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Ellis RJ, Marquine MJ, Kaul M, Fields JA, Schlachetzki JCM. Mechanisms underlying HIV-associated cognitive impairment and emerging therapies for its management. Nat Rev Neurol 2023; 19:668-687. [PMID: 37816937 PMCID: PMC11052664 DOI: 10.1038/s41582-023-00879-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/12/2023]
Abstract
People living with HIV are affected by the chronic consequences of neurocognitive impairment (NCI) despite antiretroviral therapies that suppress viral replication, improve health and extend life. Furthermore, viral suppression does not eliminate the virus, and remaining infected cells may continue to produce viral proteins that trigger neurodegeneration. Comorbidities such as diabetes mellitus are likely to contribute substantially to CNS injury in people living with HIV, and some components of antiretroviral therapy exert undesirable side effects on the nervous system. No treatment for HIV-associated NCI has been approved by the European Medicines Agency or the US Food and Drug Administration. Historically, roadblocks to developing effective treatments have included a limited understanding of the pathophysiology of HIV-associated NCI and heterogeneity in its clinical manifestations. This heterogeneity might reflect multiple underlying causes that differ among individuals, rather than a single unifying neuropathogenesis. Despite these complexities, accelerating discoveries in HIV neuropathogenesis are yielding potentially druggable targets, including excessive immune activation, metabolic alterations culminating in mitochondrial dysfunction, dysregulation of metal ion homeostasis and lysosomal function, and microbiome alterations. In addition to drug treatments, we also highlight the importance of non-pharmacological interventions. By revisiting mechanisms implicated in NCI and potential interventions addressing these mechanisms, we hope to supply reasons for optimism in people living with HIV affected by NCI and their care providers.
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Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - María J Marquine
- Department of Medicine, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Marcus Kaul
- School of Medicine, Division of Biomedical Sciences, University of California Riverside, Riverside, CA, USA
| | - Jerel Adam Fields
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Johannes C M Schlachetzki
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
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Velichkovsky BB, Razvaliaeva AY, Khlebnikova AA, Manukyan PA, Kasatkin VN. Attention and memory after COVID-19 as measured by neuropsychological tests: Systematic review and meta-analysis. Acta Psychol (Amst) 2023; 233:103838. [PMID: 36657196 PMCID: PMC9834202 DOI: 10.1016/j.actpsy.2023.103838] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
COVID-19 is associated with a range of sequelae, including cognitive dysfunctions as long-standing symptoms. Considering that the number of people infected worldwide keeps growing, it is important to understand specific domains of impairments to further organize appropriate rehabilitation procedures. In this study we conducted a meta-analysis to investigate specific cognitive functions impacted by COVID-19. A literature search was conducted in Web of Science, Scopus, PubMed, Academic Search Premier, Health Source: Nursing/Academic Edition, and preprint databases (OSF and PsyArXiv via OSF Preprints, medRxiv, bioRxiv, Research Square). We included the studies that compared cognitive functioning in COVID-19 reconvalescents and healthy controls, and used at least one validated neuropsychological test. Our findings show that short-term memory in the verbal domain, and possibly, visual short-term memory and attention, are at risk in COVID-19 reconvalescents. The impact of COVID-19 on cognitive functioning has yet to be studied in detail. In the future more controlled studies with validated computerized tests might help deepen our understanding of the issue. PSYCINFO CLASSIFICATION: 3360 Health Psychology & Medicine.
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Affiliation(s)
- Boris B. Velichkovsky
- Research Institute for Brain Development and Peak Performance, RUDN University (Peoples' Friendship University of Russia), 117198, 11A Miklukho-Maklaya str., Moscow, Russia,Lomonosov Moscow State University, 125009, 11 Mokhovaya str., Moscow, Russia
| | - Anna Yu. Razvaliaeva
- Institute of Psychology, Russian Academy of Sciences, 129366, 13 Yaroslavskaya str., Moscow, Russia,Corresponding author at: 129366, Laboratory of Cognitive and Mathematical Psychology, Institute of Psychology, Russian Academy of Sciences, 13 Yaroslavskaya str., Moscow, Russia
| | | | - Piruza A. Manukyan
- Research Institute for Brain Development and Peak Performance, RUDN University (Peoples' Friendship University of Russia), 117198, 11A Miklukho-Maklaya str., Moscow, Russia,Lomonosov Moscow State University, 125009, 11 Mokhovaya str., Moscow, Russia
| | - Vladimir N. Kasatkin
- Research Institute for Brain Development and Peak Performance, RUDN University (Peoples' Friendship University of Russia), 117198, 11A Miklukho-Maklaya str., Moscow, Russia
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Barroso SM, Sousa KCR. Neurocognitive Disorder and Emotional Symptoms in HIV+ Brazilian Elderly: Influence of Gender, Income, Diet, and Sleep. Front Hum Neurosci 2021; 15:721029. [PMID: 34594195 PMCID: PMC8477800 DOI: 10.3389/fnhum.2021.721029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/17/2021] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to identify factors associated with HIV-associated neurocognitive disorder (HAND) and symptoms of anxiety and depression in HIV+ Brazilian elderly on antiretroviral treatments. The study included 112 HIV+ elderly who completed a questionnaire, tests for cognitive screening, attention, problem solving, processing speed, visual perception, memory, and anxiety and depression scales. The results showed presence of HAND (89.3%), pathological anxiety (48.2%) and depression (58%) in the sample. Higher income was a protective factor for HAND (OR = 0.33). Waking up well-rested (OR = 0.63) and better diet quality (OR = 0.62) reduced the chance of pathological anxiety. Higher education (OR = 0.74) and waking up well-rested (OR = 0.61) reduced the chance of depression. Being female (OR = 7.73) increased the chance of depression. It can be concluded that it is important to evaluate cognitive and emotional aspects of HIV+ elders and to consider social and educational status, diet, and sleep in interventions, paying special attention to elderly women.
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Affiliation(s)
- Sabrina Martins Barroso
- Psychological Assessment and Health Investigations Center, Department of Psychology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Kelly Cristina Ramira Sousa
- Psychological Assessment and Health Investigations Center, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Coffee Intake and Neurocognitive Performance in HIV/HCV Coinfected Patients (ANRS CO13 HEPAVIH). Nutrients 2020; 12:nu12092532. [PMID: 32825538 PMCID: PMC7551576 DOI: 10.3390/nu12092532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
Coffee is one of the most consumed beverages worldwide. Previous research has demonstrated its neuroprotective effects in the elderly. People coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) experience an accelerated aging process and cognitive impairment, which significantly impair quality of life and may affect disease-related dimensions such as treatment adherence. This study aimed to analyse the relationship between regular coffee intake and neurocognitive performance (NCP) in HIV-HCV coinfected people. We used data from 139 coinfected patients who participated in both the ANRS CO13 HEPAVIH cohort and the HEPAVIH-Psy cross-sectional survey. Linear regression models adjusting for potential sociodemographic (age, gender, educational level), clinical (liver disease status, ongoing HCV treatment, HIV viral load, major depressive disorder) and socio-behavioural (cannabis use) correlates of NCP were used. Our results showed significant, positive associations between elevated coffee intake (ECI) (three or more cups of coffee per day) and NCP in verbal fluency, psychomotor speed (coding) and executive functioning. ECI might therefore preserve neurocognitive functioning in people living with HIV and HCV.
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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.
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Dux MC, Lee-Wilk T. Integration of Neuropsychological Services in a VA HIV Primary Care Clinic. Arch Clin Neuropsychol 2018; 33:290-300. [PMID: 29718082 DOI: 10.1093/arclin/acx133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/04/2017] [Indexed: 11/15/2022] Open
Abstract
The Department of Veteran Affairs (VA) is the largest health care provider for individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), with >28,000 Veterans with HIV/AIDS enrolled in care. Advances in medical treatment have improved the life-limiting effects of the disease, though many chronic symptoms persist. Comprehensive care is critical to manage the diverse constellation of symptoms. However, many patients face challenges to receiving optimal care due to limited resources, mistrust of health care providers, and/or co-occurring medical, psychiatric, and substance use disorders. The VA is a leader in developing integrated models of care to address these barriers. The inclusion of subspecialty mental health and substance abuse treatment in HIV care has been implemented across many VAs, with evidence of improved patient outcomes. However, neuropsychology has not traditionally been included, despite the fact that cognitive dysfunction represents one of the most ubiquitous complications of HIV/AIDS. Cognitive impairment is associated with myriad negative outcomes including medication non-adherence, reduced quality of life, and increased mortality. We contend that neuropsychologists are uniquely equipped to contribute to the comprehensive care of patients with HIV/AIDS. Neuropsychologists understand the range of factors that can impact cognition and have the requisite knowledge and skills to assess and treat cognitive dysfunction. Although we focus on HIV/AIDS, neuropsychologists often play critical roles in the provision of care for other infectious diseases (e.g., hepatitis C).
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Affiliation(s)
- Moira C Dux
- VA Maryland Health Care System (VAMHCS), Mental Health, Neuropsychology Section, Baltimore, MD, USA
| | - Terry Lee-Wilk
- VA Maryland Health Care System (VAMHCS), Mental Health, Neuropsychology Section, Baltimore, MD, USA
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Abstract
PURPOSE OF REVIEW Advances in diagnostic methods mean that co-infections are increasingly being detected in clinical practice, yet their significance is not always obvious. In parallel, basic science studies are increasingly investigating interactions between pathogens to try to explain real-life observations and elucidate biological mechanisms. RECENT FINDINGS Co-infections may be insignificant, detrimental, or even beneficial, and these outcomes can occur through multiple levels of interactions which include modulation of the host response, altering the performance of diagnostic tests, and drug-drug interactions during treatment. The harmful effects of chronic co-infections such as tuberculosis or Hepatitis B and C in association with HIV are well established, and recent studies have focussed on strategies to mitigate these effects. However, consequences of many acute co-infections are much less certain, and recent conflicting findings simply highlight many of the challenges of studying naturally acquired infections in humans. SUMMARY Tackling these challenges, using animal models, or careful prospective studies in humans may prove to be worthwhile. There are already tantalizing examples where identification and treatment of relevant co-infections seems to hold promise for improved health outcomes.
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Affiliation(s)
| | - Anna Turkova
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London
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Weikum D, Shrestha R, Ferro EG, Vagenas P, Copenhaver MM, Spudich S, Alpert MD, Cabello R, Lama JR, Sanchez J, Altice FL. An explanatory factor analysis of a brief self-report scale to detect neurocognitive impairment among HIV-positive men who have sex with men and transgender women in Peru. AIDS Care 2017; 29:1297-1301. [PMID: 28449599 PMCID: PMC6337065 DOI: 10.1080/09540121.2017.1322681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurocognitive impairment (NCI) has been associated with poor clinical outcomes in various patient populations. This study used exploratory factor analysis (EFA) to examine the factor structure of the existing 95-item Neuropsychological Impairment Scale (NIS) to create a suitable NCI screening instrument for people living with HIV (PLH). In Lima, Peru, 313 HIV-positive men who have sex with men (MSM) and transgender women (TGW) prescribed antiretroviral therapy (ART) completed the NIS using computer-assisted self-interviews (CASI). The EFA used principal axis factoring and orthogonal varimax rotation, which resulted in 42 items with an 8-factor solution that explained 51.8% of the overall variance. The revised, 8-factor, Brief Inventory of Neurocognitive Impairment for Peru (BINI-P) showed a diverse set of factors with excellent to good reliability (i.e., F1 α = 0.92 to F8 α = 0.78). This EFA supports the use of the BINI-P to screen for NCI among Spanish-speaking, HIV-positive MSM and TGW. Future research should examine the effectiveness of the BINI-P in detecting NCI in clinical care settings and the impact of NCI on HIV health-related outcomes, including linkage and retention in care, ART adherence and HIV risk behaviors.
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Affiliation(s)
- Damian Weikum
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT
| | - Roman Shrestha
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Enrico G. Ferro
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| | - Panagiotis Vagenas
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| | - Michael M. Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Serena Spudich
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| | - Michael D. Alpert
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| | | | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Frederick L. Altice
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT
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Chang L, Lim A, Lau E, Alicata D. Chronic Tobacco-Smoking on Psychopathological Symptoms, Impulsivity and Cognitive Deficits in HIV-Infected Individuals. J Neuroimmune Pharmacol 2017; 12:389-401. [PMID: 28303534 PMCID: PMC5529218 DOI: 10.1007/s11481-017-9728-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022]
Abstract
HIV-infected individuals (HIV+) has 2-3 times the rate of tobacco smoking than the general population, and whether smoking may lead to greater psychiatric symptoms or cognitive deficits remains unclear. We evaluated the independent and combined effects of being HIV+ and chronic tobacco-smoking on impulsivity, psychopathological symptoms and cognition. 104 participants [27 seronegative (SN)-non-Smokers, 26 SN-Smokers, 29 HIV+ non-Smokers, 22 HIV+ Smokers] were assessed for psychopathology symptoms (Symptom Checklist-90, SCL-90), depressive symptoms (Center for Epidemiologic Studies-Depression Scale, CES-D), impulsivity (Barratt Impulsiveness Scale, BIS), decision-making (The Iowa Gambling Task, IGT, and Wisconsin Card Sorting Test, WCST), and cognition (seven neurocognitive domains). Both HIV+ and Smoker groups had higher SCL-90 and CES-D scores, with highest scores in HIV+ Smokers. On BIS, both HIV+ and Smokers had higher Total Impulsiveness scores, with higher behavioral impulsivity in Smokers, highest in HIV+ Smokers. Furthermore, across the four groups, HIV+ Smokers lost most money and made fewest advantageous choices on the IGT, and had highest percent errors on WCST. Lastly, HIV+ had lower z-scores on all cognitive domains, with the lowest scores in HIV+ Smokers. These findings suggest that HIV-infection and chronic tobacco smoking may lead to additive deleterious effects on impulsivity, psychopathological (especially depressive) symptoms and cognitive dysfunction. Although greater impulsivity may be premorbid in HIV+ and Smokers, the lack of benefits of nicotine in chronic Smokers on attention and psychopathology, especially those with HIV-infection, may be due to the negative effects of chronic smoking on dopaminergic and cardio-neurovascular systems. Tobacco smoking may contribute to psychopathology and neurocognitive disorders in HIV+ individuals.
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Affiliation(s)
- Linda Chang
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA.
| | - Ahnate Lim
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
| | - Eric Lau
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
| | - Daniel Alicata
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
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