reference norms are required. In light of this challenge, data were collected from 500 healthy, HIV-uninfected participants to develop demographically corrected South African norms. When demographically corrected United States of America (U.S.) norms were applied to the performance scores of our neurologically intact, HIV-negative sample, an impairment rate of 62.2% was observed compared to a 15.0% impairment rate when the newly generated South African norms were applied. These results reiterate the findings of other low- and middle-income countries, highlighting the need for localized, country-specific norms when interpreting NC performance.
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Affiliation(s)
- Melanie Deist
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - Donald Franklin
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Mariana Cherner
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Robert K Heaton
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Georgina Spies
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Caobi A, Werne R, Gomez M, Andre M, Thomas C, Yndart A, Lima-Hernandez F, Nair M, Raymond AD. Protein cargo of Nef-containing exosomal extracellular vesicles may predict HIV-associated Neurocognitive Impairment status. RESEARCH SQUARE 2023:rs.3.rs-2740135. [PMID: 37214960 PMCID: PMC10197801 DOI: 10.21203/rs.3.rs-2740135/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Exosomal extracellular vesicles (xEVs) in plasma and cerebrospinal fluid (CSF) of aviremic people living with HIV/AIDS (PLWHA) contain the HIV Negative factor (Nef) protein. However, the role of xEVs and Nef-containing-xEVs(xEV-Nef) in HIV-associated neuropathology is unknown. Here we performed a cross-sectional analysis of the content of xEVs derived from matched serum and CSF samples of PLWHAs diagnosed with either asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), or HIV-associated dementia (HAD). The overall objective was to determine whether the content of the matched xEVs derived plasma or CSF correlated with the neurocognitive impairment (NCI) status. The size and protein content of the xEVs were characterized via dynamic light scattering (DLS) and LC-MS/MS, respectively. xEV size was not significantly different between ANI, MND, or HAD groups. CSF of PLWHAs with NCI contained significantly more xEVs than matched plasma. xEV-Nef CSF concentration was elevated in PLWHAs with NCI and correlated with CD4 T-cell count. Plasma-derived xEV protein profiles from PLWHAs with ANI or MND differed from PLWHAs without NCI. Over-representation analysis using Reactome and KEGG databases show proteins involved in pathways associated with heme scavenging, signaling(MAP kinase and integrin-alpha),Toll-like receptor regulation, clot formation, complement, and cytosolic calcium level were elevated in MND. Pathways upregulated within the ANI group involved high-density lipid (HDL) remodeling, post-translational protein phosphorylation, and platelet activation. Overall, the data shows that xEV protein profiles of ANI and MND differ, suggesting protein profiles of peripheral xEVs, xEV-Nef, and CD4 T-cell count may discern NCI status.
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Affiliation(s)
- Allen Caobi
- Herbert Wertheim College of Medicine at Florida International University, Department of Immunology and Nanomedicine, Miami, 33199, USA
| | - Rachel Werne
- Herbert Wertheim College of Medicine at Florida International University, Department of Immunology and Nanomedicine, Miami, 33199, USA
| | - Mario Gomez
- College of Arts, Sciences, and Education at Florida International University; Department of Chemistry and Biochemistry; Advanced Mass Spectrometry Facility, Miami, FL 33199
| | - Mickensone Andre
- Herbert Wertheim College of Medicine at Florida International University, Department of Immunology and Nanomedicine, Miami, 33199, USA
| | - Charo Thomas
- Herbert Wertheim College of Medicine at Florida International University, Department of Immunology and Nanomedicine, Miami, 33199, USA
| | - Adriana Yndart
- Herbert Wertheim College of Medicine at Florida International University, Department of Immunology and Nanomedicine, Miami, 33199, USA
| | - Francisco Lima-Hernandez
- College of Arts, Sciences, and Education at Florida International University; Department of Chemistry and Biochemistry; Advanced Mass Spectrometry Facility, Miami, FL 33199
| | - Madhavan Nair
- Herbert Wertheim College of Medicine at Florida International University, Department of Immunology and Nanomedicine, Miami, 33199, USA
| | - Andrea D Raymond
- Herbert Wertheim College of Medicine at Florida International University, Department of Immunology and Nanomedicine, Miami, 33199, USA
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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.
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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
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T-lymphocyte activation markers in patients with HIV-1-associated neurocognitive disorder. J Neurovirol 2022; 28:404-409. [DOI: 10.1007/s13365-022-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
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Liang HJ, Ernst T, Cunningham E, Chang L. Contributions of chronic tobacco smoking to HIV-associated brain atrophy and cognitive deficits. AIDS 2022; 36:513-524. [PMID: 34860196 PMCID: PMC8881356 DOI: 10.1097/qad.0000000000003138] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tobacco smoking is linked to cognitive deficits and greater white matter (WM) abnormalities in people with HIV disease (PWH). Whether tobacco smoking additionally contributes to brain atrophy in PWH is unknown and was evaluated in this study. DESIGN We used a 2 × 2 design that included 83 PWH (43 nonsmokers, 40 smokers) and 171 HIV-seronegative (SN, 106 nonsmokers, 65 smokers) participants and assessed their brain structure and cognitive function. METHODS Selected subcortical volumes, voxel-wise cortical volumes and thickness, and total WM volume were analyzed using FreeSurfer. Independent and interactive effects of HIV and smoking were evaluated with two-way analysis of covariance on cognitive domain Z-scores and morphometric measures on T1-weighted MRI. RESULTS Regardless of smoking status, relative to SN, PWH had smaller brain volumes [basal ganglia, thalami, hippocampi, subcortical gray matter (GM) and cerebral WM volumes (P = 0.002-0.042)], steeper age-related declines in the right superior-parietal (interaction: P < 0.001) volumes, and poorer attention/working memory and learning (P = 0.016-0.027). Regardless of HIV serostatus, smokers tended to have smaller hippocampi than nonsmokers (-0.6%, P = 0.055). PWH smokers had the smallest total and regional subcortical GM and cortical WM volume and poorest cognitive performance. CONCLUSIONS Tobacco smoking additionally contributed to brain atrophy and cognitive deficits in PWH. The greater brain atrophy in PWH smokers may be due to greater neuronal damage or myelin loss in various brain regions, leading to their poor cognitive performance. Therefore, tobacco smoking may exacerbate or increase the risk for HIV-associated neurocognitive disorders.
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Affiliation(s)
- Hua-Jun Liang
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Eric Cunningham
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Neurology, University of Maryland School of
Medicine, Baltimore, MD, USA
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Ma Q, Shi X, Chen G, Song F, Liu F, Zheng H, Shi Y, Cai DC. HIV-Associated Structural and Functional Brain Alterations in Homosexual Males. Front Neurol 2022; 12:757374. [PMID: 35095719 PMCID: PMC8796998 DOI: 10.3389/fneur.2021.757374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Neuroimaging elucidations have shown structural and functional brain alterations in HIV-infected (HIV+) individuals when compared to HIV-negative (HIV–) controls. However, HIV− groups used in previous studies were not specifically considered for sexual orientation, which also affects the brain structures and functions. The current study aimed to characterize the brain alterations associated with HIV infection while controlling for sexual orientation. Methods: Forty-three HIV+ and 40 HIV– homosexual men (HoM) were recruited and underwent resting-state MRI scanning. Group differences in gray matter volume (GMV) were assessed using a voxel-based morphometry analysis. Brain regions with the altered GMV in the HIV+ HoM group were then taken as regions of interest in a seed-based analysis to identify altered functional connectivity. Furthermore, the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity values were compared between the two groups to evaluate the HIV-associated functional abnormalities in local brain regions. Results: HIV+ HoM showed significantly increased GMV in the bilateral parahippocampal gyrus and amygdala, and decreased GMV in the right inferior cerebellum, compared with the HIV– HoM. The brain regions with increased GMV were hyper-connected with the left superior cerebellum, right lingual gyrus, and left precuneus in the HIV+ HoM. Moreover, the ALFF values of the right fusiform gyrus, and left parahippocampal gyrus were increased in the HIV+ HoM. The regional homogeneity values of the right anterior cingulate and paracingulate gyri, and left superior cerebellum were decreased in the HIV+ HoM. Conclusion: When the study population was restricted to HoM, HIV+ individuals exhibited structural alterations in the limbic system and cerebellum, and functional abnormalities in the limbic, cerebellum, and visual network. These findings complement the existing knowledge on the HIV-associated neurocognitive impairment from the previous neuroimaging studies by controlling for the potential confounding factor, sexual orientation. Future studies on brain alternations with the exclusion of related factors like sexual orientation are needed to understand the impact of HIV infection on neurocognitive function more accurately.
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Affiliation(s)
- Qiong Ma
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xiudong Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Guochao Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Fengjun Liu
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Huang Zheng
- Shanghai Commercial Sex Worker (CSW) & Man Have Sex With Man (MSM) Center, Shanghai, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- *Correspondence: Yuxin Shi
| | - Dan-Chao Cai
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Dan-Chao Cai
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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.
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Díaz-Santos M, Suárez PA, Marquine MJ, Umlauf A, Rivera Mindt M, Artiola i Fortuny L, Heaton RK, Cherner M. Updated demographically adjusted norms for the Brief Visuospatial Memory Test-revised and Hopkins Verbal Learning Test-revised in Spanish-speakers from the U.S.-Mexico border region: The NP-NUMBRS project. Clin Neuropsychol 2021; 35:374-395. [PMID: 33380275 PMCID: PMC8218787 DOI: 10.1080/13854046.2020.1861329] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We generated demographically adjusted norms for the Brief Visuospatial Memory Test-revised (BVMT-R) and the Hopkins Verbal Learning Test-revised (HVLT-R) for Spanish-speakers from the U.S.-Mexico border region as part of a larger normative project. Methods: Healthy native Spanish-speakers (n = 203; Age: 19-60 years; Education: 0-20 years, 59% women) living in Arizona (n = 63) and California (n = 140) completed the BVMT-R and the HVLT-R as part of the larger Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project. Raw scores were converted to T-scores utilizing fractional polynomial equations, which considered linear and non-linear effects of demographic variables (age, education, sex). To demonstrate the benefit of employing our population-specific norms, we computed the proportion of our participants whose test performance fell below one standard deviation (T-score < 40) when applying published norms from non-Hispanic English-speakers, compared to the base rate derived from the new normative sample. Results: The resulting demographically adjusted T-scores showed the expected psychometric properties and corrected the misclassification in rates of impairment that were obtained when applying norms based on the English-speaking sample. Unexpectedly, participants in Arizona obtained slightly lower HVLT-R T-scores than those in California. This site effect was not explained by available sociodemographic or language factors. Supplementary formulas were computed adjusting for site in addition to demographics. Conclusions: These updated norms improve accuracy in identification of learning and memory impairment among Spanish-speaking adults living in the U.S.-Mexico border region. It will be important to generate additional data for elders, as the present norms are only applicable to adults age 60 and younger.
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Affiliation(s)
- Mirella Díaz-Santos
- Hispanic Neuropsychiatric Center of Excellence – Cultural Neuropsychology Program, Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Paola A. Suárez
- Hispanic Neuropsychiatric Center of Excellence – Cultural Neuropsychology Program, Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - María J. Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Monica Rivera Mindt
- Department of Psychology & Latin American Latino Studies Institute, Fordham University and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
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11
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Liu D, Zhao C, Wang W, Wang Y, Li R, Sun J, Liu J, Liu M, Zhang X, Liang Y, Li H. Altered Gray Matter Volume and Functional Connectivity in Human Immunodeficiency Virus-Infected Adults. Front Neurosci 2020; 14:601063. [PMID: 33343289 PMCID: PMC7744568 DOI: 10.3389/fnins.2020.601063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023] Open
Abstract
People living with human immunodeficiency virus (HIV) (PLWH) are at high risk of neurocognitive impairment. The pathogenesis of neurocognitive impairment remains unclear, and there is still no diagnostic biomarker. By coupling three-dimensional T1-weighted imaging and resting-state functional imaging, we explored structural and functional alterations in PLWH and examined whether such imaging alterations had the potential to denote neurocognitive function. A total of 98 PLWH and 47 seronegative controls aged 20-53 years were recruited. Structural alterations were first explored between HIV-negative controls and PLWH. Subsequently, brain regions showing gray matter alterations were used as seeds for separate whole-brain functional connectivity (FC) analysis. Finally, the relationships between imaging alterations and cognitive function were explored. PLWH suffered from thalamus, occipital lobe, and hippocampus/parahippocampus atrophy. Visual cortices in PLWH showed decreased anticorrelation with the posterior cingulate cortex and left angular gyrus of the default mode network. FC within the visual cortices (between the left calcarine and right calcarine) and in the thalamic prefrontal circuit and between the thalamus and somatosensory association cortex were also altered. In addition, FC between the left thalamus and right dorsolateral prefrontal cortex in the cognitively impaired group was significantly different from that in the cognitively normal group in PLWH. Partial correlation analysis uncorrected for multiple comparisons suggested that some imaging alterations can be associated with neurocognition. Our study supports the presence of brain atrophy and functional reconfiguration in PLWH. Imaging alterations can be associated with neurocognitive function. We hold that neuroimaging is a promising approach in evaluating PLWH and might have the potential to clarify the pathogenesis of HIV-associated neurocognitive disorder.
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Affiliation(s)
- Dan Liu
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Cui Zhao
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Wang
- Department of Radiology, Beijing Second Hospital, Beijing, China
| | - Ruili Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jun Sun
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiaojiao Liu
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Mingming Liu
- Physical Examination Center, Cangzhou Central Hospital, Hebei, China
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Ying Liang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing University of Aeronautics and Astronautics, Beijing, China
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Gendelman HE. Predictive biomarkers for cognitive decline during progressive HIV infection. EBioMedicine 2019; 51:102538. [PMID: 31735551 PMCID: PMC7000313 DOI: 10.1016/j.ebiom.2019.10.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Howard E Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5110, United States.
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