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Weber MT, Finkelstein A, Uddin MN, Reddy EA, Arduino RC, Wang L, Tivarus ME, Zhong J, Qui X, Schifitto G. Longitudinal Effects of Combination Antiretroviral Therapy on Cognition and Neuroimaging Biomarkers in Treatment-Naïve People with HIV. Neurology 2022; 99:e1045-e1055. [PMID: 36219802 PMCID: PMC9519252 DOI: 10.1212/wnl.0000000000200829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While combination antiretroviral therapy (cART) has dramatically increased the life expectancy of people with HIV (PWH), nearly 50% develop HIV-associated neurocognitive disorders (HAND)1. This may be due to previously uncontrolled HIV viral replication, immune activation maintained by residual viral replication2 or activation from other sources3, 4, or cART-associated neurotoxicity5. The aim of this study was to determine the effect of cART on cognition and neuroimaging biomarkers markers in people with HIV (PWH) before and after initiation of cART compared to HIV negative controls (HC) and HIV elite controllers (EC) who remain untreated. METHODS We recruited three groups of participants from the University of Rochester, McGovern Medical School and SUNY Upstate Medical University: 1) ART-treatment-naïve PWH; 2) age-matched HC; and 3) EC. Participants underwent brain MRI and clinical and neuropsychological assessments at baseline, one year, and two years. PWH were also assessed 12 weeks after initiating cART. Volumetric analysis and fractal dimensionality (FD) were calculated for cortical and subcortical regions. Mixed effect regressions examined the effect of group and imaging variables on cognition. RESULTS We enrolled 47 PWH, 58 HC, and 10 EC. At baseline, PWH had worse cognition and lower cortical volumes than HC. Cognition improved following initiation of cART and remained stable over time. Greater cortical thickness was associated with better cognition at baseline; greater FD of parietal, temporal and occipital lobes was associated with better cognition at baseline and longitudinally. At baseline, EC had worse cognition, lower cortical thickness and lower FD in all four lobes and caudate than PWH and HC. Greater cortical thickness, hippocampal volumes and FD of frontal, temporal and occipital lobes were associated with better cognition longitudinally. CONCLUSIONS Initiation of cART in PWH is associated with improvement in brain structure and cognition. However, significant differences persist over time compared to HC. Similar trends in EC suggest that results are due to HIV infection rather than treatment. Stronger associations between cognition and FD suggest this imaging metric may be a more sensitive marker of neuronal injury than cortical thickness and volumetric measures.
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Affiliation(s)
- Miriam T Weber
- Department of Neurology, University of Rochester, Rochester, NY USA .,Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY USA
| | - Alan Finkelstein
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Md Nasir Uddin
- Department of Neurology, University of Rochester, Rochester, NY USA
| | | | - Roberto C Arduino
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Lu Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester NY, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester NY, USA
| | - Jianhui Zhong
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA.,Department of Imaging Sciences, University of Rochester Medical Center, Rochester NY, USA.,Department of Physics and Astronomy, University of Rochester, Rochester NY, USA
| | - Xing Qui
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester, Rochester, NY USA.,Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
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High-content analysis and Kinetic Image Cytometry identify toxicity and epigenetic effects of HIV antiretrovirals on human iPSC-neurons and primary neural precursor cells. J Pharmacol Toxicol Methods 2022; 114:107157. [PMID: 35143957 PMCID: PMC9103414 DOI: 10.1016/j.vascn.2022.107157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Despite viral suppression due to combination antiretroviral therapy (cART), HIV-associated neurocognitive disorders (HAND) continue to affect half of people with HIV, suggesting that certain antiretrovirals (ARVs) may contribute to HAND. METHODS We examined the effects of nucleoside/nucleotide reverse transcriptase inhibitors tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) and the integrase inhibitors dolutegravir (DTG) and elvitegravir (EVG) on viability, structure, and function of glutamatergic neurons (a subtype of CNS neuron involved in cognition) derived from human induced pluripotent stem cells (hiPSC-neurons), and primary human neural precursor cells (hNPCs), which are responsible for neurogenesis. RESULTS Using automated digital microscopy and image analysis (high content analysis, HCA), we found that DTG, EVG, and TDF decreased hiPSC-neuron viability, neurites, and synapses after 7 days of treatment. Analysis of hiPSC-neuron calcium activity using Kinetic Image Cytometry (KIC) demonstrated that DTG and EVG also decreased the frequency and magnitude of intracellular calcium transients. Longer ARV exposures and simultaneous exposure to multiple ARVs increased the magnitude of these neurotoxic effects. Using the Microscopic Imaging of Epigenetic Landscapes (MIEL) assay, we found that TDF decreased hNPC viability and changed the distribution of histone modifications that regulate chromatin packing, suggesting that TDF may reduce neuroprogenitor pools important for CNS development and maintenance of cognition in adults. CONCLUSION This study establishes human preclinical assays that can screen potential ARVs for CNS toxicity to develop safer cART regimens and HAND therapeutics.
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Borrajo A, Spuch C, Penedo MA, Olivares JM, Agís-Balboa RC. Important role of microglia in HIV-1 associated neurocognitive disorders and the molecular pathways implicated in its pathogenesis. Ann Med 2021; 53:43-69. [PMID: 32841065 PMCID: PMC7877929 DOI: 10.1080/07853890.2020.1814962] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
The development of effective combined anti-retroviral therapy (cART) led to a significant reduction in the death rate associated with human immunodeficiency virus type 1 (HIV-1) infection. However, recent studies indicate that considerably more than 50% of all HIV-1 infected patients develop HIV-1-associated neurocognitive disorder (HAND). Microglia are the foremost cells infected by HIV-1 in the central nervous system (CNS), and so, are also likely to contribute to the neurotoxicity observed in HAND. The activation of microglia induces the release of pro-inflammatory markers and altered secretion of cytokines, chemokines, secondary messengers, and reactive oxygen species (ROS) which activate signalling pathways that initiate neuroinflammation. In turn, ROS and inflammation also play critical roles in HAND. However, more efforts are required to understand the physiology of microglia and the processes involved in their activation in order to better understand the how HIV-1-infected microglia are involved in the development of HAND. In this review, we summarize the current state of knowledge about the involvement of oxidative stress mechanisms and role of HIV-induced ROS in the development of HAND. We also examine the academic literature regarding crucial HIV-1 pathogenicity factors implicated in neurotoxicity and inflammation in order to identify molecular pathways that could serve as potential therapeutic targets for treatment of this disease. KEY MESSAGES Neuroinflammation and excitotoxicity mechanisms are crucial in the pathogenesis of HAND. CNS infiltration by HIV-1 and immune cells through the blood brain barrier is a key process involved in the pathogenicity of HAND. Factors including calcium dysregulation and autophagy are the main challenges involved in HAND.
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Affiliation(s)
- A. Borrajo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Roma, Italy
| | - C. Spuch
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur)-Área Sanitaria de Vigo, SERGAS-UVigo, CIBERSAM, Vigo, Spain
| | - M. A. Penedo
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur)-Área Sanitaria de Vigo, SERGAS-UVigo, CIBERSAM, Vigo, Spain
| | - J. M. Olivares
- Department of Psychiatry, Área Sanitaria de Vigo, Vigo, Spain
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur)-Área Sanitaria de Vigo, SERGAS-UVigo, CIBERSAM, Vigo, Spain
| | - R. C. Agís-Balboa
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur)-Área Sanitaria de Vigo, SERGAS-UVigo, CIBERSAM, Vigo, Spain
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Alagaratnam J, Winston A. Molecular neuroimaging of inflammation in HIV. Clin Exp Immunol 2021; 210:14-23. [PMID: 35020855 PMCID: PMC9585552 DOI: 10.1093/cei/uxab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/13/2021] [Accepted: 11/03/2021] [Indexed: 01/12/2023] Open
Abstract
People with HIV now have near-normal life expectancies due to the success of effective combination antiretroviral therapy (cART). Following cART initiation, immune recovery occurs, and opportunistic diseases become rare. Despite this, high rates of non-infectious comorbidities persist in treated people with HIV, hypothesized to be related to persistent immuno-activation. One such comorbidity is cognitive impairment, which may partly be driven by ongoing neuro-inflammation in otherwise effectively treated people with HIV. In order to develop therapeutic interventions to address neuro-inflammation in effectively treated people with HIV, a deeper understanding of the pathogenic mechanisms driving persistent neuro-inflammatory responses and the ability to better characterize and measure neuro-inflammation in the central nervous system is required. This review highlights recent advances in molecular neuroimaging techniques which have the potential to assess neuro-inflammatory responses within the central nervous system in HIV disease. Proton magnetic resonance spectroscopy (1H-MRS) has been utilized to assess neuro-inflammatory responses since early in the HIV pandemic and shows promise in recent studies assessing different antiretroviral regimens. 1H-MRS is widely available in both resource-rich and some resource-constrained settings and is relatively inexpensive. Brain positron emission tomography (PET) imaging using Translocator Protein (TSPO) radioligands is a rapidly evolving field; newer TSPO-radioligands have lower signal-to-noise ratio and have the potential to localize neuro-inflammation within the brain in people with HIV. As HIV therapeutics evolve, people with HIV continue to age and develop age-related comorbidities including cognitive disorders. The use of novel neuroimaging modalities in the field is likely to advance in order to rapidly assess novel therapeutic interventions and may play a role in future clinical assessments.
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Affiliation(s)
- Jasmini Alagaratnam
- Correspondence: Jasmini Alagaratnam, Clinical Trials Centre, Winston Churchill Wing, St. Mary’s Hospital, Praed Street, London W2 1NY, UK.
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK,Department of Genitourinary Medicine & HIV, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
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MR spectroscopy in HIV associated neurocognitive disorder in the era of cART: a review. AIDS Res Ther 2021; 18:65. [PMID: 34625091 PMCID: PMC8501619 DOI: 10.1186/s12981-021-00388-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Neuroimaging has been a critical tool for understanding the neuropathological underpinnings observed in HIV. The pathophysiology of HAND is chiefly driven by neuroinflammation. Despite adhering to cART, low levels of viraemia probably persist in the brain in some patients leading to chronic immune activation with resultant neuroinflammation and consequent neuronal injury. MR spectroscopy has been widely used as a biomarker for the presence and severity of HAND in several studies. By studying the MRS signatures, it is possible to characterise the presence of neuroinflammation and neural injury. Furthermore, metabolite concentrations measured by MRS could be used as a quantitative indicator of HIV cerebral involvement, thereby affording the opportunity to assess the efficacy of cART in HAND. However, currently there are three significant limitations in the MRS HIV research literature: the relative paucity of prospective studies, the small number of regions of interrogation due to current methodology (single voxel MRS), and the evolving understanding of the impact of co-morbidities (e.g. ageing, mood disorders, alcoholism etc.) on MRS measurements. This review critically addresses the current literature of MRS studies in people living with HIV (PWH) with HAND to determine its value, especially in the context of the current cART era. In addition, we discuss technical considerations related to the disease and the future direction in HAND using MRS.
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Roca-Bayerri C, Robertson F, Pyle A, Hudson G, Payne BAI. Mitochondrial DNA Damage and Brain Aging in Human Immunodeficiency Virus. Clin Infect Dis 2021; 73:e466-e473. [PMID: 32722761 PMCID: PMC8282328 DOI: 10.1093/cid/ciaa984] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) remains common in people living with human immunodeficiency virus (PLWH), despite suppressive antiretroviral therapy (ART), but the reasons remain incompletely understood. Mitochondrial dysfunction is a hallmark of aging and of neurodegenerative diseases. We hypothesized that human immunodeficiency virus (HIV) or ART may lead to mitochondrial abnormalities in the brain, thus contributing to NCI. METHODS We studied postmortem frozen brain samples from 52 PLWH and 40 HIV-negative controls. Cellular mitochondrial DNA (mtDNA) content and levels of large-scale mtDNA deletions were measured by real-time polymerase chain reaction. Heteroplasmic mtDNA point mutations were quantified by deep sequencing (Illumina). Neurocognitive data were taken within 48 months antemortem. RESULTS We observed a decrease in mtDNA content, an increase in the mtDNA "common deletion," and an increase in mtDNA point mutations with age (all P < .05). Each of these changes was exacerbated in HIV-positive cases compared with HIV-negative controls (all P < .05). ART exposures, including nucleoside analogue reverse transcriptase inhibitors, were not associated with changes in mtDNA. The number of mtDNA point mutations was associated with low CD4/CD8 ratio (P = .04) and with NCI (global T-score, P = .007). CONCLUSIONS In people with predominantly advanced HIV infection, there is exacerbation of age-associated mtDNA damage. This change is driven by HIV per se rather than by ART toxicity and may contribute to NCI. These data suggest that mitochondrial dysfunction may be a mediator of adverse aging phenotypes in PLWH.
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Affiliation(s)
- Carla Roca-Bayerri
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Fiona Robertson
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Angela Pyle
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Gavin Hudson
- Wellcome Centre for Mitochondrial Research, Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Brendan A I Payne
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Department of Infection and Tropical Medicine, Newcastle-upon-Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom
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Ellis RJ, Peterson S, Cherner M, Morgan E, Schrier R, Tang B, Hoenigl M, Letendre S, Iudicello J. Beneficial Effects of Cannabis on Blood-Brain Barrier Function in Human Immunodeficiency Virus. Clin Infect Dis 2021; 73:124-129. [PMID: 32296832 DOI: 10.1093/cid/ciaa437] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/14/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection leads to blood-brain barrier (BBB) dysfunction that does not resolve despite viral suppression on antiretroviral therapy (ART) and is associated with adverse clinical outcomes. In preclinical models, cannabis restores BBB integrity. METHODS We studied persons with HIV (PWH) and HIV-negative (HIV-) individuals who had used cannabis recently. We assessed 2 biomarkers of BBB permeability: the cerebrospinal fluid (CSF) to serum albumin ratio (CSAR) and CSF levels of soluble urokinase plasminogen activator receptor (suPAR), a receptor for uPA, a matrix-degrading proteolytic enzyme that disrupts the BBB. A composite index of the BBB markers was created using principal components analysis. Neural injury was assessed using neurofilament light (NFL) in CSF by immunoassay. RESULTS Participants were 45 PWH and 30 HIV- individuals of similar age and ethnicity. Among PWH, higher CSF suPAR levels correlated with higher CSAR values (r = 0.47, P < .001). PWH had higher (more abnormal) BBB index values than HIV- individuals (mean ± SD, 0.361 ± 1.20 vs -0.501 ± 1.11; P = .0214). HIV serostatus interacted with cannabis use frequency, such that more frequent use of cannabis was associated with lower BBB index values in PWH but not in HIV- individuals. Worse BBB index values were associated with higher NFL in CSF (r = 0.380, P = .0169). CONCLUSIONS Cannabis may have a beneficial impact on HIV-associated BBB injury. Since BBB disruption may permit increased entry of toxins such as microbial antigens and inflammatory mediators, with consequent CNS injury, these results support a potential therapeutic role of cannabis among PWH and may have important treatment implications for ART effectiveness and toxicity.
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Affiliation(s)
- Ronald J Ellis
- University of California, San Diego, San Diego, California, USA
| | - Scott Peterson
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, USA
| | - Mariana Cherner
- University of California, San Diego, San Diego, California, USA
| | - Erin Morgan
- University of California, San Diego, San Diego, California, USA
| | - Rachel Schrier
- University of California, San Diego, San Diego, California, USA
| | - Bin Tang
- University of California, San Diego, San Diego, California, USA
| | - Martin Hoenigl
- University of California, San Diego, San Diego, California, USA
| | - Scott Letendre
- University of California, San Diego, San Diego, California, USA
| | - Jenny Iudicello
- University of California, San Diego, San Diego, California, USA
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Tivarus ME, Zhuang Y, Wang L, Murray KD, Venkataraman A, Weber MT, Zhong J, Qiu X, Schifitto G. Mitochondrial toxicity before and after combination antiretroviral therapy, a Magnetic Resonance Spectroscopy study. NEUROIMAGE-CLINICAL 2021; 31:102693. [PMID: 34020161 PMCID: PMC8144469 DOI: 10.1016/j.nicl.2021.102693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/21/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to quantify, via Magnetic Resonance Spectroscopy (MRS), the effect of combination antiretroviral therapy (cART) on brain metabolites and characterize any possible associations between changes in metabolites, age, blood biomarkers of neuronal damage, functional connectivity and cognitive performance. As cART has dramatically increased the life expectancy of HIV-infected (HIV + ) individuals and unmasked an increase in HIV-associated neurocognitive disorders, it is still not clear whether cART neurotoxicity contributes to these disorders. We hypothesized a bimodal effect, with early cART treatment of HIV infection decreasing inflammation as measured by MRS metabolites and improving cognitive performance, and chronic exposure to cART contributing to persistence of cognitive impairment via its effect on mitochondrial function. Basal ganglia metabolites, functional connectivity, cognitive scores, as well as plasma levels of neurofilament light chain (NfL) and tau protein were measured before and after 12 weeks, 1 year and 2 years of cART in a cohort of 50 cART-naïve HIV + subjects and 72 age matched HIV- healthy controls. Glutamate (Glu) levels were lower in the cART naïve patients than in healthy controls and were inversely correlated with plasma levels of NfL. There were no other significant metabolite differences between HIV + and uninfected individuals. Treatment improved Glu levels in HIV+, however, no associations were found between Glu, functional connectivity and cognitive performance. Stable brain metabolites and plasma levels of NfL and Tau over two-years of follow-ups suggest there are no signs of cART neurotoxicity in this relatively young cohort of HIV + individuals.
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Affiliation(s)
- Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester NY, USA; Department of Neuroscience, University of Rochester Medical Center, Rochester NY, USA.
| | - Yuchuan Zhuang
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, USA
| | - Lu Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
| | - Kyle D Murray
- Department of Physics and Astronomy, University of Rochester, Rochester NY, USA
| | - Arun Venkataraman
- Department of Physics and Astronomy, University of Rochester, Rochester NY, USA
| | - Miriam T Weber
- Department of Neurology, University of Rochester Medical Center, Rochester NY, USA
| | - Jianhui Zhong
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester NY, USA; Department of Physics and Astronomy, University of Rochester, Rochester NY, USA; Department of Biomedical Engineering, University of Rochester, Rochester NY, USA
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester NY, USA
| | - Giovanni Schifitto
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester NY, USA; Department of Neurology, University of Rochester Medical Center, Rochester NY, USA
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Bertrand L, Velichkovska M, Toborek M. Cerebral Vascular Toxicity of Antiretroviral Therapy. J Neuroimmune Pharmacol 2021; 16:74-89. [PMID: 31209776 PMCID: PMC7952282 DOI: 10.1007/s11481-019-09858-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/27/2019] [Indexed: 01/14/2023]
Abstract
HIV infection is associated with comorbidities that are likely to be driven not only by HIV itself, but also by the toxicity of long-term use of antiretroviral therapy (ART). Indeed, increasing evidence demonstrates that the antiretroviral drugs used for HIV treatment have toxic effects resulting in various cellular and tissue pathologies. The blood-brain barrier (BBB) is a modulated anatomophysiological interface which separates and controls substance exchange between the blood and the brain parenchyma; therefore, it is particularly exposed to ART-induced toxicity. Balancing the health risks and gains of ART has to be considered in order to maximize the positive effects of therapy. The current review discusses the cerebrovascular toxicity of ART, with the focus on mitochondrial dysfunction. Graphical Abstract Graphical representation of the interactions between HIV, antiretroviral therapy (ART), and the blood-brain barrier (BBB).
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Affiliation(s)
- Luc Bertrand
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Gautier Bldg., Room 528, 1011 NW 15th Street, Miami, FL, 33136, USA
| | - Martina Velichkovska
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Gautier Bldg., Room 528, 1011 NW 15th Street, Miami, FL, 33136, USA
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Gautier Bldg., Room 528, 1011 NW 15th Street, Miami, FL, 33136, USA.
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HIV Infection and Related Mental Disorders. Brain Sci 2021; 11:brainsci11020248. [PMID: 33671125 PMCID: PMC7922767 DOI: 10.3390/brainsci11020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/13/2023] Open
Abstract
Over the more than thirty-year period of the human immunodeficiency virus type 1 (HIV-1) epidemic, many data have been accumulated indicating that HIV infection predisposes one to the development of mental pathologies. It has been proven that cognitive disorders in HIV-positive individuals are the result of the direct exposure of the virus to central nervous system (CNS) cells. The use of antiretroviral therapy has significantly reduced the number of cases of mental disorders among people infected with HIV. However, the incidence of moderate to mild cognitive impairment at all stages of HIV infection is still quite high. This review describes the most common forms of mental pathology that occur in people living with HIV and presents the current concepts on the possible pathogenetic mechanisms of the influence of human immunodeficiency virus (HIV-1) and its viral proteins on the cells of the CNS and the CNS’s functions. This review also provides the current state of knowledge on the impact of the antiretroviral therapy on the development of mental pathologies in people living with HIV, as well as current knowledge on the interactions between antiretroviral and psychotropic drugs that occur under their simultaneous administration.
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Chan C, Foster ST, Chan KG, Cacace MJ, Ladd SL, Sandum CT, Wright PT, Volmert B, Yang W, Aguirre A, Li W, Wright NT. Repositioned Drugs for COVID-19-the Impact on Multiple Organs. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1484-1501. [PMID: 33898925 PMCID: PMC8057921 DOI: 10.1007/s42399-021-00874-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 02/02/2023]
Abstract
This review summarizes published findings of the beneficial and harmful effects on the heart, lungs, immune system, kidney, liver, and central nervous system of 47 drugs that have been proposed to treat COVID-19. Many of the repurposed drugs were chosen for their benefits to the pulmonary system, as well as immunosuppressive and anti-inflammatory effects. However, these drugs have mixed effects on the heart, liver, kidney, and central nervous system. Drug treatments are critical in the fight against COVID-19, along with vaccines and public health protocols. Drug treatments are particularly needed as variants of the SARS-Cov-2 virus emerge with some mutations that could diminish the efficacy of the vaccines. Patients with comorbidities are more likely to require hospitalization and greater interventions. The combination of treating severe COVID-19 symptoms in the presence of comorbidities underscores the importance of understanding the effects of potential COVID-19 treatments on other organs. Supplementary Information The online version contains supplementary material available at 10.1007/s42399-021-00874-8.
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Affiliation(s)
- Christina Chan
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA ,Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI USA ,Department of Biomedical Engineering, Michigan State University, East Lansing, MI USA ,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA
| | - Sean T. Foster
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA
| | - Kayla G. Chan
- Integrative Neuroscience Program, Binghamton University, Binghamton, NY USA
| | - Matthew J. Cacace
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA USA
| | - Shay L. Ladd
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA
| | - Caleb T. Sandum
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA
| | - Paul T. Wright
- Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA USA
| | - Brett Volmert
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI USA ,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA
| | - Weiyang Yang
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA ,Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI USA
| | - Aitor Aguirre
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI USA ,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA
| | - Wen Li
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA ,Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI USA
| | - Neil T. Wright
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI USA
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Ellis RJ, Moore DJ, Sundermann EE, Heaton RK, Mehta S, Hulgan T, Samuels D, Fields JA, Letendre SL. Nucleic acid oxidation is associated with biomarkers of neurodegeneration in CSF in people with HIV. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/6/e902. [PMID: 33055205 PMCID: PMC7577534 DOI: 10.1212/nxi.0000000000000902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether oxidative stress in virologically suppressed people with HIV (PWH) may contribute to or result from neurodegeneration, we measured 7,8-dihydro-8-oxoguanine (8-oxo-dG), a marker of DNA damage due to oxidative stress, and markers of age-related neurodegeneration, specifically, reduced levels of CSF Aβ-42, and elevated CSF total tau and neurofilament light (NFL). METHODS This cross-sectional study prospectively enrolled participants at 6 US centers in the CNS HIV Antiretroviral Effects Research study. Inclusion criteria included HIV+ with a plasma level of HIV RNA ≤50 copies/mL. Exclusions included significant CNS confounding conditions. Measurements of total tau and Aβ-42 were performed by bead suspension array. NFL and 8-oxo-dG were measured using ELISA. RESULTS Participants were 53 PWH, mean age 55 (±9.3) years, 19% women, and 48% non-Hispanic White. Higher 8-oxo-dG correlated with markers of AD-related neurodegeneration including lower CSF Aβ-42 (r = -0.34; p = 0.012) and higher CSF NFL (r = 0.39; p = 0.0091) and total tau (r = 0.6696; p < 0.0001). Relationships remained after adjusting for demographic variables. Levels of protein carbonyls, a marker of protein oxidation, were not related to neurodegeneration markers. CONCLUSIONS Among virologically suppressed PWH, nucleic acid oxidation was associated with standard CSF biomarkers of neurodegeneration. Potential sources of oxidative stress in PWH include low-level HIV replication, inflammation, mitochondrial dysfunction, and specific antiretroviral drugs. Results suggest that the higher levels of oxidative stress among PWH may play a role in neurodegeneration. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that among virologically suppressed PWH, nucleic acid oxidation is associated with standard CSF biomarkers of neurodegeneration.
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Affiliation(s)
- Ronald J Ellis
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego.
| | - David J Moore
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Erin E Sundermann
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Robert K Heaton
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Sanjay Mehta
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Todd Hulgan
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - David Samuels
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Jerel A Fields
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Scott L Letendre
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
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13
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Eaton P, Lewis T, Kellett-Wright J, Flatt A, Urasa S, Howlett W, Dekker M, Kisoli A, Rogathe J, Thornton J, McCartney J, Yarwood V, Irwin C, Mukaetova-Ladinska EB, Akinyemi R, Gray WK, Walker RW, Dotchin CL, Makupa PC, Quaker ALS, Paddick SM. Risk factors for symptomatic HIV-associated neurocognitive disorder in adults aged 50 and over attending a HIV clinic in Tanzania. Int J Geriatr Psychiatry 2020; 35:1198-1208. [PMID: 32497330 DOI: 10.1002/gps.5357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES HIV-associated neurocognitive disorder (HAND), although prevalent, remains a poorly researched cause of morbidity particularly in sub-Saharan Africa (SSA). We aimed to explore the risk factors for HAND in people aged 50 and over under regular follow-up at a government HIV clinic in Tanzania. METHODS HIV-positive adults aged 50 years and over were approached for recruitment at a routine HIV clinic appointment over a 4-month period. A diagnostic assessment for HAND was implemented, including a full medical/neurological assessment and a collateral history from a relative. We investigated potential risk factors using a structured questionnaire and by examination of clinic records. RESULTS Of the cohort (n = 253), 183 (72.3%) were female and the median age was 57 years. Fifty-five individuals (21.7%) met the criteria for symptomatic HAND. Participants were at a greater risk of having symptomatic HAND if they lived alone [odds ratio (OR) = 2.566, P = .015], were illiterate (OR 3.171, P = .003) or older at the time of HIV diagnosis (OR = 1.057, P = .015). Age was correlated with symptomatic HAND in univariate, but not multivariate analysis. CONCLUSIONS In this setting, HIV-specific factors, such as nadir CD4 count, were not related to symptomatic HAND. The "legacy theory" of early central nervous system damage prior to initiation of anti-retroviral therapy initiation may contribute, only in part, to a multifactorial aetiology of HAND in older people. Social isolation and illiteracy were associated with symptomatic HAND, suggesting greater cognitive reserve might be protective.
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Affiliation(s)
- Patrick Eaton
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Lewis
- Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Aidan Flatt
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Clinical Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - William Howlett
- Clinical Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marieke Dekker
- Clinical Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Aloyce Kisoli
- Clinical Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jane Rogathe
- Clinical Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | | | - Vanessa Yarwood
- The London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Irwin
- The London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeta B Mukaetova-Ladinska
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,The Evington Centre, Leicestershire NHS Partnership Trust, Leicester, UK
| | - Rufus Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Philip C Makupa
- HIV Care and Treatment Centre (CTC), Mawenzi Regional Referral Hospital, Moshi, Tanzania
| | - Andrew-Leon S Quaker
- HIV Care and Treatment Centre (CTC), Mawenzi Regional Referral Hospital, Moshi, Tanzania
| | - Stella-Maria Paddick
- Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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14
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Sivalingam K, Cirino TJ, McLaughlin JP, Samikkannu T. HIV-Tat and Cocaine Impact Brain Energy Metabolism: Redox Modification and Mitochondrial Biogenesis Influence NRF Transcription-Mediated Neurodegeneration. Mol Neurobiol 2020; 58:490-504. [PMID: 32978730 DOI: 10.1007/s12035-020-02131-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
HIV infection and drugs of abuse induce oxidative stress and redox imbalance, which cause neurodegeneration. The mechanisms by which HIV infection and cocaine consumption affect astrocyte energy metabolism, and how this leads to neurodegenerative dysfunction, remain poorly understood. Presently, we investigated how oxidative injury causes the depletion of energy resources and glutathione synthetase (GSS), which in turn activates 5' AMP-activated protein kinase (AMPK), glycolytic enzymes, and mitochondrial biogenesis, finally resulting in nuclear factor erythroid (NRF) transcription in astrocytes. Both human primary astrocytes incubated with HIV-1 Tat protein in vitro and HIV-inducible Tat (iTat) mice exposed to cocaine showed decreased levels of GSS and increased superoxide dismutase (SOD) levels. These changes, in turn, significantly activated AMPK and raised the concentrations of several glycolytic enzymes, along with oxidative phosphorylation, the mitochondrial biogenesis of peroxisome proliferator-activated receptor-γ coactivator (PGC-1α) and mitochondrial transcription factor (TFAM), and Nrf1 and Nrf2 gene transcription and protein expression. Moreover, neurons exposed to HIV-1Tat/cocaine-conditioned media showed reductions in dendritic formation, spine density, and neuroplasticity compared with control neurons. These results suggest that redox inhibition of GSS altered AMPK activation and mitochondrial biogenesis to influence Nrf transcription. These processes are important components of the astrocyte signaling network regulating brain energy metabolism in HIV-positive cocaine users. In conclusion, HIV-1 Tat alters redox inhibition, thus increasing glycolytic metabolic profiles and mitochondrial biogenesis, leading to Nrf transcription, and ultimately impacting astrocyte energy resource and metabolism. Cocaine exacerbated these effects, leading to a worsening of neurodegeneration.
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Affiliation(s)
- Kalaiselvi Sivalingam
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Texas A&M University, 1010 W Avenue B, Kingsville, TX, 78363, USA
| | - Thomas J Cirino
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Jay P McLaughlin
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Thangavel Samikkannu
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Texas A&M University, 1010 W Avenue B, Kingsville, TX, 78363, USA.
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15
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Saloner R, Fields JA, Marcondes MCG, Iudicello JE, von Känel S, Cherner M, Letendre SL, Kaul M, Grant I. Methamphetamine and Cannabis: A Tale of Two Drugs and their Effects on HIV, Brain, and Behavior. J Neuroimmune Pharmacol 2020; 15:743-764. [PMID: 32929575 DOI: 10.1007/s11481-020-09957-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022]
Abstract
HIV infection and drug use intersect epidemiologically, and their combination can result in complex effects on brain and behavior. The extent to which drugs affect the health of persons with HIV (PWH) depends on many factors including drug characteristics, use patterns, stage of HIV disease and its treatment, comorbid factors, and age. To consider the range of drug effects, we have selected two that are in common use by PWH: methamphetamine and cannabis. We compare the effects of methamphetamine with those of cannabis, to illustrate how substances may potentiate, worsen, or even buffer the effects of HIV on the CNS. Data from human, animal, and ex vivo studies provide insights into how these drugs have differing effects on the persistent inflammatory state that characterizes HIV infection, including effects on viral replication, immune activation, mitochondrial function, gut permeability, blood brain barrier integrity, glia and neuronal signaling. Moving forward, we consider how these mechanistic insights may inform interventions to improve brain outcomes in PWH. This review summarizes literature from clinical and preclinical studies demonstrating the adverse effects of METH, as well as the potentially beneficial effects of cannabis, on the interacting systemic (e.g., gut barrier leakage/microbial translocation, immune activation, inflammation) and CNS-specific (e.g., glial activation/neuroinflammation, neural injury, mitochondrial toxicity/oxidative stress) mechanisms underlying HIV-associated neurocognitive disorders.
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Affiliation(s)
- Rowan Saloner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA. .,Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego , San Diego, CA, USA.
| | - Jerel Adam Fields
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | | | - Jennifer E Iudicello
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Sofie von Känel
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Scott L Letendre
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Marcus Kaul
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA.,Division of Biomedical Sciences, University of California, Riverside, Riverside, CA, USA
| | - Igor Grant
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
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16
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De Benedetto I, Trunfio M, Guastamacchia G, Bonora S, Calcagno A. A review of the potential mechanisms of neuronal toxicity associated with antiretroviral drugs. J Neurovirol 2020; 26:642-651. [PMID: 32737860 DOI: 10.1007/s13365-020-00874-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
Abstract
Highly active antiretroviral treatment has led to unprecedented efficacy and tolerability in people living with HIV. This effect was also observed in the central nervous system with the nowadays uncommon observation of dementias; yet in more recent works milder forms are still reported in 20-30% of optimally treated individuals. The idea of a subclinical neuronal toxicity induced by antiretrovirals has been proposed and was somehow supported by the late-emerging effects associated with efavirenz use. In this manuscript we are reviewing all the potential mechanisms by which antiretroviral drugs have been associated with in vitro, ex vivo, or in vivo toxicity to cells pertaining to the central nervous system (neurons, astrocytes, oligodendrocytes, and endothelial cells). These include direct or indirect effects and pathological pathways such as amyloid deposition, damage to small cerebral vessels, and impairment in neurotransmission. The aim of this review is therefore to provide a detailed description of the available literature in order to guide further clinical research for improving patients' neurocognition and quality of life.
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Affiliation(s)
- Ilaria De Benedetto
- Department of Medical Sciences, School of Infectious and Tropical Diseases, University of Torino, c/o Amedeo di Savoia Hospital - Corso Svizzera 164, 10169, Torino, Italy.
| | - Mattia Trunfio
- Department of Medical Sciences, School of Infectious and Tropical Diseases, University of Torino, c/o Amedeo di Savoia Hospital - Corso Svizzera 164, 10169, Torino, Italy
| | | | - Stefano Bonora
- Department of Medical Sciences, School of Infectious and Tropical Diseases, University of Torino, c/o Amedeo di Savoia Hospital - Corso Svizzera 164, 10169, Torino, Italy
| | - Andrea Calcagno
- Department of Medical Sciences, School of Infectious and Tropical Diseases, University of Torino, c/o Amedeo di Savoia Hospital - Corso Svizzera 164, 10169, Torino, Italy
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17
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Pérez-Valero I, Pasquau J, Rubio R, Rivero A, Santos J, Sanz J, Mariño A, Crespo M, Hernández-Quero J, Iribarren JA, Gutiérrez F, Terrón A, Esteban H, Pérez-Molina JA. Neurocognitive safety after 96 weeks on dual therapy with atazanavir/ritonavir plus lamivudine: results of the neurocognitive substudy of the SALT randomized clinical trial. J Antimicrob Chemother 2019; 73:2444-2451. [PMID: 29897573 DOI: 10.1093/jac/dky212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background Concerns have been voiced over the capacity of deintensification strategies to preserve neurocognitive function and prevent neurocognitive impairment. Methods We present the 96 week results of a neurocognitive substudy nested within the SALT clinical trial: a randomized, open-label, non-inferiority trial that compares whether atazanavir/ritonavir + lamivudine is non-inferior to atazanavir/ritonavir + two NRTIs in HIV-suppressed patients on stable triple therapy. A global deficit score (GDS) for five neurocognitive tasks was used to assess neurocognitive function. Changes in neurocognitive function (GDS value) were determined at weeks 48 and 96. The effect of atazanavir/ritonavir + lamivudine, adjusted for significant confounders, on the change in neurocognitive function was determined using analysis of covariance (ANCOVA) at week 96. Results The per-protocol analysis included 92 participants (47 atazanavir/ritonavir + lamivudine and 45 atazanavir/ritonavir + two NRTIs). All baseline characteristics were comparable in both groups. At weeks 48 and 96, changes in GDS [week 48, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to 0.0), P = 0.39; week 96, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to -0.1); P = 0.471] were similar. This absence of differences was also observed in all cognitive tasks. Atazanavir/ritonavir + lamivudine did not impact the change in neurocognitive function at week 96; the adjusted effect of atazanavir/ritonavir + lamivudine on GDS change, considering atazanavir/ritonavir + two NRTIs as a reference, was 0.01 (95% CI -0.18 to 0.21) (P = 0.90). Conclusions Neurocognitive function remained stable after 96 weeks, both in the atazanavir/ritonavir + lamivudine and in the atazanavir/ritonavir + two NRTIs arms, provided HIV remained suppressed.
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Affiliation(s)
| | - Juan Pasquau
- Hospital Virgen de las Nieves, Internal Medicine, Granada, Spain
| | - Rafael Rubio
- H.U. Doce de Octubre, Internal Medicine, Madrid, Spain
| | | | - José Santos
- Hospital Virgen de la Victoria, Internal Medicine, Malaga, Spain
| | - Jesus Sanz
- Hospital de Alcala de Henares, Internal Medicine, Alcala de Henares, Spain
| | - Ana Mariño
- Hospital Arquitecto Marcide, Internal Medicine, O Ferrol, Spain
| | - Manel Crespo
- Hospital Vall d'Hebron, Internal Medicine, Barcelona, Spain
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18
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Cotto B, Natarajanseenivasan K, Langford D. HIV-1 infection alters energy metabolism in the brain: Contributions to HIV-associated neurocognitive disorders. Prog Neurobiol 2019; 181:101616. [PMID: 31108127 PMCID: PMC6742565 DOI: 10.1016/j.pneurobio.2019.101616] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/17/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022]
Abstract
The brain is particularly sensitive to changes in energy supply. Defects in glucose utilization and mitochondrial dysfunction are hallmarks of nearly all neurodegenerative diseases and are also associated with the cognitive decline that occurs as the brain ages. Chronic neuroinflammation driven by glial activation is commonly implicated as a contributing factor to neurodegeneration and cognitive impairment. Human immunodeficiency virus-1 (HIV-1) disrupts normal brain homeostasis and leads to a spectrum of HIV-associated neurocognitive disorders (HAND). HIV-1 activates stress responses in the brain and triggers a state of chronic neuroinflammation. Growing evidence suggests that inflammatory processes and bioenergetics are interconnected in the propagation of neuronal dysfunction. Clinical studies of people living with HIV and basic research support the notion that HIV-1 creates an environment in the CNS that interrupts normal metabolic processes at the cellular level to collectively alter whole brain metabolism. In this review, we highlight reports of abnormal brain metabolism from clinical studies and animal models of HIV-1. We also describe diverse CNS cell-specific changes in bioenergetics associated with HIV-1. Moreover, we propose that attention should be given to adjunctive therapies that combat sources of metabolic dysfunction as a mean to improve and/or prevent neurocognitive impairments.
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Affiliation(s)
- Bianca Cotto
- Lewis Katz School of Medicine at Temple University, Department of Neuroscience and Center for Neurovirology, Philadelphia, PA, 19140, USA.
| | - Kalimuthusamy Natarajanseenivasan
- Lewis Katz School of Medicine at Temple University, Department of Neuroscience and Center for Neurovirology, Philadelphia, PA, 19140, USA.
| | - Dianne Langford
- Lewis Katz School of Medicine at Temple University, Department of Neuroscience and Center for Neurovirology, Philadelphia, PA, 19140, USA.
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19
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Evaluating Neurodevelopmental Consequences of Perinatal Exposure to Antiretroviral Drugs: Current Challenges and New Approaches. J Neuroimmune Pharmacol 2019; 16:113-129. [PMID: 31512167 DOI: 10.1007/s11481-019-09880-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
As antiretroviral therapy (ART) becomes increasingly affordable and accessible to women of childbearing age across the globe, the number of children who are exposed to Human Immunodeficiency Viruses (HIV) but remain uninfected is on the rise, almost all of whom were also exposed to ART perinatally. Although ART has successfully aided in the decline of mother-to-child-transmission of HIV, the long-term effects of in utero exposure to ART on fetal and postnatal neurodevelopment remain unclear. Evaluating the safety and efficacy of therapeutic drugs for pregnant women is a challenge due to the historic limitations on their inclusion in clinical trials and the dynamic physiological states during pregnancy that can alter the pharmacokinetics of drug metabolism and fetal drug exposure. Thus, much of our data on the potential consequences of ART drugs on the developing nervous system comes from preclinical animal models and clinical observational studies. In this review, we will discuss the current state of knowledge and existing approaches to investigate whether ART affects fetal brain development, and describe novel human stem cell-based strategies that may provide additional information to better predict the impact of specific drugs on the human central nervous system. Graphical Abstract Approaches to evaluate the impact of drugs on the developing brain. Dysregulation of the developing nervous system can lead to long-lasting changes. Integration of data from animal models, clinical observations, and cell culture studies is needed to predict the safety of therapeutic antiretroviral drugs during pregnancy. New approaches include human induced pluripotent stem cell (iPSC)-based 2D and 3D models of neuronal networks and brain regions, as well as single cell profiling in response to drug exposure.
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20
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Fields JA, Ellis RJ. HIV in the cART era and the mitochondrial: immune interface in the CNS. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 145:29-65. [PMID: 31208526 DOI: 10.1016/bs.irn.2019.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) persist in the era of effective combined antiretroviral therapy (cART). A large body of literature suggests that mitochondrial dysfunction is a prospective etiology of HAND in the cART era. While viral load is often suppressed and the immune system remains intact in HIV+ patients on cART, evidence suggests that the central nervous system (CNS) acts as a reservoir for virus and low-level expression of viral proteins, which interact with mitochondria. In particular, the HIV proteins glycoprotein 120, transactivator of transcription, viral protein R, and negative factor have each been linked to mitochondrial dysfunction in the brain. Moreover, cART drugs have also been shown to have detrimental effects on mitochondrial function. Here, we review the evidence generated from human studies, animal models, and in vitro models that support a role for HIV proteins and/or cART drugs in altered production of adenosine triphosphate, mitochondrial dynamics, mitophagy, calcium signaling and apoptosis, oxidative stress, mitochondrial biogenesis, and immunometabolism in the CNS. When insightful, evidence of HIV or cART-induced mitochondrial dysfunction in the peripheral nervous system or other cell types is discussed. Lastly, therapeutic approaches to targeting mitochondrial dysfunction have been summarized with the aim of guiding new investigations and providing hope that mitochondrial-based drugs may provide relief for those suffering with HAND.
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Affiliation(s)
- Jerel Adam Fields
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.
| | - Ronald J Ellis
- Department of Neuroscience, University of California San Diego, La Jolla, CA, United States
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21
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Aung HL, Kootar S, Gates TM, Brew BJ, Cysique LA. How all-type dementia risk factors and modifiable risk interventions may be relevant to the first-generation aging with HIV infection? Eur Geriatr Med 2019; 10:227-238. [DOI: 10.1007/s41999-019-00164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/09/2019] [Indexed: 11/24/2022]
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Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
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23
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Wright EJ, Thakur KT, Bearden D, Birbeck GL. Global developments in HIV neurology. HANDBOOK OF CLINICAL NEUROLOGY 2018; 152:265-287. [PMID: 29604981 DOI: 10.1016/b978-0-444-63849-6.00019-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurologic conditions associated with HIV remain major contributors to morbidity and mortality, and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence suggests that the central nervous system (CNS) serves as a reservoir for viral replication with major implications for human immunodeficiency virus (HIV) eradication strategies. Though there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of HIV-associated neurologic conditions, significant scientific gaps remain. In many low-income settings, second- and third-line cART regimens that carry substantial neurotoxicity remain treatment mainstays. Further, patients continue to present severely immunosuppressed with CNS opportunistic infections. Public health efforts should emphasize improvements in access and optimizing treatment of HIV-positive patients, specifically in resource-limited settings, to reduce the risk of neurologic sequelae.
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Affiliation(s)
- Edwina J Wright
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Australia; The Burnet Institute, Melbourne, Australia; Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Columbia University Medical Center, New York, NY, United States
| | - David Bearden
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Gretchen L Birbeck
- Strong Epilepsy Center, Department of Neurology, University of Rochester, Rochester, NY, United States; Chikankata Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
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Barber TJ, Imaz A, Boffito M, Niubó J, Pozniak A, Fortuny R, Alonso J, Davies N, Mandalia S, Podzamczer D, Gazzard B. CSF inflammatory markers and neurocognitive function after addition of maraviroc to monotherapy darunavir/ritonavir in stable HIV patients: the CINAMMON study. J Neurovirol 2017; 24:98-105. [PMID: 29280108 DOI: 10.1007/s13365-017-0600-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/19/2017] [Accepted: 11/07/2017] [Indexed: 12/16/2022]
Abstract
CINAMMON is a phase IV, open-label, single-arm, pilot study assessing maraviroc (MVC) in the central nervous system (CNS) when added to darunavir/ritonavir monotherapy (DRV/r) in virologically suppressed HIV-infected subjects. CCR5 tropic participants on DRV/r were recruited. Participants remained on DRV/r for 12 week (w) (control phase). MVC 150 mg qd was added w12-w36 (intervention phase). Lumbar puncture (LP) and neurocognitive function (Cogstate) examinations scheduled at baseline, w12 and w36; MRI before w12, again at w36. Primary endpoint was CSF inflammatory marker changes during intervention phase. Secondary endpoints included changes in NC function and MRI parameters. CSF/plasma DRV/r concentrations measured at w12 and w36, MVC at w36. Nineteen patients recruited, 15 completed (17M, 2F). Dropouts: headache (2), knee problem (could not attend, 1), personal reasons (1). Mean age (range) 45.4 years (27.2-65.1), 13/19 white, 10/19 MSM. No changes in selected CSF markers were seen w12-w36. Overall NC function did not improve w12-w36: total age adjusted z score improved by 0.27 (weighted paired t test; p = 0.11); for executive function only, age adjusted z score improved by 0.54 (p = 0.03). MRI brain parameters unchanged. DRV plasma:CSF concentration ratio unchanged between w12 (132) and w36 (112; p = 0.577, Wilcoxon signed-rank). MVC plasma:CSF concentration ratio was 35 at w36. No changes in neuroinflammatory markers seen. In this small study, addition of 24w MVC 150 mg qd to stable DRV/r monotherapy showed possible improvement in executive function with no global NC effect. Learning effect cannot be excluded. This effect should be further evaluated.
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Affiliation(s)
- T J Barber
- Chelsea and Westminster NHS Foundation Trust and St Stephen's AIDS Trust, 4th Floor, St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK. .,Imperial College London, London, UK.
| | - A Imaz
- Bellvitge University Hospital, Barcelona, Spain
| | - M Boffito
- Chelsea and Westminster NHS Foundation Trust and St Stephen's AIDS Trust, 4th Floor, St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.,Imperial College London, London, UK
| | - J Niubó
- Bellvitge University Hospital, Barcelona, Spain
| | - A Pozniak
- Chelsea and Westminster NHS Foundation Trust and St Stephen's AIDS Trust, 4th Floor, St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - R Fortuny
- Bellvitge University Hospital, Barcelona, Spain
| | - J Alonso
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - N Davies
- Chelsea and Westminster NHS Foundation Trust and St Stephen's AIDS Trust, 4th Floor, St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.,Imperial College London, London, UK
| | - S Mandalia
- Chelsea and Westminster NHS Foundation Trust and St Stephen's AIDS Trust, 4th Floor, St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.,Imperial College London, London, UK
| | | | - B Gazzard
- Chelsea and Westminster NHS Foundation Trust and St Stephen's AIDS Trust, 4th Floor, St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.,Imperial College London, London, UK
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25
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Late-Onset Hiv Encephalopathy In Children With Long-Standing Virologic Suppression Followed By Slow Spontaneous Recovery Despite no Change In Antiretroviral Therapy: 4 Case Reports. Pediatr Infect Dis J 2017; 36:e264-e267. [PMID: 28719495 PMCID: PMC5638699 DOI: 10.1097/inf.0000000000001694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We describe 4 Children with HIV Early Antiretroviral Therapy trial participants with late-onset HIV encephalopathy despite long-standing viral suppression in blood and undetectable HIV DNA and RNA polymerase chain reaction in cerebrospinal fluid. Extensive investigations revealed no alternative etiology. Reassuringly, all 4 experienced slow spontaneous recovery despite no change in antiretroviral therapy. Virally suppressed HIV-infected children remain at risk for fluctuating neurologic signs and symptoms.
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26
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Rubin LH, Maki PM, Springer G, Benning L, Anastos K, Gustafson D, Villacres MC, Jiang X, Adimora AA, Waldrop-Valverde D, Vance DE, Bolivar H, Alden C, Martin EM, Valcour VG. Cognitive trajectories over 4 years among HIV-infected women with optimal viral suppression. Neurology 2017; 89:1594-1603. [PMID: 28904086 DOI: 10.1212/wnl.0000000000004491] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/03/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether persistent viral suppression alters cognitive trajectories among HIV-infected (HIV+) women on combination antiretroviral therapy (cART) by investigating performance longitudinally in uninfected (HIV-) and 3 groups of HIV+ women: those with consistent viral suppression after continuous cART use (VS), those without consistent virologic suppression despite continuous cART use (NVS), and those without consistent virologic suppression after intermittent cART use (Int NVS). METHODS Two hundred thirty-nine VS, 220 NVS, 172 Int NVS, and 301 HIV- women from the Women's Interagency HIV Study (WIHS) completed neuropsychological testing every 2 years for 3 visits between 2009 and 2013. Mixed-effects regressions were used to examine group differences on continuous T scores and categorical measures of impairment (T score <40). RESULTS On global function, VS women demonstrated lower scores and were more likely to score in the impaired range than HIV- women (p = 0.01). These differences persisted over time (group × time, p > 0.39). VS women demonstrated lower learning and memory scores than HIV- women (p < 0.05) and lower attention/working memory and fluency scores than HIV- and NVS women (p < 0.05). Group differences in scores persisted over time. Categorically, VS women were more likely to be impaired on attention/working memory and executive function than HIV- women (p < 0.05). On motor skills, VS and NVS women showed a greater decline and were more likely to be impaired than HIV- women (p < 0.05). CONCLUSIONS Cognitive difficulties remain among HIV+ women despite persistent viral suppression. In some instances, VS women are worse than NVS women, reinforcing the need for novel adjunctive therapies to attenuate cognitive problems.
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Affiliation(s)
- Leah H Rubin
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco.
| | - Pauline M Maki
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Gayle Springer
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Lorie Benning
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Kathryn Anastos
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Deborah Gustafson
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Maria C Villacres
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Xiong Jiang
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Adaora A Adimora
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Drenna Waldrop-Valverde
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - David E Vance
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Hector Bolivar
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Christine Alden
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Eileen M Martin
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Victor G Valcour
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
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27
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Eggers C, Arendt G, Hahn K, Husstedt IW, Maschke M, Neuen-Jacob E, Obermann M, Rosenkranz T, Schielke E, Straube E. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol 2017; 264:1715-1727. [PMID: 28567537 PMCID: PMC5533849 DOI: 10.1007/s00415-017-8503-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023]
Abstract
The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus-brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
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Affiliation(s)
- Christian Eggers
- Department of Neurology, Krankenhaus Barmherzige Brüder, Seilerstätte 2, 4021, Linz, Austria.
| | - Gabriele Arendt
- Neurologische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Katrin Hahn
- Neurologische Klinik, Charité, Berlin, Germany
| | - Ingo W Husstedt
- Klinik für Neurologie, Universitätsklinikum Münster, Münster, Germany
| | - Matthias Maschke
- Neurologische Abteilung, Brüderkrankenhaus Trier, Trier, Germany
| | - Eva Neuen-Jacob
- Institut für Neuropathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Mark Obermann
- Direktor des Zentrums für Neurologie, Asklepios Kliniken Schildautal, Seesen, Germany
| | - Thorsten Rosenkranz
- Neurologische Abteilung, Asklepios-Klinik Hamburg-St. Georg, Hamburg, Germany
| | - Eva Schielke
- Praxis für Neurologie Berlin-Mitte, 10117, Berlin, Germany
| | - Elmar Straube
- HIV-Schwerpunktpraxis, 30890, Barsinghausen, Germany
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Apostolova N, Blas-Garcia A, Galindo MJ, Esplugues JV. Efavirenz: What is known about the cellular mechanisms responsible for its adverse effects. Eur J Pharmacol 2017; 812:163-173. [PMID: 28690189 DOI: 10.1016/j.ejphar.2017.07.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 02/08/2023]
Abstract
The HIV infection remains an important health problem worldwide. However, due to the efficacy of combined antiretroviral therapy (cART), it has ceased to be a mortal condition, becoming a chronic disease instead. Efavirenz, the most prescribed non-nucleoside analogue reverse transcriptase inhibitor (NNRTI), has been a key component of cART since its commercialization in 1998. Though still a drug of choice in many countries, its primacy has been challenged by the arrival of newer antiretroviral agents with better toxicity profiles and treatment adherence. The major side effects related to EFV have been widely described in clinical studies, however the mechanisms that participate in their pathogenesis remain largely ununderstood. This review provides an insight into the cellular and molecular mechanisms responsible for the development of the most significant undesired effects induced by efavirenz, both short- and long-term, revealed by in vitro and in vivo experimental pharmacological research. Growing evidence implicates the drug in energy metabolism, mitochondrial function, and other cellular processes involved in stress responses including oxidative stress, inflammation and autophagy.
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Affiliation(s)
- Nadezda Apostolova
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia-Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain.
| | - Ana Blas-Garcia
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia-Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain
| | - Maria J Galindo
- Unidad de Enfermedades Infecciosas - Medicina Interna, Hospital Clínico Universitario de Valencia, Spain
| | - Juan V Esplugues
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia-Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain; FISABIO-Hospital Universitario Dr. Peset, Valencia, Spain
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Gannon PJ, Akay-Espinoza C, Yee AC, Briand LA, Erickson MA, Gelman BB, Gao Y, Haughey NJ, Zink MC, Clements JE, Kim NS, Van De Walle G, Jensen BK, Vassar R, Pierce RC, Gill AJ, Kolson DL, Diehl JA, Mankowski JL, Jordan-Sciutto KL. HIV Protease Inhibitors Alter Amyloid Precursor Protein Processing via β-Site Amyloid Precursor Protein Cleaving Enzyme-1 Translational Up-Regulation. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:91-109. [PMID: 27993242 DOI: 10.1016/j.ajpath.2016.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 12/14/2022]
Abstract
Mounting evidence implicates antiretroviral (ARV) drugs as potential contributors to the persistence and evolution of clinical and pathological presentation of HIV-associated neurocognitive disorders in the post-ARV era. Based on their ability to induce endoplasmic reticulum (ER) stress in various cell types, we hypothesized that ARV-mediated ER stress in the central nervous system resulted in chronic dysregulation of the unfolded protein response and altered amyloid precursor protein (APP) processing. We used in vitro and in vivo models to show that HIV protease inhibitor (PI) class ARVs induced neuronal damage and ER stress, leading to PKR-like ER kinase-dependent phosphorylation of the eukaryotic translation initiation factor 2α and enhanced translation of β-site APP cleaving enzyme-1 (BACE1). In addition, PIs induced β-amyloid production, indicative of increased BACE1-mediated APP processing, in rodent neuroglial cultures and human APP-expressing Chinese hamster ovary cells. Inhibition of BACE1 activity protected against neuronal damage. Finally, ARVs administered to mice and SIV-infected macaques resulted in neuronal damage and BACE1 up-regulation in the central nervous system. These findings implicate a subset of PIs as potential mediators of neurodegeneration in HIV-associated neurocognitive disorders.
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Affiliation(s)
- Patrick J Gannon
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cagla Akay-Espinoza
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan C Yee
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa A Briand
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Michelle A Erickson
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Yan Gao
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Norman J Haughey
- Richard T. Johnson Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Christine Zink
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janice E Clements
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas S Kim
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gabriel Van De Walle
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brigid K Jensen
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Vassar
- Department of Cell and Molecular Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - R Christopher Pierce
- Department of Psychiatry, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander J Gill
- Department of Neurology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dennis L Kolson
- Department of Neurology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Alan Diehl
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph L Mankowski
- Richard T. Johnson Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly L Jordan-Sciutto
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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HIV-associated neurodegeneration and neuroimmunity: multivoxel MR spectroscopy study in drug-naïve and treated patients. Eur Radiol 2017; 27:4218-4236. [PMID: 28293774 DOI: 10.1007/s00330-017-4772-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/29/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to test neurobiochemical changes in normal appearing brain tissue in HIV+ patients receiving and not receiving combined antiretroviral therapy (cART) and healthy controls, using multivoxel MR spectroscopy (mvMRS). METHODS We performed long- and short-echo 3D mvMRS in 110 neuroasymptomatic subjects (32 HIV+ subjects on cART, 28 HIV+ therapy-naïve subjects and 50 healthy controls) on a 3T MR scanner, targeting frontal and parietal supracallosal subcortical and deep white matter and cingulate gyrus (NAA/Cr, Cho/Cr and mI/Cr ratios were analysed). The statistical value was set at p < 0.05. RESULTS Considering differences between HIV-infected and healthy subjects, there was a significant decrease in the NAA/Cr ratio in HIV+ subjects in all observed locations, an increase in mI/Cr levels in the anterior cingulate gyrus (ACG), and no significant differences in Cho/Cr ratios, except in ACG, where the increase showed trending towards significance in HIV+ patients. There were no significant differences between HIV+ patients on and without cART in all three ratios. CONCLUSION Neuronal loss and dysfunction affects the whole brain volume in HIV-infected patients. Unfortunately, cART appears to be ineffective in halting accelerated neurodegenerative process induced by HIV but is partially effective in preventing glial proliferation. KEY POINTS • This is the first multivoxel human brain 3T MRS study in HIV. • All observed areas of the brain are affected by neurodegenerative process. • Cingulate gyrus and subcortical white matter are most vulnerable to HIV-induced neurodegeneration. • cART is effective in control of inflammation but ineffective in preventing neurodegeneration.
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Edagwa B, McMillan J, Sillman B, Gendelman HE. Long-acting slow effective release antiretroviral therapy. Expert Opin Drug Deliv 2017; 14:1281-1291. [PMID: 28128004 DOI: 10.1080/17425247.2017.1288212] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Advances in long-acting antiretroviral therapy (ART) can revolutionize current HIV/AIDS treatments. We coined the term 'long-acting slow effective release ART' (LASER ART) to highlight the required formulation properties of slow drug dissolution, poor water-solubility, bioavailability, little-to-no off-target toxicities and improved regimen adherence. Drug carrier technologies characterized by high antiretroviral drug (ARV) payloads in a single carrier improve the pharmacokinetic and pharmacodynamic profiles. The surface modifications of ARV carriers target monocyte-macrophages and facilitate drug transport across physiological barriers and to virus-susceptible CD4 + T cells. Areas covered: The review highlights developments of reservoir-targeted LASER ART for improved therapeutic outcomes. Such nanoART delivery platforms include decorated multifunctional nano- and micro-particles, prodrugs and polymer conjugates. Therapeutic strategies such as gene-editing technologies boost ART effectiveness. Expert opinion: The persistence of HIV-1 in lymphoid, gut and nervous system reservoirs poses a challenge to viral eradication. Emerging slow-release drug carriers can target intracellular pathogens, activate antiviral immunity, promote genome editing, sustain drug depots and combine therapeutics with image contrast agents, and can meet unmet clinical needs for HIV-infected patients. Such efforts will bring the medicines to reservoir sites and accelerate viral clearance.
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Affiliation(s)
- Benson Edagwa
- a Department of Pharmacology and Experimental Neuroscience , University of Nebraska Medical Center , Omaha , NE , USA
| | - JoEllyn McMillan
- a Department of Pharmacology and Experimental Neuroscience , University of Nebraska Medical Center , Omaha , NE , USA
| | - Brady Sillman
- a Department of Pharmacology and Experimental Neuroscience , University of Nebraska Medical Center , Omaha , NE , USA
| | - Howard E Gendelman
- a Department of Pharmacology and Experimental Neuroscience , University of Nebraska Medical Center , Omaha , NE , USA.,b Departments of Pharmaceutical Sciences , University of Nebraska Medical Center , Omaha , NE , USA
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Hung KM, Chen PC, Hsieh HC, Calkins MJ. Mitochondrial defects arise from nucleoside/nucleotide reverse transcriptase inhibitors in neurons: Potential contribution to HIV-associated neurocognitive disorders. Biochim Biophys Acta Mol Basis Dis 2016; 1863:406-413. [PMID: 27840304 DOI: 10.1016/j.bbadis.2016.11.017] [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: 08/23/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023]
Abstract
The cornerstone of current HIV treatment is a class of drugs called nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). However, patients who receive long term treatment with NRTIs often develop severe side effects, which are related to mitochondrial toxicity. The potential contribution of NRTI-mediated toxicity to HIV-associated neurocognitive disorders (HAND) has not been fully explored. NRTI toxicity is thought to be mediated through mitochondrial DNA polymerase γ (pol γ) inhibition, which impairs mitochondrial DNA (mtDNA) synthesis and leads to various mitochondrial dysfunctions. To evaluate the relationship between NRTI-mediated pol γ inhibition and mitochondrial toxicity in neurons, we systematically investigated mitochondrial regulation in NRTI-treated primary cortical neurons by measuring parameters related to mtDNA content, retrograde signaling responses and mitochondrial homeostasis. The effects of four different NRTIs with variable pol γ inhibitory activity and mitochondrial toxicity were assessed. The strong pol γ inhibitor, ddI, abolished mtDNA synthesis and greatly reduced mtDNA content. However, mtDNA transcription was not as severely affected, and no defects in oxidative phosphorylation were observed. Detrimental effects on mitochondrial respiration and motility were observed after AZT treatment in the absence of mtDNA depletion or inhibition of mtDNA synthesis. The results suggest that individual NRTIs, such as ddI and AZT, have the potential to cause mitochondrial toxicity in neurons. This mitochondrial toxicity would be expected to contribute to neurotoxicity in the central nervous system, and therefore, HAND etiology may be affected by NRTI treatment.
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Affiliation(s)
- Kui-Ming Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pei-Chun Chen
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Han-Chieh Hsieh
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Marcus J Calkins
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
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Neuronal-Glia Markers by Magnetic Resonance Spectroscopy in HIV Before and After Combination Antiretroviral Therapy. J Acquir Immune Defic Syndr 2016; 71:24-30. [PMID: 26258565 DOI: 10.1097/qai.0000000000000779] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Combination antiretroviral therapy (cART) can suppress plasma HIV RNA to undetectable levels; yet reports indicate persistent HIV-associated neurocognitive disorders (HAND) among treated individuals. We sought to investigate imaging correlates of incomplete cognitive recovery among individuals with chronic HIV. METHODS We used single voxel proton magnetic resonance spectroscopy in 4 regions of the brain to measure changes in neuronal and glia biomarkers in cART-naive subjects before (n = 59, 27 with HAND) and after 12 months of cART. RESULTS At baseline, we observed elevated total choline (CHO) in the basal ganglia (BG, P = 0.002) and in the posterior cingulate gyrus (PCG, P = 0.022) associated with HIV infection. Myo-inositol (MI) was elevated in the frontal white matter (FWM, P = 0.040). N-acetylaspartate was elevated in the BG (P = 0.047). Using a mixed model approach among all HIV-infected individuals, at 6 months, we observed decreased n- acetylaspartate in FWM (P = 0.031), decreased creatine in PCG (P = 0.026) and increased MI in frontal gray matter (FGM, P = 0.023). At 12 months, we observed an increase in BG MI (P = 0.038) and in FGM (P = 0.021). Compared to those with normal cognition, HAND cases had higher FGM MI (P = 0.014) at baseline. At 12 months, individuals that remained cognitively impaired compared with those without HAND exhibited elevated CHO in the PCG (P = 0.018) and decreased glutamate in both FWM (P = 0.027) and BG (P = 0.013). CONCLUSIONS cART started during chronic HIV is associated with reduced neuronal-glia and inflammatory markers. Alterations in CHO are noted among individuals who remain impaired after 12 months of cART.
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Abstract
OBJECTIVE In this work, we evaluated the association of human immunodeficiency virus (HIV) infection and methamphetamine (METH) use with mitochondrial injury in the brain and its implication on neurocognitive impairment. DESIGN Mitochondria carry their genome (mtDNA) and play a critical role in cellular processes in the central nervous system. METH is commonly used in HIV-infected populations. HIV infection and METH use can cause damage to mtDNA and lead to neurocognitive morbidity. We evaluated HIV infection and METH use with mitochondrial injury in the brain. METHODS We obtained white and gray matter from Brodmann areas 7, 8, 9, 46 of the following: HIV-infected individuals with history of past METH use (HIV+METH+, n = 16), HIV-infected individuals with no history of past METH use (HIV+METH-, n = 11), and HIV-negative controls (HIV-METH-, n = 30). We used the 'common deletion', a 4977 bp mutation, as a measurement of mitochondrial injury, and quantified levels of mtDNA and 'common deletion' by droplet digital PCR, and evaluated in relation to neurocognitive functioning [Global Deficit Score (GDS)]. RESULTS Levels of mtDNA and mitochondrial injury were highest in white matter of Brodmann area 46. A higher relative proportion of mtDNA carrying the 'common deletion' was associated with lower GDS (P < 0.01) in HIV+METH+ but higher GDS (P < 0.01) in HIV+METH-. CONCLUSIONS Increased mitochondrial injury was associated with worse neurocognitive function in HIV+METH- individuals. Among HIV+METH+ individuals, an opposite effect was seen.
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Gates TM, Cysique LA. The Chronicity of HIV Infection Should Drive the Research Strategy of NeuroHIV Treatment Studies: A Critical Review. CNS Drugs 2016; 30:53-69. [PMID: 26749584 PMCID: PMC4733144 DOI: 10.1007/s40263-015-0302-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
HIV infection has become a chronic illness when successfully treated with combined antiretroviral therapy (cART). The long-term health prognosis of aging with controlled HIV infection and HIV-associated neurocognitive disorder (HAND) remains unclear. In this review, we propose that, almost 20 years after the introduction of cART, a change in research focus is needed, with a greater emphasis on chronicity effects driving our research strategy. We argue that pre-emptive documentation of episodes of mild neurocognitive dysfunction is needed to determine their long-term prognosis. This strategy would also seek to optimally represent the entire HAND spectrum in therapeutic trials to assess positive and/or negative treatment effects on brain functions. In the first part of the paper, to improve the standard implementation of the Frascati HAND diagnostic criteria, we provide a brief review of relevant quantitative neuropsychology concepts to clarify their appropriate application for a non-neuropsychological audience working in HIV research and wanting to conduct randomized clinical trials on brain functions. The second part comprises a review of various antiretroviral drug classes and individual agents with respect to their effects on HAND, while also addressing the question of when cART should be initiated to potentially reduce HAND incidence. In each section, we use recent observational studies and randomized controlled trials to illustrate our perspective while also providing relevant statistical comments. We conclude with a discussion of the neuroimaging methods that could be combined with neuropsychological approaches to enhance the validity of HIV neurology (neuroHIV) treatment effect studies.
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Affiliation(s)
- Thomas M Gates
- St. Vincent's Hospital Department of Neurology, Sydney, Australia
- St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Lucette A Cysique
- Neuroscience Research Australia, 139 Barker Street, Randwick, PO Box 1165, Sydney, NSW, 2031, Australia.
- The University of New South Wales, Sydney, Australia.
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Brier MR, Wu Q, Tanenbaum AB, Westerhaus ET, Kharasch ED, Ances BM. Effect of HAART on Brain Organization and Function in HIV-Negative Subjects. J Neuroimmune Pharmacol 2015; 10:517-21. [PMID: 26446778 PMCID: PMC4662631 DOI: 10.1007/s11481-015-9634-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/30/2015] [Indexed: 10/23/2022]
Abstract
HIV causes neural dysfunction in infected individuals. This dysfunction often manifests as cognitive symptoms and can be detected using neuroimaging. Highly active anti-retroviral therapy (HAART), in addition to providing virologic control, has reduced the number of profoundly impaired individuals but more mild forms of neurocognitive disorders remains prevalent. A potential confound in previous studies of HIV-associated cognitive dysfunction is that HAART may be neurotoxic. Thus, observed effects, attributed to HIV, may be in part due to HAART. It is unclear whether and to what extent current medications contribute to observed brain dysfunction. We studied changes in functional connectivity and cerebral blood flow in HIV uninfected (HIV-) individuals before and after being given two common antiretroviral medications: efavirenz and ritonavir. Neither drug was associated with significant changes in functional connectivity or cerebral blood flow. Our results suggests that previous changes in functional connectivity and cerebral blood flow in HIV infected individuals receiving HAART may largely due to the virus and remaining reservoirs and less due to toxic action of these anti-retroviral medications.
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Affiliation(s)
- Matthew R Brier
- Department of Neurology, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Qian Wu
- Department of Neurology, School of Medicine, Washington University in St Louis, St Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St Louis, St Louis, MO, USA
| | - Aaron B Tanenbaum
- Department of Neurology, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Elizabeth T Westerhaus
- Department of Neurology, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Evan D Kharasch
- Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
| | - Beau M Ances
- Department of Neurology, School of Medicine, Washington University in St Louis, St Louis, MO, USA.
- Department of Biomedical Engineering, Washington University in St Louis, St Louis, MO, USA.
- Department of Radiology, Washington University in St Louis, St Louis, MO, USA.
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Wade BS, Valcour VG, Wendelken-Riegelhaupt L, Esmaeili-Firidouni P, Joshi SH, Gutman BA, Thompson PM. Mapping abnormal subcortical brain morphometry in an elderly HIV+ cohort. NEUROIMAGE-CLINICAL 2015; 9:564-73. [PMID: 26640768 PMCID: PMC4625216 DOI: 10.1016/j.nicl.2015.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/21/2015] [Accepted: 10/05/2015] [Indexed: 11/22/2022]
Abstract
Over 50% of HIV + individuals exhibit neurocognitive impairment and subcortical atrophy, but the profile of brain abnormalities associated with HIV is still poorly understood. Using surface-based shape analyses, we mapped the 3D profile of subcortical morphometry in 63 elderly HIV + participants and 31 uninfected controls. The thalamus, caudate, putamen, pallidum, hippocampus, amygdala, brainstem, accumbens, callosum and ventricles were segmented from high-resolution MRIs. To investigate shape-based morphometry, we analyzed the Jacobian determinant (JD) and radial distances (RD) defined on each region's surfaces. We also investigated effects of nadir CD4 + T-cell counts, viral load, time since diagnosis (TSD) and cognition on subcortical morphology. Lastly, we explored whether HIV + participants were distinguishable from unaffected controls in a machine learning context. All shape and volume features were included in a random forest (RF) model. The model was validated with 2-fold cross-validation. Volumes of HIV + participants' bilateral thalamus, left pallidum, left putamen and callosum were significantly reduced while ventricular spaces were enlarged. Significant shape variation was associated with HIV status, TSD and the Wechsler adult intelligence scale. HIV + people had diffuse atrophy, particularly in the caudate, putamen, hippocampus and thalamus. Unexpectedly, extended TSD was associated with increased thickness of the anterior right pallidum. In the classification of HIV + participants vs. controls, our RF model attained an area under the curve of 72%. We model subcortical morphometry of elderly HIV + participants. We explore classifying HIV status based on shape and volume of brain regions. Morphometry of brain regions was associated with infection status and duration. HIV status was classifiable with 72% accuracy in morphometry-based classifiers.
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Affiliation(s)
- Benjamin S.C. Wade
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Victor G. Valcour
- Memory and Aging Center, Dept. of Neurology, University of California, San Francisco, CA, USA
| | | | | | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, CA, USA
| | - Boris A. Gutman
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Paul M. Thompson
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
- Corresponding author at: Imaging Genetics Center, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA 90292, USA.Imaging Genetics CenterUniversity of Southern California4676 Admiralty WayMarina del ReyCA90292USA
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Fazeli PL, Marquine MJ, Dufour C, Henry BL, Montoya J, Gouaux B, Moore RC, Letendre. SL, Woods SP, Grant I, Jeste DV, Moore DJ. Physical Activity is Associated with Better Neurocognitive and Everyday Functioning Among Older Adults with HIV Disease. AIDS Behav 2015; 19:1470-7. [PMID: 25731660 PMCID: PMC4527965 DOI: 10.1007/s10461-015-1024-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the association between physical activity (PA), neurocognitive impairment (NCI), and instrumental activities of daily living (IADLs) among older HIV+ persons. One hundred older HIV+ adults completed the International Physical Activity Questionnaire, a neurocognitive battery, and IADL scale. Higher levels of moderate PA were associated with lower odds of NCI (p = 0.01), even when covariates were modeled. The association between moderate PA and NCI was driven by executive function (p = 0.04). Higher levels of moderate PA were also associated with lower odds of IADL Dependence (p = 0.03), although this fell to a trend (p = 0.08) when including covariates. Follow-up analysis showed those with both NCI and IADL Dependence had lower moderate PA than those with neither (p = 0.03). While these cross-sectional findings suggest PA is associated with better neurocognitive and everyday functioning in older HIV+ adults, longitudinal studies utilizing objective PA methods are needed to evaluate directionality and mechanisms.
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Affiliation(s)
- Pariya L. Fazeli
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Maria J. Marquine
- Department of Psychiatry, University of California San Diego, San Diego, CA
- Stein Institute for Research on Aging, University of California San Diego, San Diego, CA
| | - Catherine Dufour
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Brook L. Henry
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jessica Montoya
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA
- Stein Institute for Research on Aging, University of California San Diego, San Diego, CA
| | - Scott L. Letendre.
- Department of Medicine, University of California San Diego, San Diego, CA
| | | | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, San Diego, CA
- Stein Institute for Research on Aging, University of California San Diego, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA
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[HIV 1-associated neurocognitive disorder: current epidemiology, pathogenesis, diagnosis and management]. DER NERVENARZT 2015; 85:1280-90. [PMID: 25292163 DOI: 10.1007/s00115-014-4082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
By restoring the immunological function the modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. As opposed to the classical manifestations of HIV-induced immunosuppression the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) has not noticeably decreased and HAND continues to be relevant in daily clinical practice. At present, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the introduction of combination antiretroviral treatment (cART). The predominant clinical manifestation is a subcortical dementia with deficits in the domains attention, concentration and memory. Signs of central motor pathway lesions have become less frequent and less prominent. Prior to the advent of cART the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In patients with at least partially successfully treated infections, this relationship no longer exists, but a plethora of poorly understood immunological and probably toxic phenomena are under discussion.This consensus paper summarizes the progress made in the last 12 years in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
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Abstract
PURPOSE OF REVIEW To summarize contemporary observations regarding the effects of highly active antiretroviral therapy (HAART) on the brain. RECENT FINDINGS The effects of HAART on the structure and function of the brain during HIV/AIDS is currently a subject of intense interest because the brain is one of the most drug-impenetrable organs that is infected by HIV-1 and as such represents an important reservoir for replication-competent virus. The effects of HAART on neurocognitive impairment caused by HIV-1 infection remain uncertain with both beneficial and adverse outcomes reported with different HAART regimens. Similarly, the effects of individual HAART regimens on viral quantity in cerebrospinal fluid as a surrogate indicator of brain virus burden are variable. Indeed, the situation is further complicated by the ranking of antiretroviral therapies (ARTs) by their central nervous system penetration-effectiveness score on the basis of ART concentrations in cerebrospinal fluid. Experimental studies have also yielded equivocal findings depending on the model and individual ART. At the same time, a burgeoning body of experimental data has demonstrated neurotoxic effects of several ARTs, including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). SUMMARY HAART selection strategies are currently guided by efficacy, resistance testing, toxicity, potential drug interactions and theoretical brain penetration. As improved strategies are developed to target the viral reservoir within the brain, greater knowledge of the effects of ARTs on neural tissues will be needed to operationalize their use in a rational manner that maximizes antiretroviral efficacy and minimizes the neurotoxic complications.
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Neuropathological sequelae of Human Immunodeficiency Virus and apathy: A review of neuropsychological and neuroimaging studies. Neurosci Biobehav Rev 2015; 55:147-64. [PMID: 25944459 DOI: 10.1016/j.neubiorev.2015.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 02/07/2023]
Abstract
Apathy remains a common neuropsychiatric disturbance in the Human Immunodeficiency Virus (HIV-1) despite advances in anti-retroviral treatment (ART). The goal of the current review is to recapitulate findings relating apathy to the deleterious biobehavioral effects of HIV-1 in the post-ART era. Available literatures demonstrate that the emergence of apathy with other neurocognitive and neuropsychiatric symptoms may be attributed to neurotoxic effects of viral proliferation, e.g., aggregative effect of Tat and gp120 on apoptosis, transport and other enzymatic reactions amongst dopaminergic neurons and neuroglia. An assortment of neuroimaging modalities converge on the severity of apathy symptoms associated with the propensity of the virus to replicate within frontal-striatal brain circuits that facilitate emotional processing. Burgeoning research into functional brain connectivity also supports the effects of microvascular and neuro-inflammatory injury linked to aging with HIV-1 on the presentation of neuropsychiatric symptoms. Summarizing these findings, we review domains of HIV-associated neurocognitive and neuropsychiatric impairment linked to apathy in HIV. Taken together, these lines of research suggest that loss of affective, cognitive and behavioral inertia is commensurate with the neuropathology of HIV-1.
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HIV-associated Neurocognitive Disorders and Antiretroviral Therapy: Current Concepts and Controversies. Curr Infect Dis Rep 2015; 17:485. [PMID: 25916996 DOI: 10.1007/s11908-015-0485-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Antiretroviral drugs may help prevent neurological decline in individuals with HIV infection by suppressing viral replication and associated chronic immune activation in the central nervous system. However, HIV control in the brain may come at the price of drug-induced neurotoxicity. Herein, we review recent advances in the balance between adequate viral suppression in the nervous system and adverse effects of the medications used in HIV treatment.
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Baker LM, Paul RH, Heaps-Woodruff JM, Chang JY, Ortega M, Margolin Z, Usher C, Basco B, Cooley S, Ances BM. The Effect of Central Nervous System Penetration Effectiveness of Highly Active Antiretroviral Therapy on Neuropsychological Performance and Neuroimaging in HIV Infected Individuals. J Neuroimmune Pharmacol 2015; 10:487-92. [PMID: 25900078 DOI: 10.1007/s11481-015-9610-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 04/12/2015] [Indexed: 12/14/2022]
Abstract
The incidence of HIV-associated dementia has been greatly reduced in the era of highly active antiretroviral therapy (HAART); however milder forms of cognitive impairment persist. It remains uncertain whether HAART regimens with a high degree of central nervous system penetration effectiveness (CPE) exert beneficial neurological outcomes in HIV-infected (HIV+) individuals on stable treatment. Sixty-four HIV-infected adults on HAART were assigned a CPE score using a published ranking system and divided into high (≥7; n = 35) and low (<7; n = 29) CPE groups. All participants completed neuropsychological testing in addition to structural neuroimaging. Neuropsychological tests included measures known to be sensitive to HIV with values converted into standardized scores (NPZ-4) based on published normative scores. A semi-automated methodology was utilized to assess brain volumetrics within cortical (grey and white matter) and subcortical (thalamus, caudate, putamen) regions of interest. Analyses assessed NPZ-4 and brain volumetric differences between HIV+ individuals with high and low CPE scores. No significant differences in brain integrity were observed between the two groups. Long-term HAART regimens with a high degree of CPE were not associated with significantly improved neuropsychological or neuroimaging outcomes in HIV+ adults. Results suggest that alternate mechanisms may potentially contribute to better neurological outcomes in the era of HAART.
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Affiliation(s)
- Laurie M Baker
- Department of Psychology, University of Missouri- Saint Louis, Saint Louis, MO, USA
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Silverstein PS, Kumar S, Kumar A. HIV-1, HCV and alcohol in the CNS: potential interactions and effects on neuroinflammation. Curr HIV Res 2015; 12:282-92. [PMID: 25053363 DOI: 10.2174/1570162x12666140721122956] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/01/2014] [Accepted: 06/01/2014] [Indexed: 01/01/2023]
Abstract
Approximately 25% of the HIV-1 positive population is also infected with HCV. The effects of alcohol on HIV-1 or HCV infection have been a research topic of interest due to the high prevalence of alcohol use in these infected patient populations. Although it has long been known that HIV-1 infects the brain, it has only been a little more than a decade since HCV infection of the CNS has been characterized. Both viruses are capable of infecting and replicating in microglia and increasing the expression of proinflammatory cytokines and chemokines, including IL-6 and IL-8. Investigations focusing on the effects of HIV-1, HCV or alcohol on neuroinflammation have demonstrated that these agents are capable of acting through overlapping signaling pathways, including MAPK signaling molecules. In addition, HIV-1, HCV and alcohol have been demonstrated to increase permeability of the blood-brain barrier. Patients infected with either HIV-1 or HCV, or those who use alcohol, exhibit metabolic abnormalities in the CNS that result in altered levels of n-acetyl aspartate, choline and creatine in various regions of the brain. Treatment of HIV/HCV co-infection in alcohol users is complicated by drug-drug interactions, as well as the effects of alcohol on drug metabolism. The drug-drug interactions between the antiretrovirals and the antivirals, as well as the effects of alcohol on drug metabolism, complicate existing models of CNS penetration, making it difficult to assess the efficacy of treatment on CNS infection.
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Affiliation(s)
| | | | - Anil Kumar
- Division of Pharmacology and Toxicology, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
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45
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Winston A, Puls R, Kerr SJ, Duncombe C, Li P, Gill JM, Ramautarsing R, Taylor-Robinson SD, Emery S, Cooper DA. Differences in the direction of change of cerebral function parameters are evident over three years in HIV-infected individuals electively commencing initial cART. PLoS One 2015; 10:e0118608. [PMID: 25723494 PMCID: PMC4344345 DOI: 10.1371/journal.pone.0118608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/21/2015] [Indexed: 11/24/2022] Open
Abstract
Background Changes in cerebral metabolite ratios (CMR) measured on 1H-MRS and changes in cognitive function (CF) are described in subjects commencing combination antiretroviral therapy (cART), although the dynamics of such changes are poorly understood. Methods Neuroasymptomatic, HIV-infected subjects electively commencing cART were eligible. CMR were assessed in three anatomical voxels and CF assessed at baseline, week 48 and week 144. Overall differences in absolute change in CMRs and CF parameters between 0–48 and 48–144 weeks were assessed. Results Twenty-two subjects completed study procedures. Plasma HIV-RNA was <50 copies/mL in all at week 48 and in all, but two subjects at week 144. In general, between weeks 0–48 a rise in N-acetyl-aspartate(NAA)/Creatine(Cr) ratio and a decline in myo-Inositol(mI)/Cr ratio were observed. Between weeks 48–144, small rises in NAA/Cr ratio were observed in two anatomical voxels, whereas a rise in mI/Cr ratio was observed in all anatomical locations (0.31 (0.66) and -0.27 (1.35) between weeks 0–48 and 0.13 (0.91) and 1.13 (1.71) between weeks 48–144 for absolute changes in NAA/Cr and mI/Cr (SD) in frontal-grey voxel, respectively). Global CF score improved between weeks 0–48 and then declined between weeks 48–144 (0.63 (1.16) and -0.63 (0.1.41) for mean absolute change (SD) between weeks 0–48 and weeks 48–144, respectively). Conclusions The direction of change of cerebral function parameters differs over time in HIV-infected subjects commencing cART, highlighting the need for long-term follow-up in such studies. The changes we have observed between weeks 48–144 may represent the initial development of cerebral toxicities from cART.
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Affiliation(s)
- Alan Winston
- Department of Medicine, Imperial College London, London, United Kingdom
- * E-mail:
| | - Rebekah Puls
- The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia
| | - Stephen J. Kerr
- The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia
- HIV NAT, Bangkok, Thailand
| | | | - Patrick Li
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | | | | | | | - Sean Emery
- The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia
| | - David A. Cooper
- The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia
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Could antiretroviral neurotoxicity play a role in the pathogenesis of cognitive impairment in treated HIV disease? AIDS 2015; 29:253-61. [PMID: 25426811 DOI: 10.1097/qad.0000000000000538] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Whilst effective antiretroviral therapy is protective against the more severe forms of HIV-associated brain disease, there remains a large burden of clinically symptomatic cognitive impairment in the modern era. Although several potential pathogenic mechanisms have been proposed, the underlying pathology remains elusive. In this review, we summarize the evidence describing neuronal toxicity of antiretroviral agents themselves in both preclinical and clinical situations, as well as the potential pathological mechanisms underlying this toxicity. We also consider the implications for future practice and clinical research in which case determining optimal antiretroviral combinations that effectively suppress HIV replication whilst minimizing neurotoxic effects on the central nervous system may become paramount.
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Zahr NM, Alt C, Mayer D, Rohlfing T, Manning-Bog A, Luong R, Sullivan EV, Pfefferbaum A. Associations between in vivo neuroimaging and postmortem brain cytokine markers in a rodent model of Wernicke's encephalopathy. Exp Neurol 2014; 261:109-19. [PMID: 24973622 PMCID: PMC4194214 DOI: 10.1016/j.expneurol.2014.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/13/2014] [Accepted: 06/17/2014] [Indexed: 02/03/2023]
Abstract
Thiamine (vitamin B1) deficiency, associated with a variety of conditions, including chronic alcoholism and bariatric surgery for morbid obesity, can result in the neurological disorder Wernicke's encephalopathy (WE). Recent work building upon early observations in animal models of thiamine deficiency has demonstrated an inflammatory component to the neuropathology observed in thiamine deficiency. The present, multilevel study including in vivo magnetic resonance imaging (MRI) and spectroscopy (MRS) and postmortem quantification of chemokine and cytokine proteins sought to determine whether a combination of these in vivo neuroimaging tools could be used to characterize an in vivo MR signature for neuroinflammation. Thiamine deficiency for 12days was used to model neuroinflammation; glucose loading in thiamine deficiency was used to accelerate neurodegeneration. Among 38 animals with regional brain tissue assayed postmortem for cytokine/chemokine protein levels, three groups of rats (controls+glucose, n=6; pyrithiamine+saline, n=5; pyrithiamine+glucose, n=13) underwent MRI/MRS at baseline (time 1), after 12days of treatment (time 2), and 3h after challenge (glucose or saline, time 3). In the thalamus of glucose-challenged, thiamine deficient animals, correlations between in vivo measures of pathology (lower levels of N-acetyle aspartate and higher levels of lactate) and postmortem levels of monocyte chemotactic protein-1 (MCP-1, also known as chemokine ligand 2, CCL2) support a role for this chemokine in thiamine deficiency-related neurodegeneration, but do not provide a unique in vivo signature for neuroinflammation.
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Affiliation(s)
- Natalie M Zahr
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305, USA; Neuroscience Program, SRI International, Menlo Park, CA 94025, USA.
| | - Carsten Alt
- Immunology Program, SRI International, Menlo Park, CA 94025, USA; Palo Alto Institute for Research and Education, Palo Alto, CA 94304, USA
| | - Dirk Mayer
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305, USA; Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Torsten Rohlfing
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
| | - Amy Manning-Bog
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
| | - Richard Luong
- Department of Comparative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Edwards R321, Stanford, CA 94305, USA
| | - Edith V Sullivan
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305, USA
| | - Adolf Pfefferbaum
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305, USA; Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
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48
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Abstract
Monocytes and macrophages play critical roles in HIV transmission, viral spread early in infection, and as a reservoir of virus throughout infection. There has been a recent resurgence of interest in the biology of monocyte subsets and macrophages and their role in HIV pathogenesis, partly fuelled by efforts to understand difficulties in achieving HIV eradication. This article examines the importance of monocyte subsets and tissue macrophages in HIV pathogenesis. Additionally, we will review the role of monocytes and macrophages in the development of serious non-AIDS events including cardiovascular disease and neurocognitive impairment, their significance in viral persistence, and how these cells represent an important obstacle to achieving HIV eradication.
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Crowell CS, Malee KM, Yogev R, Muller WJ. Neurologic disease in HIV-infected children and the impact of combination antiretroviral therapy. Rev Med Virol 2014; 24:316-31. [PMID: 24806816 DOI: 10.1002/rmv.1793] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022]
Abstract
The prevalence of HIV-associated neurocognitive impairment in perinatally HIV-infected children has declined since the introduction of combination antiretroviral therapy (cART). Early initiation of cART in infancy has been shown to positively impact neurodevelopment; however, children continue to be diagnosed with HIV outside of the early infancy period and can experience subtle to severe neurocognitive deficits despite cART. The causes of these neurocognitive deficits despite effective cART are multifactorial and likely include continued viral replication in the CNS, ongoing neuroinflammation, irreversible CNS injury prior to cART initiation, neurotoxic effects of cART, and socioeconomic and psychosocial effects. Many aspects of our understanding of HIV-associated neurocognitive disorders have emerged from research in adult patients, but perinatally HIV-infected children represent a very different population. These children were exposed to HIV during a period of rapid brain development and have lifelong infection and potential lifelong cART exposure. HIV is no longer a rapidly fatal disease, and most HIV-infected children in resource-rich countries are living into adulthood. It is therefore critical to optimize neurocognitive outcomes of these youth. This review summarizes current understanding of the pathogenesis of HIV-associated CNS infection and the impact of cART on neurocognitive function in children and adolescents and discusses important areas for future research.
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Affiliation(s)
- Claudia S Crowell
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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50
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The role of neuroplasticity and cognitive reserve in aging with HIV: recommendations for cognitive protection and rehabilitation. J Neurosci Nurs 2014; 45:306-16. [PMID: 24025470 DOI: 10.1097/jnn.0b013e31829d8b29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
By and large, the immune systems of people infected with HIV are being protected and maintained by advances in highly active antiretroviral therapy; as such, this is extending the lives of people into old age. Unfortunately, for many living with this disease, HIV is associated with neuroinflammation, co-morbidities, and accelerated aging which can compromise brain function, resulting in cognitive deficits. The purpose of this article is to highlight how to interpret these deficits within the framework of neuroplasticity and cognitive reserve for this clinical population. We suggest several recommendations for cognitive rehabilitation and mitigation such as addressing lifestyle factors, psychostimulants, cognitive remediation therapy, and treatment of depression and anxiety. Implications for nursing research and practice are posited.
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