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Prynn JE, Davey C, Davis D, Kuper H, Mugisha J, Seeley J. Cognition in older adults in Uganda: Correlates, trends over time and association with mortality in prospective population study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001798. [PMID: 37922221 PMCID: PMC10624290 DOI: 10.1371/journal.pgph.0001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/11/2023] [Indexed: 11/05/2023]
Abstract
Dementia is an important and growing issue in sub-Saharan Africa, but epidemiological data are lacking. Risk factors may differ from other regions due to high stroke incidence and HIV prevalence. Understanding the epidemiology of cognition in older adults in Africa is crucial for informing public health strategies to improve the lives of people with dementia and their carers. The Wellbeing of Older People Study in Uganda is an open cohort of adults aged 50+ with and without HIV, established in 2009. Detailed socio-demographic and health data have been collected at four waves spanning 10 years, including cognitive assessment using internationally validated WHO-recommended tests: verbal recall, digit span, and verbal fluency. Mortality data was collected until the end of the fourth wave (2019). We examined associations of low baseline cognition scores and changes in cognition score over time using random effects modelling, care needs of people with lower cognition scores, and the relationship between cognition score and mortality. Data were collected on 811 participants. Older age, lower educational attainment, lower socio-economic position, and extremes of BMI were associated with lower cognition scores. Cognition scores declined faster at older ages, but rate of decline was not associated with cardiovascular disease or HIV at baseline. People with lower cognition scores required more assistance with Activities of Daily Living, but mortality rates were similar across the range of cognition scores. The crucial next step will be to investigate types and presentation of clinical dementia in this cohort, so we can better understand the clinical relevance of these findings to inform public health planning.
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Affiliation(s)
- Josephine E. Prynn
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Calum Davey
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Hannah Kuper
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Crucial Role of Central Nervous System as a Viral Anatomical Compartment for HIV-1 Infection. Microorganisms 2021; 9:microorganisms9122537. [PMID: 34946138 PMCID: PMC8705402 DOI: 10.3390/microorganisms9122537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/11/2021] [Accepted: 07/17/2021] [Indexed: 11/17/2022] Open
Abstract
The chronic infection established by the human immunodeficiency virus 1 (HIV-1) produces serious CD4+ T cell immunodeficiency despite the decrease in HIV-1 ribonucleic acid (RNA) levels and the raised life expectancy of people living with HIV-1 (PLWH) through treatment with combined antiretroviral therapies (cART). HIV-1 enters the central nervous system (CNS), where perivascular macrophages and microglia are infected. Serious neurodegenerative symptoms related to HIV-associated neurocognitive disorders (HAND) are produced by infection of the CNS. Despite advances in the treatment of this infection, HAND significantly contribute to morbidity and mortality globally. The pathogenesis and the role of inflammation in HAND are still incompletely understood. Principally, growing evidence shows that the CNS is an anatomical reservoir for viral infection and replication, and that its compartmentalization can trigger the evolution of neurological damage and thus make virus eradication more difficult. In this review, important concepts for understanding HAND and neuropathogenesis as well as the viral proteins involved in the CNS as an anatomical reservoir for HIV infection are discussed. In addition, an overview of the recent advancements towards therapeutic strategies for the treatment of HAND is presented. Further neurological research is needed to address neurodegenerative difficulties in people living with HIV, specifically regarding CNS viral reservoirs and their effects on eradication.
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The Impact of Antiretroviral Therapy on Neurocognitive Outcomes Among People Living with HIV in Low- and Middle-Income Countries (LMICs): A Systematic Review. AIDS Behav 2021; 25:492-523. [PMID: 32851562 DOI: 10.1007/s10461-020-03008-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Low and middle-income countries (LMICs) are the epicenter of the HIV epidemic. The scale-up of antiretroviral therapy (ART) has reduced mortality, but HIV-associated neurocognitive impairment (HANI) remains prevalent, which impacts functional performance, medication adherence, and quality of life. We aimed to evaluate the effect of ART on neurocognitive outcomes among people living with HIV/AIDS in LMICs and to identify determinants of these outcomes. We searched electronic databases and reference lists for studies published between 1996 and 2019. Two reviewers screened the primary studies for inclusion and performed the critical appraisal. Results were synthesized using the 'Synthesis without meta-analysis' approach through simple vote counting. We identified 31 studies conducted across four regions (Africa, Asia, South America, and Eastern Europe). Nine studies were cross-sectional, 15 were prospective, and seven were randomized controlled trials. The majority of the articles showed improved neurocognitive performance with ART use but found no association with treatment duration, regimen, central penetrating effectiveness, and conventional biomarkers. Despite the lack of appropriate norms and not accounting for practice effect in most studies, the evidence suggests ART is useful in the treatment of HIV-associated neurocognitive impairment (HANI) but limited in addressing legacy effects, and peripheral, and central viral reservoirs. Improved early ART treatment programs, viral reservoir eradication strategies, and identification of novel biomarkers will be critical in efforts to minimize HIV-associated neurocognitive impairment. PROSPERO registration: CRD42020152908.
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Cilliers K, Muller CJF. Effect of Human Immunodeficiency Virus on Trace Elements in the Brain. Biol Trace Elem Res 2021; 199:41-52. [PMID: 32239375 DOI: 10.1007/s12011-020-02129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
Comorbidities of human immunodeficiency virus (HIV) include HIV-associated neurocognitive disorder (HAND). Changes in the brain due to HIV include atrophy, hyperintensities, and diffusion changes. However, no research has focused on trace elements concentration changes in the brain due to HIV, as seen in other neurodegenerative diseases. Therefore, the aim of this study was to determine the concentration of several trace elements in the brains of individuals with and without HIV infection. Prior to formalin embalming, blood was drawn and tested in triplicate with Determine HIV-1/2 rapid tests and confirmed with a SD HIV Device 1/2 3.0 rapid HIV Kit. After embalming, tissue was sampled from the caudate nucleus and analyzed using inductively coupled plasma mass spectrometry. A Kruskal-Wallis test was used to determine statistically significant differences between the two groups (p < 0.05). Fifteen HIV-positive and 14 HIV-negative male cadavers were included (mean age 44, range 22 to 61). Cadmium was marginally decreased, possibly due to malnutrition or utilization by the HIV nucleocapsid. Nickel was marginally increased, perhaps due to a reduced capability to remove metals from the body. In conclusion, this article provides the first information on trace element levels in the brains from HIV-infected individuals and postulates that cadmium and nickel may play a role in the pathophysiology of HAND. This information can contribute to finding a treatment for HAND, other than the use of antiretroviral drugs. Future studies should asses the levels of cadmium and nickel in a larger cohort of HIV-infected individuals.
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Affiliation(s)
- Karen Cilliers
- Division of Clinical Anatomy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa.
| | - Christo J F Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
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Cilliers K, Muller CJF. Effect of human immunodeficiency virus on the brain: A review. Anat Rec (Hoboken) 2020; 304:1389-1399. [PMID: 33231355 DOI: 10.1002/ar.24573] [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] [Received: 07/10/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Thirty million people are infected with human immunodeficiency virus (HIV) worldwide, and HIV-associated neurocognitive disorder (HAND) is one of the most common comorbidities of HIV. However, the effect of HIV on the brain has not been fully investigated. This article aimed to review the changes to the brain due to HIV in terms of atrophy, diffusion changes, and hyperintensities. Studies have observed significant atrophy in subcortical gray matter, as well as in cortical white and gray matter. Moreover, the ventricles enlarge, and the sulci widen. Although HIV causes changes to the white and gray matter of the brain, few diffusion tensor imaging studies have investigated the changes to gray matter integrity. White and gray matter hyperintensities have frequently been observed in HIV-positive individuals, with the subcortical gray matter (caudate nucleus and putamen) and periventricular white matter frequently affected. In conclusion, subcortical gray matter is the first brain region to be affected and is affected most severely. Additionally, this review highlights the gaps in the literature, since the effect of HIV on the brain is not fully known. Future studies should continue to investigate the effect of HIV on the brain in different stages of the disease, and alternate therapies should be developed since highly active antiretroviral therapy is currently ineffective at treating HAND.
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Affiliation(s)
- Karen Cilliers
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Christo J F Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Western Cape, South Africa.,Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
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Ciccarelli N. Considerations on nosology for HIV-associated neurocognitive disorders: it is time to update? Infection 2019; 48:37-42. [PMID: 31691905 DOI: 10.1007/s15010-019-01373-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Abstract
AIMS The prognosis and the clinical manifestations of HIV infection have changed with the introduction of the potent combination antiretroviral therapy (cART); however, up to 50% of patients meet research criteria for "HIV-associated neurocognitive disorders" (HAND) according with current nosology. The majority of patients affected by HAND, especially in cohorts with suppressed plasma viremia, showed an Asymptomatic Neurocognitive Impairment (ANI), without any functional impairment. After more than 10 years from the introduction of the current so-called "Frascati criteria", this mini-review aimed to address the emerging limitations in current diagnosis procedures. METHODS We discussed the most relevant literature on HAND prevalence, etiology, and diagnosis. RESULTS We addressed three main emerging issues: (1) the unclear clinical relevance of ANI entity; (2) the evidences that Frascati criteria could produce a significant overestimation of HAND; (3) the need to better identify patients with a higher risk to develop HAND requiring routine neuropsychological examinations. CONCLUSIONS Frascati criteria should be updated to better respond to the present characteristics of HIV + cohorts and to help clinicians in their cognitive and global management.
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Affiliation(s)
- Nicoletta Ciccarelli
- Department of Psychology, Catholic University, Largo Agostino Gemelli 1, 20123, Milan, Italy.
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Incidence and Properties of Neurologic Disorders Recovered from Iranian Patients with HIV Infection: A Case Series. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.81981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
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Abstract
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) affects roughly half the HIV-positive population. The symptoms of cognitive slowing, poor concentration, and memory problems can impact on everyday life. Its diagnosis is validated where possible by identifying deficits in two cognitive domains on neuropsychologic testing in patients either with or without symptoms. Corroborating evidence may be found on imaging, blood tests, and cerebrospinal fluid analysis, though sensitive and specific biomarkers are currently lacking. The introduction of combined antiretroviral therapy in the 1990s has generated a therapeutic paradox whereby the number of severe cases of HAND has fallen, yet milder forms continue to rise in prevalence. New emphasis has been placed on identifying the cause of apparent ongoing HIV infection and inflammation of the central nervous system (CNS) in the face of durable systemic viral suppression, and how this equates to the neuronal dysfunction underlying HAND. The interaction with aging and comorbidities is becoming increasingly common as the HIV-positive population enters older adulthood, with neurodegenerative, metabolic, and vascular causes of cognitive impairment combining and probably accelerating in the context of chronic HIV infection. Therapies targeted to the CNS, but without neurotoxic side-effects, are being investigated to attempt to reduce the likelihood of developing, and improving, HAND.
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Affiliation(s)
| | - Bruce James Brew
- Departments of Neurology and HIV Medicine, St. Vincent's Hospital and Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, NSW, Australia.
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Wright EJ, Thakur KT, Bearden D, Birbeck GL. Global developments in HIV neurology. HANDBOOK OF CLINICAL NEUROLOGY 2018; 152:265-287. [PMID: 29604981 DOI: 10.1016/b978-0-444-63849-6.00019-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurologic conditions associated with HIV remain major contributors to morbidity and mortality, and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence suggests that the central nervous system (CNS) serves as a reservoir for viral replication with major implications for human immunodeficiency virus (HIV) eradication strategies. Though there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of HIV-associated neurologic conditions, significant scientific gaps remain. In many low-income settings, second- and third-line cART regimens that carry substantial neurotoxicity remain treatment mainstays. Further, patients continue to present severely immunosuppressed with CNS opportunistic infections. Public health efforts should emphasize improvements in access and optimizing treatment of HIV-positive patients, specifically in resource-limited settings, to reduce the risk of neurologic sequelae.
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Affiliation(s)
- Edwina J Wright
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Australia; The Burnet Institute, Melbourne, Australia; Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Columbia University Medical Center, New York, NY, United States
| | - David Bearden
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Gretchen L Birbeck
- Strong Epilepsy Center, Department of Neurology, University of Rochester, Rochester, NY, United States; Chikankata Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
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HIV-1 counteracts an innate restriction by amyloid precursor protein resulting in neurodegeneration. Nat Commun 2017; 8:1522. [PMID: 29142315 PMCID: PMC5688069 DOI: 10.1038/s41467-017-01795-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022] Open
Abstract
While beta-amyloid (Aβ), a classic hallmark of Alzheimer's disease (AD) and dementia, has long been known to be elevated in the human immunodeficiency virus type 1 (HIV-1)-infected brain, why and how Aβ is produced, along with its contribution to HIV-associated neurocognitive disorder (HAND) remains ill-defined. Here, we reveal that the membrane-associated amyloid precursor protein (APP) is highly expressed in macrophages and microglia, and acts as an innate restriction against HIV-1. APP binds the HIV-1 Gag polyprotein, retains it in lipid rafts and blocks HIV-1 virion production and spread. To escape this restriction, Gag promotes secretase-dependent cleavage of APP, resulting in the overproduction of toxic Aβ isoforms. This Gag-mediated Aβ production results in increased degeneration of primary cortical neurons, and can be prevented by γ-secretase inhibitor treatment. Interfering with HIV-1's evasion of APP-mediated restriction also suppresses HIV-1 spread, offering a potential strategy to both treat infection and prevent HAND.
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Womersley JS, Seedat S, Hemmings SMJ. Childhood maltreatment and HIV-associated neurocognitive disorders share similar pathophysiology: a potential sensitisation mechanism? Metab Brain Dis 2017; 32:1717-1733. [PMID: 28681198 DOI: 10.1007/s11011-017-0062-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/16/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) are increasingly prevalent despite the use of antiretroviral therapies. Previous research suggests that individual host factors play an important role in determining susceptibility to HAND. In this review, we propose that childhood trauma (CT) and HAND share several common aetiological mechanisms, namely hypothalamic-pituitary-adrenal axis dysregulation, neuroinflammation and oxidative stress. These convergent and consequent mechanisms may translate into an increased risk of developing HAND in individuals who have experienced early life stress. We provide an overview of basic and clinical research relating to these pathophysiological mechanisms and suggest that further research examine brain-derived neurotrophic factor and telomere length as common mediating factors and potential therapeutic targets for HAND and CT. Graphical abstract Both childhood trauma and HIV-associated neurocognitive disorders are associated with HPA axis dysregulation, inflammation and oxidative stress.
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Affiliation(s)
- Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
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Brief Report: Peripheral Monocyte/Macrophage Phenotypes Associated With the Evolution of Cognitive Performance in HIV-Infected Patients. J Acquir Immune Defic Syndr 2017; 76:219-224. [PMID: 28902679 DOI: 10.1097/qai.0000000000001480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The contribution of monocyte activation in the development of HIV-associated neurocognitive disorders is not completely understood. This study aimed to explore the predictive value of peripheral monocyte/macrophage (M/M) phenotypes on the evolution of cognitive performance in a population of virologically suppressed HIV-infected patients. SETTING Prospective, observational, longitudinal study. METHODS HIV-1-infected patients with HIV-RNA <50copies/mL for >12 months underwent neuropsychological examination at baseline and after 1 year. Cognitive performance was evaluated using Z-transformed scores, and neurocognitive impairment (NCI) was defined according to Frascati criteria. Peripheral M/M phenotypes (classic CD14CD16, intermediate CD14CD16, and nonclassic CD14CD16) and specific surface activation markers (eg, CD163, CD11b, and CD38) were evaluated using flow cytometry at baseline. Predictive value of peripheral M/M phenotypes on the evolution of cognitive performance over 1-year follow-up was also evaluated. RESULTS Overall, 54 patients [85.2% men, median age 50 years (range 27-60 years), 27.8% hepatitis C virus coinfected, 48.1% with past AIDS-defining events, median nadir CD4 83 cells/μL (range 1-334), median baseline CD4 547 cells/μL (range 136-1652)] were enrolled. Proportion of patients with NCI was low, accounting for 13% at baseline and 16.5% after 1 year (P = 0.687). Memory was the only single domain in which decreased performance after 1 year was observed (-0.25 Z-score, P = 0.025). In patients with significant decrease (≥0.5 SD) in memory performance (n = 20), significantly lower CD14CD16CD163 (% CD14CD16) (P = 0.038) and higher CD14CD38 (% CD14) (P = 0.030) levels were observed. CONCLUSIONS In virologically suppressed HIV-infected patients, the evolution of memory performance could be linked to the expression of certain peripheral activated M/M phenotypes. Such associations should be verified in larger populations over the long term.
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Abstract
Effective combination antiretroviral therapy has transformed HIV infection into a chronic disease, with HIV-infected individuals living longer and reaching older age. Neurological disease remains common in treated HIV, however, due in part to ongoing inflammation and immune activation that persist in chronic infection. In this review, we highlight recent developments in our understanding of several clinically relevant neurologic complications that can occur in HIV infection despite treatment, including HIV-associated neurocognitive disorders, symptomatic CSF escape, cerebrovascular disease, and peripheral neuropathy.
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Affiliation(s)
- Nisha S Bhatia
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Felicia C Chow
- Departments of Neurology and Medicine (Infectious Diseases), University of California, San Francisco, CA, USA
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Valdebenito S, Barreto A, Eugenin EA. The role of connexin and pannexin containing channels in the innate and acquired immune response. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2017; 1860:154-165. [PMID: 28559189 DOI: 10.1016/j.bbamem.2017.05.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 12/20/2022]
Abstract
Connexin (Cx) and pannexin (Panx) containing channels - gap junctions (GJs) and hemichannels (HCs) - are present in virtually all cells and tissues. Currently, the role of these channels under physiological conditions is well defined. However, their role in the immune response and pathological conditions has only recently been explored. Data from several laboratories demonstrates that infectious agents, including HIV, have evolved to take advantage of GJs and HCs to improve viral/bacterial replication, enhance inflammation, and help spread toxicity into neighboring areas. In the current review, we discuss the role of Cx and Panx containing channels in immune activation and the pathogenesis of several infectious diseases. This article is part of a Special Issue entitled: Gap Junction Proteins edited by Jean Claude Herve.
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Affiliation(s)
- Silvana Valdebenito
- Public Health Research Institute (PHRI), Newark, NJ, USA; Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, USA
| | - Andrea Barreto
- Public Health Research Institute (PHRI), Newark, NJ, USA; Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, USA
| | - Eliseo A Eugenin
- Public Health Research Institute (PHRI), Newark, NJ, USA; Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, USA.
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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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Ene L, Marcotte TD, Umlauf A, Grancea C, Temereanca A, Bharti A, Achim CL, Letendre S, Ruta SM. Latent toxoplasmosis is associated with neurocognitive impairment in young adults with and without chronic HIV infection. J Neuroimmunol 2016; 299:1-7. [PMID: 27725106 DOI: 10.1016/j.jneuroim.2016.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 12/11/2022]
Abstract
We evaluated the impact of latent toxoplasmosis (LT) on neurocognitive (NC) and neurobehavioural functioning in young adults with and without chronic HIV infection, using a standardised NC test battery, self-reported Beck Depression Inventory, Frontal System Behavior Scale, MINI-International Neuropsychiatric Interview and risk-assessment battery. 194 young adults (median age 24years, 48.2% males) with chronic HIV infection (HIV+) since childhood and 51 HIV seronegative (HIV-) participants were included. HIV+ individuals had good current immunological status (median CD4: 479 cells/μl) despite a low CD4 nadir (median: 93 cells/μl). LT (positive anti-Toxoplasma IgG antibodies) was present in one third of participants. The impairment rates in the HIV- with and without Toxo were not significantly different (p=0.17). However, we observed an increasing trend (p<0.001) in impairment rates with HIV and LT status: HIV-/LT- (6.1%); HIV-/LT+ (22%), HIV+/LT- (31%), HIV+/LT+ (49%). In a multivariable analysis using the entire study group there were main effects on cognition for HIV and also for LT. Within the HIV+ group LT was associated with worse performance globally (p=0.006), in memory (p=0.009), speed of information processing (p=0.01), verbal (p=0.02) and learning (p=0.02) domains. LT was not associated with depressive symptoms, frontal systems dysfunction or risk behaviors in any of the groups. HIV participants with lower Toxoplasma antibody concentration had worse NC performance, with higher GDS values (p=0.03) and worse learning (p=0.002), memory (p=0.006), speed of information processing (p=0.01) T scores. Latent Toxoplasmosis may contribute to NC impairment in young adults, including those with and without chronic HIV infection.
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Affiliation(s)
- L Ene
- "Dr. Victor Babes" Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
| | - T D Marcotte
- University of California San Diego, La Jolla, CA, USA
| | - A Umlauf
- University of California San Diego, La Jolla, CA, USA
| | - C Grancea
- "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania
| | - A Temereanca
- "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania
| | - A Bharti
- University of California San Diego, La Jolla, CA, USA
| | - C L Achim
- University of California San Diego, La Jolla, CA, USA
| | - S Letendre
- University of California San Diego, La Jolla, CA, USA
| | - S M Ruta
- "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania
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18
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Marcario JK, Pendyala G, Riazi M, Fleming K, Marquis J, Callen S, Lisco SJ, Fowler SC, Cheney PD, Buch SJ. Effects of Morphine on Behavioral Task Performance in SIV-Infected Rhesus Macaques. J Neuroimmune Pharmacol 2016; 11:348-57. [PMID: 27039332 DOI: 10.1007/s11481-016-9667-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
The abuse of opiates such as morphine in synergy with HIV infection not only exacerbates neuropathogenesis but significantly impacts behavioral attributes in HIV infected subjects. Thus, the goal of the current study was to characterize behavioral perturbations in rhesus macaques subjected to chronic morphine and SIV infection. Specifically, we assessed three behavioral tasks: motor skill (MS), forelimb force (FFT) and progressive ratio (PR) tasks. After collecting baseline control data (44 weeks) and data during the morphine-only dependency period (26 weeks), a subset of animals were productively infected with neurovirulent strains of SIVmac (R71/E17) for an additional 33 weeks. A general pattern in the results is that behavioral decline occurred with high CSF viral loads but not necessarily with high plasma viral loads. Compared to saline controls, all treated animals showed significant decreases in performance on all three behavioral tasks during the morphine-only dependency period. During the post infection period, only the morphine plus SIV group showed a significant further decline and this only occurred for the MS task. Taken together, these data demonstrate a clear effect of morphine to produce behavioral deficits and also suggest that morphine can act synergistically with SIV/HIV to exacerbate behavioral deficits.
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Affiliation(s)
- Joanne K Marcario
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., mailstop 3043, Kansas City, KS, 66160-7336, USA
| | - Gurudutt Pendyala
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mariam Riazi
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., mailstop 3043, Kansas City, KS, 66160-7336, USA
| | - Kandace Fleming
- Research Design and Analysis Unit, Life Span Institute, University of Kansas, Lawrence, KS, USA
| | - Janet Marquis
- Research Design and Analysis Unit, Life Span Institute, University of Kansas, Lawrence, KS, USA
| | - Shannon Callen
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, 985880 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Steven J Lisco
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Stephen C Fowler
- Department of Pharmacology and Toxicology, University of Kansas, Lawrence, KS, USA
| | - Paul D Cheney
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., mailstop 3043, Kansas City, KS, 66160-7336, USA.
| | - Shilpa J Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, 985880 Nebraska Medical Center, Omaha, NE, 68198, USA.
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19
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Choi BY, DiNitto DM, Marti CN, Choi NG. Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients. West J Emerg Med 2016; 17:153-64. [PMID: 26973741 PMCID: PMC4786235 DOI: 10.5811/westjem.2016.1.28310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/03/2016] [Accepted: 01/07/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction A disproportionate number of individuals with human immunodeficiency virus (HIV) have mental health and substance-use disorders (MHSUDs), and MHSUDs are significantly associated with their emergency department (ED) visits. With an increasing share of older adults among HIV patients, this study investigated the associations of MHSUDs with ED outcomes of HIV patients in four age groups: 21–34, 35–49, 50–64, and 65+ years. Methods We used the 2012 Nationwide Emergency Department Sample (NEDS) dataset (unweighted n=23,244,819 ED events by patients aged 21+, including 115,656 visits by patients with HIV). Multinomial and binary logistic regression analyses, with “treat-and-release” as the base outcome, were used to examine associations between ED outcomes and MHSUDs among visits that included a HIV diagnosis in each age group. Results Mood and “other” mental disorders had small effects on ED-to-hospital admissions, as opposed to treat-and-release, in age groups younger than 65+ years, while suicide attempts had medium effects (RRR=3.56, CI [2.69–4.70]; RRR=4.44, CI [3.72–5.30]; and RRR=5.64, CI [4.38–7.26] in the 21–34, 35–49, and 50–64 age groups, respectively). Cognitive disorders had medium-to-large effects on hospital admissions in all age groups and large effects on death in the 35–49 (RRR=7.29, CI [3.90–13.62]) and 50–64 (RRR=5.38, CI [3.39–8.55]) age groups. Alcohol use disorders (AUDs) had small effects on hospital admission in all age groups (RRR=2.35, 95% CI [1.92–2.87]; RRR=2.15, 95% CI [1.95–2.37]; RRR=1.92, 95% CI [1.73–2.12]; and OR=1.93, 95% CI [1.20–3.10] in the 21–34, 35–49, 50–64, and 65+ age groups, respectively). Drug use disorders (DUDs) had small-to-medium effects on hospital admission (RRR=4.40, 95% CI [3.87–5.0]; RRR=4.07, 95% CI [3.77–4.40]; RRR=4.17, 95% CI [3.83–4.55]; and OR=2.53, 95% CI [2.70–3.78] in the 21–34, 35–49, 50–64, and 65+ age groups, respectively). AUDs and DUDs were also significantly related to the risk of death, and DUDs had a small effect on the risk of discharge against medical advice in the 35–49 and 50–64 age groups. Conclusion The high prevalence of MHSUDs and their significant roles in ED visit outcomes in patients with HIV provide support for integrated care for these patients outside the ED to reduce their ED visits and costly hospital admissions and institutional care that follows, especially for the increasing numbers of older adults with HIV.
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Affiliation(s)
- Brian Y Choi
- Warren Alpert Medical School at Brown Univeristy and Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island
| | - Diana M DiNitto
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - C Nathan Marti
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - Namkee G Choi
- The University of Texas at Austin, School of Social Work, Austin, Texas
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20
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Chronic SIV and morphine treatment increases heat shock protein 5 expression at the synapse. J Neurovirol 2015; 21:592-8. [PMID: 26037114 DOI: 10.1007/s13365-015-0356-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/13/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
The abuse of opiates such as morphine in synergy with HIV infection accelerates neurocognitive impairments and neuropathology in the CNS of HIV-infected subjects, collectively referred to as HAND. To identify potential pathogenic markers associated with HIV and morphine in perturbing the synaptic architecture, we performed quantitative mass spectrometry proteomics on purified synaptosomes isolated from the caudate of two groups of rhesus macaques chronically infected with SIV differing by one regimen-morphine treatment. The upregulation of heat shock 70-kDa protein 5 in the SIV + morphine group points to increased cellular stress during SIV/morphine interaction thus leading to CNS dysfunction.
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