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Chan P, Spudich S. Central Nervous System Effects of Early HIV Infection and Consequences of Antiretroviral Therapy Initiation during Acute HIV. Viruses 2024; 16:1082. [PMID: 39066244 PMCID: PMC11281648 DOI: 10.3390/v16071082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
HIV infection is a multi-organ disease that involves the central nervous system (CNS). While devastating CNS complications such as HIV-associated dementia and CNS opportunistic infection typically manifest years after HIV acquisition, HIV RNA is readily detected in the cerebrospinal fluid in untreated neuroasymptomatic people with HIV, highlighting that HIV neuroinvasion predates overt clinical manifestations. Over the past two decades, increased awareness of HIV infection within the at-risk population, coupled with the accessibility of nucleic acid testing and modern HIV immunoassays, has made the detection of acute and early HIV infection readily achievable. This review aims to summarize research findings on CNS involvement during acute and early HIV infection, as well as the outcomes following the immediate initiation of antiretroviral therapy during this early stage of infection. The knowledge gap in long-term neuroprotection through early ART within the first year of infection will be discussed.
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Affiliation(s)
- Phillip Chan
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA
- Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT 06510, USA
| | - Serena Spudich
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA
- Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT 06510, USA
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Hu Z, Cinque P, Dravid A, Hagberg L, Yilmaz A, Zetterberg H, Fuchs D, Gostner J, Blennow K, Spudich SS, Kincer L, Zhou S, Joseph S, Swanstrom R, Price RW, Gisslén M. Changes in Cerebrospinal Fluid Proteins across the Spectrum of Untreated and Treated Chronic HIV-1 Infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.03.592451. [PMID: 38746436 PMCID: PMC11092784 DOI: 10.1101/2024.05.03.592451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Using the Olink Explore 1536 platform, we measured 1,463 unique proteins in 303 cerebrospinal fluid (CSF) specimens from four clinical centers that included uninfected controls and 12 groups of people living with HIV-1 infection representing the spectrum of progressive untreated and treated chronic infection. We present three initial analyses of these measurements: an overview of the CSF protein features of the sample; correlations of the CSF proteins with CSF HIV-1 RNA and neurofilament light chain protein (NfL) concentrations; and comparison of the CSF proteins in HIV-associated dementia ( HAD ) and neurosymptomatic CSF escape ( NSE ). These reveal a complex but coherent picture of CSF protein changes that includes highest concentrations of many proteins during CNS injury in the HAD and NSE groups and variable protein changes across the course of neuroasymptomatic systemic HIV-1 progression, including two common patterns, designated as lymphoid and myeloid patterns, related to the principal involvement of their underlying inflammatory cell lineages. Antiretroviral therapy reduced CSF protein perturbations, though not always to control levels. The dataset of these CSF protein measurements, along with background clinical information, is posted online. Extended studies of this unique dataset will provide more detailed characterization of the dynamic impact of HIV-1 infection on the CSF proteome across the spectrum of HIV-1 infection, and further the mechanistic understanding of HIV-1-related CNS pathobiology.
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Riggs PK, Anderson AM, Tang B, Rubin LH, Morgello S, Marra CM, Gelman BB, Clifford DB, Franklin D, Heaton RK, Ellis RJ, Fennema-Notestine C, Letendre SL. Elevated Plasma Protein Carbonyl Concentration Is Associated with More Abnormal White Matter in People with HIV. Viruses 2023; 15:2410. [PMID: 38140650 PMCID: PMC10747698 DOI: 10.3390/v15122410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Structural brain abnormalities, including those in white matter (WM), remain common in people with HIV (PWH). Their pathogenesis is uncertain and may reflect multiple etiologies. Oxidative stress is associated with inflammation, HIV, and its comorbidities. The post-translational carbonylation of proteins results from oxidative stress, and circulating protein carbonyls may reflect this. In this cross-sectional analysis, we evaluated the associations between protein carbonyls and a panel of soluble biomarkers of neuronal injury and inflammation in plasma (N = 45) and cerebrospinal fluid (CSF, n = 32) with structural brain MRI. The volume of abnormal WM was normalized for the total WM volume (nAWM). In this multisite project, all regression models were adjusted for the scanner. The candidate covariates included demographics, HIV disease characteristics, and comorbidities. Participants were PWH on virally suppressive antiretroviral therapy (ART) and were mostly white (64.4%) men (88.9%), with a mean age of 56.8 years. In unadjusted analyses, more nAWM was associated with higher plasma protein carbonyls (p = 0.002) and higher CCL2 (p = 0.045). In the adjusted regression models for nAWM, the association with plasma protein carbonyls remained significant (FDR p = 0.018). Protein carbonyls in plasma may be a valuable biomarker of oxidative stress and its associated adverse health effects, including within the central nervous system. If confirmed, these findings would support the hypothesis that reducing oxidative stress could treat or prevent WM injury in PWH.
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Affiliation(s)
- Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Albert M. Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Leah H. Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, and Epidemiology, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Mt Sinai School of Medicine, New York, NY 10029, USA
| | - Christina M. Marra
- Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - Benjamin B. Gelman
- Departments of Pathology, and Neuroscience & Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - David B. Clifford
- Department of Neurology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Donald Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA
| | - Christine Fennema-Notestine
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Scott L. Letendre
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
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