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Siddiqui A, He C, Lee G, Figueroa A, Slaughter A, Robinson-Papp J. Neuropathogenesis of HIV and emerging therapeutic targets. Expert Opin Ther Targets 2022; 26:603-615. [PMID: 35815686 PMCID: PMC9887458 DOI: 10.1080/14728222.2022.2100253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION HIV infection causes a wide range of neurological complications, many of which are among the most common complications of chronic HIV infection in the era of combined antiretroviral therapy. These neurological conditions arise due to complex interactions between HIV viral proteins and neuronal and glial cells that lead to the activation of various inflammatory and neurotoxic pathways across the nervous system. AREAS COVERED This review summarizes the current literature on the pathogenesis and clinical manifestations of neurological injuries associated with HIV in the brain, spinal cord, and peripheral nervous system. Molecular pathways relevant for possible therapeutic targets or advancements are emphasized. Gaps in knowledge and current challenges in therapeutic design are also discussed. EXPERT OPINION Several challenges exist in the development of therapeutic targets for HIV-associated cognitive impairments. However, recent developments in drug delivery systems and treatment strategies are encouraging. Treatments for HIV-associated pain and peripheral sensory neuropathies currently consist of symptomatic management, but a greater understanding of their pathogenesis can lead to the development of targeted molecular therapies and disease-modifying therapies. HIV-associated autonomic dysfunction may affect the course of systemic disease via disrupted neuro-immune interactions; however, more research is needed to facilitate our understanding of how these processes present clinically.
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Affiliation(s)
- Alina Siddiqui
- Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York City, NY, 10029 USA
| | - Celestine He
- Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York City, NY, 10029 USA
| | - Gina Lee
- Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York City, NY, 10029 USA
| | - Alex Figueroa
- University of Texas at Southwestern Medical School, Dallas, TX, 75390 USA
| | - Alexander Slaughter
- Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York City, NY, 10029 USA
| | - Jessica Robinson-Papp
- Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York City, NY, 10029 USA
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Abnormal cognitive aging in people with HIV: Evidence from Data Integration between two countries' cohort studies. AIDS 2022; 36:1171-1179. [PMID: 35471252 DOI: 10.1097/qad.0000000000003230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous research has shown inconsistent results on whether cognitive aging is abnormal in people with HIV (PWH) because of low sample size, cross-sectional design, and nonstandard neuropsychological methods. To address these issues, we integrated data from two longitudinal studies: Australian HIV and Brain Ageing Research Program (N = 102) and CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study (N = 924) and determined the effect of abnormal aging on neurocognitive impairment (NCI) among PWH. METHODS Both studies used the same neuropsychological test battery. NCI was defined based on demographically corrected global deficit score (≥0.5 = impaired). Both studies also assessed comorbidities, neuropsychiatric conditions and functional status using similar tools. To determine the cross-sectional and longitudinal effects of age on the risk of NCI, a generalized linear mixed-effect model tested main and interaction effects of age group (young, <50 vs. old, ≥50) and time on NCI adjusting the effects of covariates. RESULTS Older PWH had 83% higher chance of NCI compared with younger PWH [odds ratio (OR) = 1.83 (1.15-2.90), P < 0.05]. Older participants also had a greater risk of increases in NCI over the follow-up [OR = 1.66 (1.05-2.64), P < 0.05] than younger participants. Nonwhite ethnicity (P < 0.05), having a contributing (P < 0.05) or confounding (P < 0.001) comorbidity, greater cognitive symptoms (P < 0.001), and abnormal creatinine level (P < 0.05), plasma viral load greater than 200 copies/ml (P < 0.05), being from the Australian cohort (P < 0.05) were also associated with a higher risk of NCI. CONCLUSION Data integration may serve as a strategy to increase sample size and study power to better assess abnormal cognitive aging effect in PWH, which was significant in the current study.
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A Systematic Review of Risk Factors for Suicide Among Persons Living with HIV (1996-2020). AIDS Behav 2022; 26:2559-2573. [PMID: 35107660 DOI: 10.1007/s10461-022-03591-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/01/2022]
Abstract
Persons living with HIV (PWH) are at elevated risk for suicide. We conducted a systematic literature review following PRISMA-P guidelines to examine risk factors associated with suicide as a cause of morbidity among PWH. We searched six electronic databases using search terms (suicide, suicide attempt, self-harm, self-injurious behavior, HIV, AIDS, PWH). We focused on factors that were specific to HIV infection (CD4 count, HIV-1 RNA, and antiretroviral therapy [ART]). The initial search yielded N = 2657 studies. Eligible studies included suicide as an outcome, quantitative study design, and publication in peer-reviewed journals from 1996 through 2020. Fourteen studies met inclusion criteria. PWH share risk factors for suicide found in the general population: psychiatric illness, previous suicide attempt, drug and alcohol misuse. PWH also have HIV-specific risk factors for suicide. HIV diagnosis in the past two years and transmission related to injection drug use were associated with increased risk; HIV-1 RNA, ART, and AIDS-defining illness were not.
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Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, Abouo FN, Tanon A, Messou E, Seydi M, Dabis F, Dartigues JF, de Rekeneire N. Effects of Age, Level of Education and HIV Status on Cognitive Performance in West African Older Adults: The West Africa IeDEA Cohort Collaboration. AIDS Behav 2021; 25:3316-3326. [PMID: 34050826 DOI: 10.1007/s10461-021-03309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/28/2022]
Abstract
An in-depth understanding of the impact of aging, cognitive reserve, and HIV status on cognitive function is needed in older West African adults. Ninety-nine HIV-negative and 334 HIV-positive adults aged ≥ 50 years were enrolled in three clinics (Senegal and Côte d'Ivoire) participating in the IeDEA West Africa collaboration. All subjects underwent the Free and Cued Selective Reminding Test (FCSRT) and the Isaacs Set Test (IST). Age (both linear and quadratic), education level, and HIV status effects on Z-scores were assessed using multivariate linear regression models. Interactions between HIV status and age or educational level were tested. In the present cohort of older West African adults, the role of age and educational level on episodic memory and verbal fluency was observed without revealing an interaction between HIV status and age effect. As age had quadratic effects, older HIV-positive adults should not be considered as a unique group irrespective of their age. Low-educated HIV-positive patients had the lowest verbal fluency performance compared to others. Further studies are needed to duplicate these results. In clinical settings, screening and adapted programs focusing on improving cognition in those patients are needed.
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Lam JO, Hou CE, Hojilla JC, Anderson AN, Gilsanz P, Alexeeff SE, Levine-Hall T, Hood N, Lee C, Satre DD, Silverberg MJ. Comparison of dementia risk after age 50 between individuals with and without HIV infection. AIDS 2021; 35:821-828. [PMID: 33394681 PMCID: PMC7969394 DOI: 10.1097/qad.0000000000002806] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare risk of dementia after age 50 by HIV status among individuals in a primary care setting. DESIGN Observational cohort study; participants were identified from 2013 to 2017 and followed through 2019. METHODS Participants were people with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWOH), all at least 50 years old and with no prior diagnosis of dementia. The study setting was Kaiser Permanente Northern California, an integrated healthcare delivery system in the United States. Incident dementia diagnoses and baseline data on sociodemographics, smoking, alcohol use, other substance use, and clinical factors were gathered from the electronic health record. Cumulative proportion of incident dementia by HIV status was assessed using Kaplan--Meier curves. Unadjusted and adjusted hazard ratios for incident dementia by HIV status were generated using Cox proportional hazards models with age as the time scale. RESULTS The study included 5381 PWH and 119 022 PWOH (average age at baseline: 57 and 58 years, respectively). Incident dementia was diagnosed in 117 PWH and 2427 PWOH. By age 80, 25.8% of PWH and 13.8% of PWOH had been diagnosed with dementia, corresponding with an unadjusted hazard ratio of 1.98 (95% CI 1.64-2.39). After adjustment for sociodemographic, substance use, and clinical factors, including frequency of outpatient visits, the risk of dementia among PWH remained elevated (vs. PWOH, adjusted hazard ratio = 1.58, 95% CI 1.31-1.92). CONCLUSION Compared with PWOH, PWH were at 58% higher risk for dementia despite HIV treatment with ART. Research is needed to investigate the potential benefits of targeted risk factor management or earlier cognitive screening in this population.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco
| | - J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Nicole Hood
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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Aung HL, Bloch M, Vincent T, Quan D, Jayewardene A, Liu Z, Gates TM, Brew B, Mao L, Cysique LA. Cognitive ageing is premature among a community sample of optimally treated people living with HIV. HIV Med 2021; 22:151-164. [PMID: 33085207 PMCID: PMC7984032 DOI: 10.1111/hiv.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evidence of premature cognitive ageing amongst people living with HIV (PLHIV) remains controversial due to previous research limitations including underpowered studies, samples with suboptimal antiretroviral access, varying rate of virological control, high rate of AIDS, over-representation of non-community samples, and inclusion of inappropriate controls. The current study addresses these limitations, while also considering mental health and non-HIV comorbidity burden to determine whether PLHIV showed premature cognitive ageing compared with closely comparable HIV-negative controls. METHODS This study enrolled 254 PLHIV [92% on antiretroviral therapy; 84% with HIV RNA < 50 copies/mL; 15% with AIDS) and 72 HIV-negative gay and bisexual men [mean (SD) age = 49 (10.2) years] from a single primary care clinic in Sydney, Australia. Neurocognitive function was evaluated with the Cogstate Computerized Battery (CCB) at baseline and 6 months after. Linear mixed-effects (LME) models examined main and interaction effects of HIV status and chronological age on the CCB demographically uncorrected global neurocognitive z-score (GZS), adjusting for repeated testing, and then adjusting sequentially for HIV disease markers, mental health and comorbidities. RESULTS HIV status and age interacted with a lower GZS (β = -0.43, P < 0.05). Higher level of anxiety symptoms (β = -0.11, P < 0.01), historical AIDS (β = -0.12, P < 0.05) and historical HIV brain involvement (β = -0.12, P < 0.05) were associated with lower GZS. CONCLUSIONS We found a robust medium-sized premature ageing effect on cognition in a community sample with optimal HIV care. Our study supports routine screening of cognitive and mental health among PLHIV aged ≥ 50 years.
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Affiliation(s)
- HL Aung
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
| | - M Bloch
- Faculty of MedicineUNSWSydneyNSWAustralia
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - T Vincent
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - D Quan
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - A Jayewardene
- Holdsworth House Medical PracticeSydneyNSWAustralia
- Charles Perkins CentreUniversity of SydneySydneyNSWAustralia
| | - Z Liu
- Stats CentralUNSWSydneyNSWAustralia
| | - TM Gates
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
| | - B Brew
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
- Faculty of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - L Mao
- Centre for Social Research in HealthUNSWSydneyNSWAustralia
| | - LA Cysique
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
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Aung HL, Aghvinian M, Gouse H, Robbins RN, Brew BJ, Mao L, Cysique LA. Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review. AIDS Behav 2021; 25:917-960. [PMID: 33025390 PMCID: PMC7886778 DOI: 10.1007/s10461-020-03053-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
Despite evidence of premature, accentuated and accelerated aging for some age-related conditions such as cardiovascular diseases in people living with HIV (PLHIV), the evidence for these abnormal patterns of aging on neurocognition remains unclear. Further, no systematic review has been dedicated to this issue. Using PRISMA guidelines, we searched standard databases (PubMed, EMBASE, CINAHL and PsycINFO). Articles were included if they analyzed and reported the effect of age on neurocognition among PLHIV as one of their major findings, if they were conducted in the combination anti-retroviral therapy era (after 1996) and published in a peer-reviewed journal in English. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) appraisal tools. To systematically target the abnormal patterns of neurocognitive aging, we define premature cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive test performance covering both the normal and abnormal performance range; accentuated cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive impairment (NCI) rate, thus covering the abnormal performance range only; accelerated cognitive aging as significant interaction effect of HIV status and age on longitudinal neurocognitive test performance or incidence of NCI. Because these definitions require an age-comparable HIV-negative (HIV-) control group, when no controls were included, we determined the range of the age effect on neurocognitive test performance or NCI among PLHIV. A total of 37 studies originating from the US (26), UK (2), Italy (2), Poland (2), China (2), Japan (1), Australia (1), and Brazil (1) were included. Six studies were longitudinal and 14 included HIV- controls. The quality appraisal showed that 12/37 studies neither used an age-matched HIV- controls nor used demographically corrected cognitive scores. A meta-analysis was not possible because study methods and choice of neurocognitive measurement methods and outcomes were heterogeneous imposing a narrative synthesis. In studies with an HIV- control sample, premature neurocognitive aging was found in 45% of the cross-sectional analyses (9/20), while accelerated neurocognitive aging was found in 75% of the longitudinal analyses (3/4). There was no evidence for accentuated aging, but this was tested only in two studies. In studies without an HIV- control sample, the age effect was always present but wide (NCI OR = 1.18-4.8). While large sample size (> 500) was associated with abnormal patterns of cognitive aging, most of the studies were under powered. Other study characteristics such as longitudinal study design and higher proportion of older participants were also associated with the findings of abnormal cognitive aging. There is some support for premature and accelerated cognitive aging among PLHIV in the existing literature especially among large and longitudinal studies and those with higher proportion of older samples. Future HIV and cognitive aging studies need to harmonize neuropsychological measurement methods and outcomes and use a large sample from collaborative multi-sites to generate more robust evidences.
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Affiliation(s)
- Htein Linn Aung
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Neuroscience Research Australia, Sydney, Australia.
- Faculty of Medicine, UNSW, Sydney, Australia.
| | | | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Lucette A Cysique
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
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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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Nir TM, Fouche JP, Ananworanich J, Ances BM, Boban J, Brew BJ, Chaganti JR, Chang L, Ching CRK, Cysique LA, Ernst T, Faskowitz J, Gupta V, Harezlak J, Heaps-Woodruff JM, Hinkin CH, Hoare J, Joska JA, Kallianpur KJ, Kuhn T, Lam HY, Law M, Lebrun-Frénay C, Levine AJ, Mondot L, Nakamoto BK, Navia BA, Pennec X, Porges EC, Salminen LE, Shikuma CM, Surento W, Thames AD, Valcour V, Vassallo M, Woods AJ, Thompson PM, Cohen RA, Paul R, Stein DJ, Jahanshad N. Association of Immunosuppression and Viral Load With Subcortical Brain Volume in an International Sample of People Living With HIV. JAMA Netw Open 2021; 4:e2031190. [PMID: 33449093 PMCID: PMC7811179 DOI: 10.1001/jamanetworkopen.2020.31190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Despite more widely accessible combination antiretroviral therapy (cART), HIV-1 infection remains a global public health challenge. Even in treated patients with chronic HIV infection, neurocognitive impairment often persists, affecting quality of life. Identifying the neuroanatomical pathways associated with infection in vivo may delineate the neuropathologic processes underlying these deficits. However, published neuroimaging findings from relatively small, heterogeneous cohorts are inconsistent, limiting the generalizability of the conclusions drawn to date. OBJECTIVE To examine structural brain associations with the most commonly collected clinical assessments of HIV burden (CD4+ T-cell count and viral load), which are generalizable across demographically and clinically diverse HIV-infected individuals worldwide. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study established the HIV Working Group within the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) consortium to pool and harmonize data from existing HIV neuroimaging studies. In total, data from 1295 HIV-positive adults were contributed from 13 studies across Africa, Asia, Australia, Europe, and North America. Regional and whole brain segmentations were extracted from data sets as contributing studies joined the consortium on a rolling basis from November 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURES Volume estimates for 8 subcortical brain regions were extracted from T1-weighted magnetic resonance images to identify associations with blood plasma markers of current immunosuppression (CD4+ T-cell counts) or detectable plasma viral load (dVL) in HIV-positive participants. Post hoc sensitivity analyses stratified data by cART status. RESULTS After quality assurance, data from 1203 HIV-positive individuals (mean [SD] age, 45.7 [11.5] years; 880 [73.2%] male; 897 [74.6%] taking cART) remained. Lower current CD4+ cell counts were associated with smaller hippocampal (mean [SE] β = 16.66 [4.72] mm3 per 100 cells/mm3; P < .001) and thalamic (mean [SE] β = 32.24 [8.96] mm3 per 100 cells/mm3; P < .001) volumes and larger ventricles (mean [SE] β = -391.50 [122.58] mm3 per 100 cells/mm3; P = .001); in participants not taking cART, however, lower current CD4+ cell counts were associated with smaller putamen volumes (mean [SE] β = 57.34 [18.78] mm3 per 100 cells/mm3; P = .003). A dVL was associated with smaller hippocampal volumes (d = -0.17; P = .005); in participants taking cART, dVL was also associated with smaller amygdala volumes (d = -0.23; P = .004). CONCLUSIONS AND RELEVANCE In a large-scale international population of HIV-positive individuals, volumes of structures in the limbic system were consistently associated with current plasma markers. Our findings extend beyond the classically implicated regions of the basal ganglia and may represent a generalizable brain signature of HIV infection in the cART era.
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Affiliation(s)
- Talia M. Nir
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jean-Paul Fouche
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jintanat Ananworanich
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- South East Asian Research Collaboration in HIV, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- AIGHD, University of Amsterdam, Amsterdam, the Netherlands
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Jasmina Boban
- Faculty of Medicine, Department of Radiology, University of Novi Sad, Novi Sad, Serbia
| | - Bruce J. Brew
- Department of Neurology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Department of Immunology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Peter Duncan Neurosciences Unit, St Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia
| | - Joga R. Chaganti
- Department of Medical Imaging, St Vincent’s Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Chang
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Neurology, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Lucette A. Cysique
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ernst
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Faskowitz
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Vikash Gupta
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington
| | | | - Charles H. Hinkin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Jacqueline Hoare
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kalpana J. Kallianpur
- Hawaii Center for AIDS, University of Hawaii, Honolulu
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii, Honolulu
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Hei Y. Lam
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Meng Law
- Department of Radiology, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Christine Lebrun-Frénay
- Neurology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | | | - Lydiane Mondot
- Department of Radiology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | - Beau K. Nakamoto
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
| | - Bradford A. Navia
- Infection Unit, School of Public Health, Tufts University Medical School, Boston, Massachusetts
| | - Xavier Pennec
- Cote d’Azur University, Sophia Antipolis, France
- Epione Team, Inria, Sophia Antipolis Mediterrannee, Sophia Antipolis, France
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Lauren E. Salminen
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | | | - Wesley Surento
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - April D. Thames
- Department of Psychology, University of Southern California, Los Angeles
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, San Francisco, California
| | - Matteo Vassallo
- Internal Medicine/Infectious Diseases, Centre Hospitalier de Cannes, Cannes, France
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Ronald A. Cohen
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Robert Paul
- Psychological Sciences, Missouri Institute of Mental Health, University of Missouri, St Louis
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
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10
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Neuroimaging Advances in Diagnosis and Differentiation of HIV, Comorbidities, and Aging in the cART Era. Curr Top Behav Neurosci 2021; 50:105-143. [PMID: 33782916 DOI: 10.1007/7854_2021_221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the "cART era" of more widely available and accessible treatment, aging and HIV-related comorbidities, including symptoms of brain dysfunction, remain common among HIV-infected individuals on suppressive treatment. A better understanding of the neurobiological consequences of HIV infection is essential for developing thorough treatment guidelines and for optimizing long-term neuropsychological outcomes and overall brain health. In this chapter, we first summarize magnetic resonance imaging (MRI) methods used in over two decades of neuroHIV research. These methods evaluate brain volumetric differences and circuitry disruptions in adults living with HIV, and help map clinical correlations with brain function and tissue microstructure. We then introduce and discuss aging and associated neurological complications in people living with HIV, and processes by which infection may contribute to the risk for late-onset dementias. We describe how new technologies and large-scale international collaborations are helping to disentangle the effect of genetic and environmental risk factors on brain aging and neurodegenerative diseases. We provide insights into how these advances, which are now at the forefront of Alzheimer's disease research, may advance the field of neuroHIV. We conclude with a summary of how we see the field of neuroHIV research advancing in the decades to come and highlight potential clinical implications.
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11
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Abstract
: The persistence of HIV in the central nervous system is somewhat controversial particularly in the context of HIV viral suppression from combined antiretroviral therapy. Further, its significance in relation to HIV pathogenesis in the context of HIV-associated neurocognitive disorders, systemic HIV pathogenesis, and eradication in general, but especially from the brain, are even more contentious. This review will discuss each of these aspects in detail, highlighting new data, particularly from recent conference presentations.
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12
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O'Connor E, Zeffiro T. Is treated HIV infection still toxic to the brain? PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:259-284. [PMID: 31481166 DOI: 10.1016/bs.pmbts.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clinically apparent HIV infection, accompanied by CNS opportunistic infections and HIV encephalopathy, was often associated with profound structural and functional brain effects prior to the introduction of anti-retroviral therapy (ART). With treatment, HIV structural and functional brain effects are smaller and have not been as easily detected. With near complete elimination of CNS opportunistic infections, the HIV neuroimaging research community now grapples with the problem of detecting subtler structural and functional changes against a background of persisting confounds, such as comorbidities and clinical features common in the HIV infected population. This situation also raises the question of whether imaging measure changes that are reported as HIV brain effects are purely related to viral infection, rather than originating from confounding effects that might include age, substance use, hepatitis C coinfection, cerebrovascular risk factors, ART, premorbid cognitive skills and illness duration. In addition to cohort characteristics, variation in image acquisition and analysis techniques may also contribute to study outcome heterogeneity. We review the potential effects of these confounds on detection of HIV infection effects and discuss strategies to avoid or mitigate the effects of these confounds. We then present a systematic approach to measurement, design and analysis in HIV neuroimaging studies, combining both experimental and statistical control techniques to determine if HIV infection effects persist, fluctuate or worsen in groups achieving viral suppression from ART.
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Affiliation(s)
- Erin O'Connor
- University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Thomas Zeffiro
- University of Maryland School of Medicine, Baltimore, MD, United States.
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13
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Alford K, Banerjee S, Nixon E, O'Brien C, Pounds O, Butler A, Elphick C, Henshaw P, Anderson S, Vera JH. Assessment and Management of HIV-Associated Cognitive Impairment: Experience from a Multidisciplinary Memory Service for People Living with HIV. Brain Sci 2019; 9:brainsci9020037. [PMID: 30744034 PMCID: PMC6406482 DOI: 10.3390/brainsci9020037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
As the HIV population ages, the prevalence of cognitive impairment (CI) is increasing, yet few services exist for the assessment and management of these individuals. Here we provide an initial description of a memory assessment service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen by the clinic. We present patient demographic data, assessment outcomes, diagnoses given and interventions delivered to those seen in the clinic. 41 patients (79%) of those seen in the clinic had objective CI: 16 (31%) met criteria for HIV-associated Neurocognitive Disorder (HAND), 2 (4%) were diagnosed with dementia, 14 (27%) showed CI associated with mental illness and/or drugs/alcohol, 7 (13%) had CI which was attributed to factors other than HIV and in 2 (4%) patients the cause remains unclear. 32 (62%) patients showed some abnormality on Magnetic Resonance Imaging (MRI) brain scans. Patients attending the clinic performed significantly worse than normative scores on all tests of global cognition and executive function. Interventions offered to patients included combination antiretroviral therapy modification, signposting to other services, case management, further health investigations and in-clinic advice. Our experience suggests that the need exists for specialist HIV memory services and that such a model of working can be successfully implemented into HIV patient care. Further work is needed on referral criteria and pathways. Diagnostic processes and treatment offered needs to consider and address the multifactorial aetiology of CI in HIV and this is essential for effective assessment and management.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
- Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, UK.
| | - Eileen Nixon
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Clara O'Brien
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Olivia Pounds
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Andrew Butler
- Department of Medicine, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
| | - Claire Elphick
- Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, UK.
| | - Phillip Henshaw
- Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, UK.
| | - Stuart Anderson
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
- Department of Medicine, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
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14
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Velichkovska M, Surnar B, Nair M, Dhar S, Toborek M. Targeted Mitochondrial COQ 10 Delivery Attenuates Antiretroviral-Drug-Induced Senescence of Neural Progenitor Cells. Mol Pharm 2019; 16:724-736. [PMID: 30592424 PMCID: PMC6364271 DOI: 10.1021/acs.molpharmaceut.8b01014] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
HIV infection is associated with symptoms of accelerated or accentuated aging that are likely to be driven not only by HIV itself but also by the toxicity of long-term use of antiretroviral drugs. Therefore, it is crucially important to understand the mechanisms by which antiretroviral drugs may contribute to aging. The aim of this study was to investigate the hypothesis that antiretroviral drugs cause increased reactive oxygen species (ROS) generation that results in mitochondrial dysfunction and culminates in promoting cellular senescence. In addition, we applied targeted nanoparticle (NP)-based delivery to specifically enrich mitochondria with coenzyme Q10 (CoQ10) in order to enhance antioxidant protection. The studies employed neural progenitor cells (NPCs), as differentiation of these cells into mature neurons is affected both during HIV infection and in the aging process. Exposure of cultured NPCs to various combinations of HIV antiretroviral therapy (ART) induced a more than 2-fold increase in mitochondrial ROS generation and mitochondrial membrane potential, a more than 50% decrease in oxygen consumption and ATP levels, a 60% decrease in SIRT3 expression, and a 42% decrease in cell proliferation relative to control levels. These alterations were accompanied by a 37% increase in beta-galactosidase staining and a shortening of the telomere length to more than half of the length of controls as assessed by quantitative telomere-FISH labeling, indicating accelerated NPC senescence in response to ART exposure. Importantly, CoQ10 delivered by targeted nanoparticles effectively attenuated these effects. Overall, these results indicate that ART promotes cellular senescence by causing mitochondrial dysfunction, which can be successfully reversed by supplementation with mitochondria-targeted CoQ10.
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Affiliation(s)
- Martina Velichkovska
- †Department
of Biochemistry and Molecular Biology and §Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Bapurao Surnar
- †Department
of Biochemistry and Molecular Biology and §Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Madhavan Nair
- Department
of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United
States
| | - Shanta Dhar
- †Department
of Biochemistry and Molecular Biology and §Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Michal Toborek
- †Department
of Biochemistry and Molecular Biology and §Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States,Address: Department of Biochemistry
and Molecular Biology, University of Miami School of Medicine, Gautier
Bldg., Room 528, 1011 NW 15th Street, Miami, FL 33136. Phone: 305-243-0230. E-mail:
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15
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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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16
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Vascular cognitive impairment and HIV-associated neurocognitive disorder: a new paradigm. J Neurovirol 2019; 25:710-721. [DOI: 10.1007/s13365-018-0706-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023]
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17
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Cysique LA, Brew BJ. Comorbid depression and apathy in HIV-associated neurocognitive disorders in the era of chronic HIV infection. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:71-82. [PMID: 31727231 DOI: 10.1016/b978-0-444-64012-3.00006-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter provides an overview of the current research on the question of depression and apathy in HIV-associated neurocognitive disorders (HAND) in the era of chronic HIV infection. After presenting the epidemiology of each condition showing that depression and apathy are the two most frequent psychiatric comorbidities of HAND, we review the current research, particularly in relation to the milder forms of HAND that characterize treated HIV cohorts. Doing so, we include findings on depression and apathy in non-HIV aging population and the risk of dementia, findings that are relevant to the aging HIV cohorts carrying a high burden of psychiatric comorbidities. We then present a review of the research pertaining to the differentiation between depression and apathy. A section is dedicated to the question of suicidality in chronic HIV infection, which is underappreciated. An overview of the pharmacologic and psychosocial interventions relevant to depression and apathy in HIV cohorts treated with antiretroviral treatment is provided. The chapter concludes with future directions for the research on apathy and depression with emphasis on the question of aging and the need for longitudinal studies.
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Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Bruce J Brew
- Neurology and HIV Departments, St. Vincent's Hospital, Sydney, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
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18
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Alford K, Vera JH. Cognitive Impairment in people living with HIV in the ART era: A Review. Br Med Bull 2018; 127:55-68. [PMID: 29868901 DOI: 10.1093/bmb/ldy019] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive disorders are a common issue impacting those living with human immunodeficiency virus (HIV). Effective antiretroviral treatment has lessened the severity but not the frequency of these impairments. Such deficits reduce quality of life and present a significant challenge to clinicians in the context of an ageing HIV population with a growing number of comorbidities. SOURCES OF DATA This review is based on recent published literature in the field of HIV-associated cognitive impairment (HAND). AREAS OF AGREEMENT The pathogenesis of HAND is multifactorial and can be categorized into HIV viral factors, antiretroviral factors and individual factors. The risk factors associated with HAND are well documented. AREAS OF CONTROVERSY The prevalence of HAND in HIV populations varies and is dependent on populations studied and assessment batteries used. Disease progression is poorly understood and has important implication for screening programmes. The relative contribution of pathogenic mechanisms causing HAND is unclear, but recent papers point to inflammation as a significant contributor. GROWING AREAS The role of psychiatric diseases, such as depression, in the development and maintenance of HAND has recently been examined and requires clinical consideration. Furthermore, as the HIV population ages, its clinical management faces new challenges. AREAS TIMELY FOR DEVELOPING RESEARCH Identifying biomarkers for HAND which are practical in a clinical setting and utilizing new imaging technologies to better monitor diagnosis and disease progression. Furthermore, the development of therapeutics targeting inflammation appears of increasing importance.
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Affiliation(s)
- K Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex Brighton, UK
| | - J H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex Brighton, UK.,Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
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19
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Haynes BI, Pitkanen M, Kulasegaram R, Casey SJ, Schutte M, Towgood K, Peters B, Barker GJ, Kopelman MD. HIV: ageing, cognition and neuroimaging at 4-year follow-up. HIV Med 2018; 19:376-385. [PMID: 29441669 DOI: 10.1111/hiv.12598] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the hypothesis of accelerated cognitive ageing in HIV-positive individuals using longitudinal assessment of cognitive performance and quantitative magnetic resonance imaging (MRI). METHODS We assessed a broad cognitive battery and quantitative MRI metrics [voxel-based morphometry (VBM) and diffusion tensor imaging (DTI)] in asymptomatic HIV-positive men who have sex with men (15 aged 20-40 years and 15 aged ≥ 50 years), and HIV-seronegative matched controls (nine aged 20-40 years and 16 aged ≥ 50 years). RESULTS Being HIV positive was associated with greater decreases in executive function and global cognition. Additionally, using DTI, we found that the HIV-positive group had a greater increase in mean diffusivity, but we did not find group differences in volume change using VBM. With respect to the HIV status by age group interaction, this was statistically significant for change in global cognition, with older HIV-positive individuals showing greater global cognitive decline, but there were no significant interaction effects on other measures. Lastly, change in cognitive performance was correlated with change in the DTI measures, and this effect was stronger for the HIV-positive participants. CONCLUSIONS In the present study, we found some evidence for accelerated ageing in HIV-positive individuals, with a statistically significant HIV status by age group interaction in global cognition, although this interaction could not be explained by the imaging findings. Moreover, we also found that change in cognitive performance was correlated with change in the DTI measures, and this effect was stronger for the HIV-positive participants. This will need replication in larger studies using a similarly lengthy follow-up period.
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Affiliation(s)
- B I Haynes
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - M Pitkanen
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.,South London and Maudsley NHS Trust based at St Thomas' Hospital, London, UK
| | - R Kulasegaram
- Guy's and St Thomas' NHS Trust, St Thomas' Hospital, London, UK
| | - S J Casey
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - M Schutte
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - K Towgood
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - B Peters
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.,South London and Maudsley NHS Trust based at St Thomas' Hospital, London, UK
| | - G J Barker
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - M D Kopelman
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.,South London and Maudsley NHS Trust based at St Thomas' Hospital, London, UK
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20
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Cysique LA, Jugé L, Gates T, Tobia M, Moffat K, Brew BJ, Rae C. Covertly active and progressing neurochemical abnormalities in suppressed HIV infection. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e430. [PMID: 29312999 PMCID: PMC5754644 DOI: 10.1212/nxi.0000000000000430] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 11/15/2022]
Abstract
Objective To assess whether HIV-related brain injury is progressive in persons with suppressed HIV infection. Methods Seventy-three HIV+ virally suppressed men and 35 HIV- men, screened for psychiatric and alcohol/drug use disorders, underwent neuropsychological evaluation and proton magnetic resonance spectroscopy (1H-MRS) at baseline and after and 23 ± 5 months. 1H-MRS included brain regions known to be vulnerable to HIV and aging: frontal white matter (FWM), posterior cingulate cortex (PCC), and caudate area (CA). Major brain metabolites such as creatine (Cr: marker of cellular energy), N-acetyl aspartate (NAA: marker of neuronal integrity), choline (marker of cellular membrane turnover), glutamate/glutamine (excitatory/inhibitory neurotransmitter), and myo-Inositol (mI: marker of neuroinflammation) were calculated with reference to water signal. Neurocognitive decline was corrected for practice effect and baseline HIV-associated neurocognitive disorder (HAND) status. Results Across the study period, 44% had intact cognition, 42% stable HAND (including the single case that improved), 10% progressing HAND, and 4% incident HAND. When analyzing the neurochemical data per neurocognitive trajectories, we found decreasing PCC Cr in all subgroups compared with controls (p < 0.002). In addition, relative to the HIV- group, stable HAND showed decreasing FWM Cr, incident HAND showed steep FWM Cr reduction, whereas progressing HAND had a sharply decreasing PCC NAA and reduced but stable CA NAA. When analyzing the neurochemical data at the group level (HIV+ vs HIV- groups), we found stable abnormal metabolite concentrations over the study period: decreased FWM and PCC Cr (both p < 0.001), decreased PCC NAA and CA NAA (both p < 0.05) and PCC mI increase (p < 0.05). HIV duration and historical HAND had modest effects on metabolite changes. Conclusions Our study reveals covertly active or progressing HIV-related brain injury in the majority of this virally suppressed cohort, reflecting ongoing neuropathogenic processes that are only partially worsened by historical HAND and HIV duration. Longer-term studies will be important for determining the prognosis of these slowly evolving neurochemical abnormalities.
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Affiliation(s)
- Lucette A Cysique
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Lauriane Jugé
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Thomas Gates
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Michael Tobia
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Kirsten Moffat
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Bruce J Brew
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Caroline Rae
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
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21
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Stoff DM, Colosi D, Rubtsova A, Wingood G. HIV and Aging Research in Women: An Overview. Curr HIV/AIDS Rep 2017; 13:383-391. [PMID: 27771876 DOI: 10.1007/s11904-016-0338-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper reviews some background issues as a foundation to place the ensuing supplement papers of this special issue section in context. The articles in this special supplement issue deepen and expand our understanding of biomedical, neurocognitive, and psychosocial aspects involved in human immunodeficiency virus (HIV) of older women, primarily through the use of the Women's Interagency HIV Study (WIHS) prospective cohort study. As it relates to research on the intersection between HIV and aging in women, we discuss (i) epidemiology as introduction, (ii) the cohort study design featuring the WIHS, (iii) definitions, (iv) models, and (v) section articles.
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Affiliation(s)
- David M Stoff
- National Institute of Mental Health, Bethesda, MD, USA.
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22
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Ding Y, Lin H, Shen W, Wu Q, Gao M, He N. Interaction Effects between HIV and Aging on Selective Neurocognitive Impairment. J Neuroimmune Pharmacol 2017; 12:661-669. [PMID: 28470583 DOI: 10.1007/s11481-017-9748-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/21/2017] [Indexed: 01/17/2023]
Abstract
HIV infection and aging are each associated with neurocognitive impairment (NCI). This study examined the combined effects of HIV infection and aging on NCI. We performed a cross-sectional survey among 345 HIV-infected and 345 HIV-uninfected participants aged at least 40 years. The International HIV Dementia Scale (IHDS) and Chinese version of Mini-mental State Examination (MMSE) were administered to screen for NCI. HIV-infected individuals had higher prevalence of NCI than uninfected individuals (46.7% vs 15.1% for IHDS using cut-off of ≤ 10; 17.1% vs 2.6% for MMSE). Significant main effects of HIV and age were observed on IHDS and MMSE composite scores and all domains except for HIV on attention and calculation. Significant interaction effects between HIV and age were observed on motor speed, orientation, registration and recall, and mainly attributed to the inferior performance of HIV-infected patients aged over 60 years. Among HIV-infected individuals, in multivariable logistic models, older age, depressive symptoms and history of nevirapine treatment were associated with NCI using both IHDS and MMSE, whereas lower education current smoker and current CD4 ≥ 800 cells/μL were associated only with NCI using IHDS, and hypertension was associated only with NCI using MMSE. Findings suggest that HIV and older age may confer interactive effects on cognitive function in several domains with older HIV-infected adults experiencing greater NCI, which requires further longitudinal investigation. Furthermore, HIV early diagnosis and treatment may prevent or reverse NCI, but extra attention should be given to adverse effects including metabolic changes associated with long-term treatment.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.,The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Haijiang Lin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.,Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - Qionghai Wu
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.,The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China. .,The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China. .,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
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Cole JH, Underwood J, Caan MWA, De Francesco D, van Zoest RA, Leech R, Wit FWNM, Portegies P, Geurtsen GJ, Schmand BA, Schim van der Loeff MF, Franceschi C, Sabin CA, Majoie CBLM, Winston A, Reiss P, Sharp DJ. Increased brain-predicted aging in treated HIV disease. Neurology 2017; 88:1349-1357. [PMID: 28258081 PMCID: PMC5379929 DOI: 10.1212/wnl.0000000000003790] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/17/2017] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To establish whether HIV disease is associated with abnormal levels of age-related brain atrophy, by estimating apparent brain age using neuroimaging and exploring whether these estimates related to HIV status, age, cognitive performance, and HIV-related clinical parameters. METHODS A large sample of virologically suppressed HIV-positive adults (n = 162, age 45-82 years) and highly comparable HIV-negative controls (n = 105) were recruited as part of the Comorbidity in Relation to AIDS (COBRA) collaboration. Using T1-weighted MRI scans, a machine-learning model of healthy brain aging was defined in an independent cohort (n = 2,001, aged 18-90 years). Neuroimaging data from HIV-positive and HIV-negative individuals were then used to estimate brain-predicted age; then brain-predicted age difference (brain-PAD = brain-predicted brain age - chronological age) scores were calculated. Neuropsychological and clinical assessments were also carried out. RESULTS HIV-positive individuals had greater brain-PAD score (mean ± SD 2.15 ± 7.79 years) compared to HIV-negative individuals (-0.87 ± 8.40 years; b = 3.48, p < 0.01). Increased brain-PAD score was associated with decreased performance in multiple cognitive domains (information processing speed, executive function, memory) and general cognitive performance across all participants. Brain-PAD score was not associated with age, duration of HIV infection, or other HIV-related measures. CONCLUSION Increased apparent brain aging, predicted using neuroimaging, was observed in HIV-positive adults, despite effective viral suppression. Furthermore, the magnitude of increased apparent brain aging related to cognitive deficits. However, predicted brain age difference did not correlate with chronological age or duration of HIV infection, suggesting that HIV disease may accentuate rather than accelerate brain aging.
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Affiliation(s)
- James H Cole
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy.
| | - Jonathan Underwood
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Matthan W A Caan
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Davide De Francesco
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Rosan A van Zoest
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Robert Leech
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Ferdinand W N M Wit
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Peter Portegies
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Gert J Geurtsen
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Ben A Schmand
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Maarten F Schim van der Loeff
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Claudio Franceschi
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Caroline A Sabin
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Charles B L M Majoie
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Alan Winston
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - Peter Reiss
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
| | - David J Sharp
- From the Computational, Cognitive & Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine (J.H.C., R.L., D.J.S.), and Division of Infectious Diseases (J.U., A.W.), Imperial College London, UK; Departments of Radiology (M.W.A.C., C.B.L.M.M.), Global Health, Amsterdam Institute for Global Health and Development (AIGHD) (R.A.v.Z., F.W.N.M.W., P.R.), Neurology (P.P., B.A.S.), and Medical Psychology (G.J.G., B.A.S.), Academic Medical Center, Amsterdam, the Netherlands; Department of Infection & Population Health (D.D.F., C.A.S.), University College London, UK; Dutch HIV Monitoring Foundation (F.W.N.M.W., P.R.); Department of Neurology (P.P.), OLVG Hospital; Public Health Service of Amsterdam (M.F.S.v.d.L.), the Netherlands; and Alma Mater Studiorum (C.F.), University of Bologna, Italy
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Cysique LA, Soares JR, Geng G, Scarpetta M, Moffat K, Green M, Brew BJ, Henry RG, Rae C. White matter measures are near normal in controlled HIV infection except in those with cognitive impairment and longer HIV duration. J Neurovirol 2017; 23:539-547. [PMID: 28324319 DOI: 10.1007/s13365-017-0524-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/30/2022]
Abstract
The objective of the current study was to quantify the degree of white matter (WM) abnormalities in chronic and virally suppressed HIV-infected (HIV+) persons while carefully taking into account demographic and disease factors. Diffusion tensor imaging (DTI) was conducted in 40 HIV- and 82 HIV+ men with comparable demographics and life style factors. The HIV+ sample was clinically stable with successful viral control. Diffusion was measured across 32 non-colinear directions with a b-value of 1000 s/mm2; fractional anisotropy (FA) and mean diffusivity (MD) maps were quantified with Itrack IDL. Using the ENIGMA DTI protocol, FA and MD values were extracted for each participant and in 11 skeleton regions of interest (SROI) from standard labels in the JHU ICBM-81 atlas covering major striato-frontal and parietal tracks. We found no major differences in FA and MD values across the 11 SROI between study groups. Within the HIV+ sample, we found that a higher CNS penetrating antiretroviral treatment, higher current CD4+ T cell count, and immune recovery from the nadir CD4+ T cell count were associated with increased FA and decreased MD (p < 0.05-0.006), while HIV duration, symptomatic, and asymptomatic cognitive impairment were associated with decreased FA and increased MD (p < 0.01-0.004). Stability of HIV treatment and antiretroviral CNS penetration efficiency in addition to current and historical immune recovery were related to higher FA and lower MD (p = 0.04-p < 0.01). In conclusion, WM DTI measures are near normal except for patients with neurocognitive impairment and longer HIV disease duration.
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Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia. .,Faculty of Medicine, UNSW Australia, Sydney, 2052, NSW, Australia. .,Peter Duncan Neuroscience Research Unit at the St. Vincent's Applied Medical Research Centre, Darlinghurst, 2010, NSW, Australia.
| | - James R Soares
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Guangqiang Geng
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Maia Scarpetta
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Kirsten Moffat
- Department of Imaging, St. Vincent's Hospital, Darlinghurst, 2010, NSW, Australia
| | - Michael Green
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Bruce J Brew
- Faculty of Medicine, UNSW Australia, Sydney, 2052, NSW, Australia.,Peter Duncan Neuroscience Research Unit at the St. Vincent's Applied Medical Research Centre, Darlinghurst, 2010, NSW, Australia.,Department of Neurology, Sydney St. Vincent's Hospital, Darlinghurst, 2010, NSW, Australia.,Department of Immunology, Sydney St. Vincent's Hospital, Darlinghurst, 2010, NSW, Australia
| | - Roland G Henry
- School of Medicine, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Caroline Rae
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,Faculty of Medicine, UNSW Australia, Sydney, 2052, NSW, Australia
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Zhang Y, Kwon D, Esmaeili-Firidouni P, Pfefferbaum A, Sullivan EV, Javitz H, Valcour V, Pohl KM. Extracting patterns of morphometry distinguishing HIV associated neurodegeneration from mild cognitive impairment via group cardinality constrained classification. Hum Brain Mapp 2016; 37:4523-4538. [PMID: 27489003 DOI: 10.1002/hbm.23326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/11/2016] [Accepted: 07/19/2016] [Indexed: 01/11/2023] Open
Abstract
HIV-Associated Neurocognitive Disorder (HAND) is the most common constellation of cognitive dysfunctions in chronic HIV infected patients age 60 or older in the U.S. Only few published methods assist in distinguishing HAND from other forms of age-associated cognitive decline, such as Mild Cognitive Impairment (MCI). In this report, a data-driven, nonparameteric model to identify morphometric patterns separating HAND from MCI due to non-HIV conditions in this older age group was proposed. This model enhanced the potential for group separation by combining a smaller, longitudinal data set containing HAND samples with a larger, public data set including MCI cases. Using cross-validation, a linear model on healthy controls to harmonize the volumetric scores extracted from MRIs for demographic and acquisition differences between the two independent, disease-specific data sets was trained. Next, patterns distinguishing HAND from MCI via a group sparsity constrained logistic classifier were identified. Unlike existing approaches, our classifier directly solved the underlying minimization problem by decoupling the minimization of the logistic regression function from enforcing the group sparsity constraint. The extracted patterns consisted of eight regions that distinguished HAND from MCI on a significant level while being indifferent to differences in demographics and acquisition between the two sets. Individually selecting regions through conventional morphometric group analysis resulted in a larger number of regions that were less accurate. In conclusion, simultaneously analyzing all brain regions and time points for disease specific patterns contributed to distinguishing with high accuracy HAND-related impairment from cognitive impairment found in the HIV uninfected, MCI cohort. Hum Brain Mapp 37:4523-4538, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yong Zhang
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, 94305
| | - Dongjin Kwon
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, 94305.,Center for Health Sciences, SRI International, Menlo Park, California, 94025
| | | | - Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, California, 94025
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, 94305
| | - Harold Javitz
- Center for Technology in Learning in the Education Division, SRI International, Menlo Park, California, 94025
| | - Victor Valcour
- Memory and Aging Center, UCSF, San Francisco, California
| | - Kilian M Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, 94305.,Center for Health Sciences, SRI International, Menlo Park, California, 94025
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Parkinsonism in HIV infected patients during antiretroviral therapy - data from a Brazilian tertiary hospital. Braz J Infect Dis 2016; 20:499-501. [PMID: 27449286 PMCID: PMC9425509 DOI: 10.1016/j.bjid.2016.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/15/2016] [Accepted: 05/29/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Advances in the treatment of HIV infection in the last decades have increased life expectancy of these patients and raise the question of what kind of effect chronic infection and its treatment might exert on the behavior of age-related conditions such as neurodegenerative diseases. PATIENT DATA We performed a retrospective analysis of patients' records to assess the frequency of the association between HIV infection and parkinsonian symptoms in our hospital population. Among 249 records we identified four individuals with reported parkinsonian symptoms initiated after HIV diagnosis. Three of them had no other identifiable cause of secondary parkinsonism. All had symptom onset before the age of 60. Based on this study sample one could estimate an incidence rate of nearly 101 per 100.000 person/year, which is similar to the risk of Parkinson's disease in the general population above 70 years. DISCUSSION These findings suggest that HIV infected individuals might be at a higher risk for developing parkinsonism as a manifestation of early neurodegeneration. Prospective and larger studies are needed to address this particular association and its characteristics.
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Maraviroc-intensified combined antiretroviral therapy improves cognition in virally suppressed HIV-associated neurocognitive disorder. AIDS 2016; 30:591-600. [PMID: 26825032 DOI: 10.1097/qad.0000000000000951] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether intensification of combined antiretroviral therapy (cART) with the CC chemokine receptor type 5 (CCR5) entry inhibitor maraviroc leads to improvement in global neurocognitive functioning in virally suppressed men with HIV-associated neurocognitive disorder (HAND). DESIGN Prospective, double observer-blinded, open-label pilot randomized-controlled trial. Participants were randomized to remain on their existing cART regimen (control arm; n = 8) or receive maraviroc-intensification (maraviroc arm; n = 9). METHODS Participants completed a five-domain neuropsychological battery at baseline, 6- and 12-month visits. Raw scores were transformed into age-corrected z-scores and averaged into a global z-score. Single voxel (H)-magnetic resonance spectroscopy (MRS) major cerebral metabolite concentrations were collected at baseline and 12 months in the basal ganglia and frontal white matter and quantified using jMRUI. Neuroinflammatory biomarkers cerebrospinal fluid neopterin and β2-microglobulin were also measured. RESULTS Fourteen of the 17 participants completed the study: nine maraviroc arm and five control. We found medium to large effect sizes in favour of improved global neurocognitive performance in the maraviroc arm over time {arm*time interaction: P < 0.05; 6 month: [β=-0.10, standard error (SE)= 0.04, 90% confidence interval (90%CI)= -0.18,.03; P < 0.03] yielding a large effect-size d = 0.77 (90%CI = -0.19,1.71); 12 month: [β=-0.01; SE = 0.05; 90%CI = -0.09, 0.06; P < 0.77] yielding a moderate effect-size d = 0.55 (90%CI = -0.47,1.55)}. No treatment-related changes were detected for H-MRS metabolites or cerebrospinal fluid biomarkers. CONCLUSION This pilot study provides feasibility, tolerability, proof-of-concept and preliminary evidence for clinically relevant neurocognitive improvement in cART enhancement with maraviroc in virally suppressed HAND patients. Lack of concomitant brain metabolite and biomarker change may be related to complex dynamics of brain repair.
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Abstract
In much of the developed world, the HIV epidemic has largely been controlled by antiretroviral treatment. Even so, there is growing concern that HIV-infected individuals may be at risk for accelerated brain aging and a range of cognitive impairments. What promotes or resists these changes is largely unknown. There is also interest in discovering factors that promote resilience to HIV and combat its adverse effects in children. Here, we review recent developments in brain imaging that reveal how the virus affects the brain. We relate these brain changes to changes in blood markers, cognitive function, and other patient outcomes or symptoms, such as apathy or neuropathic pain. We focus on new and emerging techniques, including new variants of brain MRI. Diffusion tensor imaging, for example, can map the brain's structural connections, while fMRI can uncover functional connections. Finally, we suggest how large-scale global research alliances, such as ENIGMA, may resolve controversies over effects where evidence is now lacking. These efforts pool scans from tens of thousands of individuals and offer a source of power not previously imaginable for brain imaging studies.
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Affiliation(s)
- Paul Thompson
- Dept. of Neurology, Keck USC School of Medicine, Imaging Genetics Center, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA 90292, Phone: (323) 44-BRAIN Fax: (323) 442-0137
| | - Neda Jahanshad
- Dept. of Neurology, Keck USC School of Medicine, Imaging Genetics Center, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA 90292, Phone: (323) 44-BRAIN Fax: (323) 442-0137
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Affiliation(s)
- Amy Justice
- aDepartment of Internal Medicine, Yale University and the Veterans Affairs Healthcare System, West Haven, CT 06516, USA bChronic Viral Illness Service and Division of Geriatrics, McGill University Health Center, Montreal, Quebec, Canada
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