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Wedderburn CJ, Sevenoaks T, Fouche JP, Phillips NJ, Lawn SD, Stein DJ, Hoare J. Motivation levels and white matter microstructure in children living with HIV. Sci Rep 2024; 14:4425. [PMID: 38396081 PMCID: PMC10891087 DOI: 10.1038/s41598-024-54411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Central nervous system involvement in HIV infection leads to neurobehavioural sequelae. Although apathy is a well-recognised symptom in adults living with HIV linked to alterations in brain structure, there is scarce research examining motivation in children living with HIV (CLWH). We used the Children's Motivation Scale (CMS; normative mean = 50, SD = 10) to assess motivation levels in 76 CLWH aged 6-16 years (63 on antiretroviral therapy [ART]; 13 ART-naïve slow progressors) in South Africa. Overall, CLWH scored low on the CMS (mean = 35.70 [SD = 5.87]). Motivation levels were significantly reduced in children taking ART compared to ART-naïve slow progressors (p = 0.02), but were not correlated with markers of HIV disease (CD4 + cell count or viral load), or neurocognitive function (p > 0.05). CMS scores were correlated with diffusion tensor imaging metrics of white matter microstructure in specific frontostriatal brain regions (p < 0.05). On multiple regression, associations with the anterior limb of the internal capsule, a subcortical white matter region, remained significant after adjusting for potential confounders. These findings suggest that reduced motivation may be an important neurobehavioural symptom in CLWH and may reflect changes in white matter microstructure of frontostriatal brain regions.
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Affiliation(s)
- Catherine J Wedderburn
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tatum Sevenoaks
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nicole J Phillips
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Stephen D Lawn
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- SA MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Caceres GA, Scambray KA, Malee K, Smith R, Williams PL, Wang L, Jenkins LM. Relationship between brain structural network integrity and emotional symptoms in youth with perinatally-acquired HIV. Brain Behav Immun 2024; 116:101-113. [PMID: 38043871 PMCID: PMC10842701 DOI: 10.1016/j.bbi.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023] Open
Abstract
Perinatally acquired HIV infection (PHIV) currently affects approximately 1.7 million children worldwide. Youth with PHIV (YPHIV) are at increased risk for emotional and behavioral symptoms, yet few studies have examined relationships between these symptoms and brain structure. Previous neuroimaging studies in YPHIV report alterations within the salience network (SN), cognitive control network (CCN), and default mode network (DMN). These areas have been associated with social and emotional processing, emotion regulation, and executive function. We examined structural brain network integrity from MRI using morphometric similarity networks and graph theoretical measures of segregation (transitivity), resilience (assortativity), and integration (global efficiency). We examined brain network integrity of 40 YPHIV compared to 214 youths without HIV exposure or infection. Amongst YPHIV, we related structural brain network metrics to the Emotional Symptoms Index of the Behavioral Assessment System for Children, 2nd edition. We also examined the relationship of inflammatory biomarkers in YPHIV to brain network integrity. YPHIV had significantly lower global efficiency in the SN, DMN, and the whole brain network compared to controls. YPHIV also demonstrated lower assortativity or resilience (i.e., network robustness) compared to controls in the DMN and whole brain network. Further, higher emotional symptom score was associated with higher global efficiency in the SN and lower global efficiency in the DMN, signaling more emotional challenges. A significant association was also found between several inflammatory and cardiac markers with structural network integrity. These findings suggest an impact of HIV on developing brain networks, and potential dysfunction of the SN and DMN in relation to network efficiency.
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Affiliation(s)
- Gabriella A Caceres
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kiana A Scambray
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kathleen Malee
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Renee Smith
- University of Illinois, Chicago, IL, United States
| | - Paige L Williams
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lei Wang
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Lisanne M Jenkins
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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Salan T, Willen EJ, Cuadra A, Sheriff S, Maudsley AA, Govind V. Whole-brain MR spectroscopic imaging reveals regional metabolite abnormalities in perinatally HIV infected young adults. Front Neurosci 2023; 17:1134867. [PMID: 36937663 PMCID: PMC10017464 DOI: 10.3389/fnins.2023.1134867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Perinatally acquired HIV (PHIV) has been associated with brain structural and functional deficiencies, and with poorer cognitive performance despite the advent of antiretroviral therapy (ART). However, investigation of brain metabolite levels in PHIV measured by proton magnetic resonance spectroscopy (MRS) methods, is still limited with often inconclusive or contradictory findings. In general, these MRS-based methods have used a single voxel approach that can only evaluate metabolite concentrations in a few select brain anatomical regions. Additionally, most of the published data have been on children perinatally infected with HIV with only a few studies examining adult populations, though not exclusively. Therefore, this prospective and cross-sectional study aims to evaluate metabolite differences at the whole-brain level, using a unique whole-brain proton magnetic resonance spectroscopy imaging (MRSI) method, in a group of PHIV infected young adults (N = 28) compared to age and gender matched control sample (N = 28), and to find associations with HIV clinical factors and neurocognitive scores. MRSI data were acquired on a 3T scanner with a TE of 70 ms. Brain metabolites levels of total N-acetylaspartate (tNAA), total choline (tCho) and total creatine (tCre), as well as ratios of tNAA/tCre, tCho/tCre, and tNAA/tCho, were obtained from the whole brain level and evaluated at the level of gray matter (GM) and white matter (WM) tissue types and anatomical regions of interest (ROI). Our results indicate extensive metabolic abnormalities throughout the brains of PHIV infected subjects with significantly elevated levels of tCre and tCho, notably in GM regions. Decreases in tNAA and ratios of tNAA/tCre and tNAA/tCho were also found mostly in WM regions. These metabolic alterations indicate increased glial activation, inflammation, neuronal dysfunction, and energy metabolism in PHIV infected individuals, which correlated with a reduction in CD4 cell count, and lower cognitive scores. Our findings suggest that significant brain metabolite alterations and associated neurological complications persist in the brains of those with PHIV on long-term ART, and advocates the need for continued monitoring of their brain health.
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Affiliation(s)
- Teddy Salan
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Elizabeth J. Willen
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Anai Cuadra
- Department of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Andrew A. Maudsley
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
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van Genderen JG, Chia C, Van den Hof M, Mutsaerts HJMM, Reneman L, Pajkrt D, Schrantee A. Brain Differences in Adolescents Living With Perinatally Acquired HIV Compared With Adoption Status Matched Controls: A Cross-sectional Study. Neurology 2022; 99:e1676-e1684. [PMID: 35940898 PMCID: PMC9559945 DOI: 10.1212/wnl.0000000000200946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite effective combination antiretroviral therapy (cART), adolescents with perinatally acquired HIV (PHIV) exhibit cognitive impairment, of which structural changes could be the underlying pathophysiologic mechanism. Prior MRI studies found lower brain volumes, higher white matter (WM) hyperintensity (WMH) volume, lower WM integrity, and differences in cerebral blood flow (CBF). However, these findings may be confounded by adoption status, as a large portion of adolescents with PHIV have been adopted. Adoption has been associated with malnutrition and neglect, which, in turn, may have affected brain development. We investigated the long-term effects of PHIV on the brain, while minimizing the confounding effect of adoption status. METHODS We determined whole-brain gray matter (GM) and WM volume with 3D T1-weighted scans; total WMH volume with fluid-attenuated inversion recovery; CBF in the following regions of interest (ROIs): WM, GM, and subcortical GM with arterial spin labeling; and whole-brain WM microstructural markers: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) with diffusion tensor imaging in cART-treated adolescents with PHIV visiting our outpatient clinic in Amsterdam and controls matched for age, sex, ethnic origin, socioeconomic status, and adoption status. We assessed differences in neuroimaging parameters between adolescents with PHIV and controls using linear regression models adjusted for age and sex and applied multiple comparison correction. RESULTS Thirty-five adolescents with PHIV and 38 controls were included with a median age of 14.9 (interquartile range [IQR]: 10.7-18.5) and 15.6 (IQR: 11.1-17.6) years, respectively, with a similar rate of adoption. We found a lower overall FA (beta = -0.012; p < 0.014, -2.4%), a higher MD (beta = 0.014, p = 0.014, 1.3%), and a higher RD (beta = 0.02, p = 0.014, 3.3%) in adolescents with PHIV vs adoption-matched controls, but no differences in AD. We found comparable GM, WM, and WMH volume and CBF in ROIs between adolescents with PHIV and controls. We did not find an association between cognitive profiles and WM microstructural markers in adolescents with PHIV. DISCUSSION Irrespective of adoption status, adolescents with PHIV exhibited subtle lower WM integrity. Our findings may point toward early-acquired WM microstructural alterations associated with HIV.
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Affiliation(s)
- Jason G van Genderen
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands.
| | - Cecilia Chia
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Malon Van den Hof
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Henk J M M Mutsaerts
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Liesbeth Reneman
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Dasja Pajkrt
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Anouk Schrantee
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
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Khobo IL, Jankiewicz M, Holmes MJ, Little F, Cotton MF, Laughton B, van der Kouwe AJW, Moreau A, Nwosu E, Meintjes EM, Robertson FC. Multimodal magnetic resonance neuroimaging measures characteristic of early cART-treated pediatric HIV: A feature selection approach. Hum Brain Mapp 2022; 43:4128-4144. [PMID: 35575438 PMCID: PMC9374890 DOI: 10.1002/hbm.25907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 11/09/2022] Open
Abstract
Children with perinatally acquired HIV (CPHIV) have poor cognitive outcomes despite early combination antiretroviral therapy (cART). While CPHIV-related brain alterations can be investigated separately using proton magnetic resonance spectroscopy (1 H-MRS), structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and functional MRI (fMRI), a set of multimodal MRI measures characteristic of children on cART has not been previously identified. We used the embedded feature selection of a logistic elastic-net (EN) regularization to select neuroimaging measures that distinguish CPHIV from controls and measured their classification performance via the area under the receiver operating characteristic curve (AUC) using repeated cross validation. We also wished to establish whether combining MRI modalities improved the models. In single modality analysis, sMRI volumes performed best followed by DTI, whereas individual EN models on spectroscopic, gyrification, and cortical thickness measures showed no class discrimination capability. Adding DTI and 1 H-MRS in basal measures to sMRI volumes produced the highest classification performancevalidation accuracy = 85 % AUC = 0.80 . The best multimodal MRI set consisted of 22 DTI and sMRI volume features, which included reduced volumes of the bilateral globus pallidus and amygdala, as well as increased mean diffusivity (MD) and radial diffusivity (RD) in the right corticospinal tract in cART-treated CPHIV. Consistent with previous studies of CPHIV, select subcortical volumes obtained from sMRI provide reasonable discrimination between CPHIV and controls. This may give insight into neuroimaging measures that are relevant in understanding the effects of HIV on the brain, thereby providing a starting point for evaluating their link with cognitive performance in CPHIV.
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Affiliation(s)
- Isaac L. Khobo
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Marcin Jankiewicz
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Martha J. Holmes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Francesca Little
- Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mark F. Cotton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Barbara Laughton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Andre J. W. van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- A.A. Martinos Centre for Biomedical ImagingMassachusetts General HospitalBostonMassachusettsUSA
- Department of RadiologyHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Emmanuel Nwosu
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
| | - Ernesta M. Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Frances C. Robertson
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
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Ma J, Yang X, Xu F, Li H. Application of Diffusion Tensor Imaging (DTI) in the Diagnosis of HIV-Associated Neurocognitive Disorder (HAND): A Meta-Analysis and a System Review. Front Neurol 2022; 13:898191. [PMID: 35873786 PMCID: PMC9302369 DOI: 10.3389/fneur.2022.898191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/20/2022] [Indexed: 12/20/2022] Open
Abstract
Background The patients with HIV-associated neurocognitive disorder (HAND) are often accompanied by white matter structure damage. Diffusion tensor imaging (DTI) is an important tool to detect white matter structural damage. However, the changes in DTI values reported in many studies are diverse in different white matter fiber tracts and brain regions. Purpose Our research is dedicated to evaluating the consistency and difference of the correlation between HAND and DTI measures in different studies. Additionally, the value of DTI in HAND evaluation is used to obtain consensus and independent conclusions between studies. Methods We searched PubMed and Web of Science to collect relevant studies using DTI for the diagnosis of HAND. After screening and evaluating the search results, meta-analysis is used for quantitative research on data. Articles that cannot collect data but meet the research relevance will be subjected to a system review. Results The meta-analysis shows that the HAND group has lower fractional anisotropy (standardized mean difference = −0.57 p < 0.0001) and higher mean diffusivity (standardized mean difference = 0.04 p < 0.0001) than the healthy control group in corpus callosum. In other white matter fibers, we found similar changes in fractional anisotropy (standardized mean difference = −1.18 p < 0.0001) and mean diffusivity (standardized mean difference = 0.69 p < 0.0001). However, the heterogeneity (represented by I2) between the studies is high (in corpus callosum 94, 88%, in other matter fibers 95, 81%). After subgroup analysis, the heterogeneity is obtained as 19.5, 40.7% (FA, MD in corpus callosum) and 0, 0% (FA, MD among other white matter fibers). Conclusion The changes in white matter fibers in patients with HAND are statistically significant at the observation level of DTI compared with healthy people. The differences between the studies are mainly derived from demographics, start and maintenance time of antiretroviral therapy, differences in nadir CD4+T cells, and the use of different neurocognitive function scales. As an effective method to detect the changes in white matter fibers, DTI is of great significance for the diagnosis of HAND, but there are still some shortcomings. In the absence of neurocognitive function scales, independent diagnosis remains difficult. Systematic Review Registration:https://inplasy.com/inplasy-2021-10-0079/.
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Affiliation(s)
- Juming Ma
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Xue Yang
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Fan Xu
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
- *Correspondence: Hongjun Li
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Longitudinal Assessment of Lipoprotein(a) Levels in Perinatally HIV-Infected Children and Adolescents. Viruses 2021; 13:v13102067. [PMID: 34696496 PMCID: PMC8539147 DOI: 10.3390/v13102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
HIV is an independent risk factor of cardiovascular disease (CVD); therefore, perinatally HIV-infected (PHIV) children potentially have a greater CVD risk at older age. Lipoprotein(a) (Lp(a)) is an established risk factor for CVD in the general population. To evaluate a potential increased CVD risk for PHIV children, we determined their lipid profiles including Lp(a). In the first substudy, we assessed the lipid profiles of 36 PHIV children visiting the outpatient clinic in Amsterdam between 2012 and 2020. In the second substudy, we enrolled 21 PHIV adolescents and 23 controls matched for age, sex and ethnic background on two occasions with a mean follow-up time of 4.6 years. We assessed trends of lipid profiles and their determinants, including patient and disease characteristics, using mixed models. In the first substudy, the majority of PHIV children were Black (92%) with a median age of 8.0y (5.7–10.8) at first assessment. Persistent elevated Lp(a) levels were present in 21/36 (58%) children (median: 374 mg/L (209–747); cut off = 300). In the second substudy, the median age of PHIV adolescents was 17.5y (15.5–20.7) and of matched controls 16.4y (15.8–19.5) at the second assessment. We found comparable lipid profiles between groups. In both studies, increases in LDL-cholesterol and total cholesterol were associated with higher Lp(a) levels. A majority of PHIV children and adolescents exhibited elevated Lp(a) levels, probably associated with ethnic background. Nonetheless, these elevated Lp(a) levels may additionally contribute to an increased CVD risk.
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8
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Rowe K, Buivydaite R, Heinsohn T, Rahimzadeh M, Wagner RG, Scerif G, Stein A. Executive function in HIV-affected children and adolescents: a systematic review and meta-analyses. AIDS Care 2021; 33:833-857. [PMID: 33764813 DOI: 10.1080/09540121.2021.1873232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This review aimed to determine: whether EF is affected in children and adolescents (2-24-years-old) with perinatal HIV infection, perinatal HIV exposure without infection, and behaviourally acquired HIV. A systematic review (PROSPERO number: CRD42017067813) was conducted using 11 electronic databases (01.01.1981-09.07.2019) and 8 conference websites. Primary quantitative studies with EF scores on cognitive tasks and/or behavioural report measures were included. Meta-analyses were performed by EF subtype and subpopulations compared. 1789 records were found. Sixty-one studies were included in the narrative synthesis; 32 (N = 7884 participants) were included in meta-analyses. There was a distinct pattern of reduced EF in those with perinatal HIV infection on antiretroviral therapy compared to controls: pooled effect sizes were largest for verbal and visuospatial working memory, with smaller effects on planning, inhibitory control and set-shifting. Data were limited for other HIV-affected subpopulations. Perinatal HIV infection is associated with reduced EF with varying effect sizes for the different EF subtypes.
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Affiliation(s)
- Kirsten Rowe
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Ruta Buivydaite
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Torben Heinsohn
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Mana Rahimzadeh
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Gaia Scerif
- Developmental Cognitive Neuroscience, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alan Stein
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Sarma MK, Pal A, Keller MA, Welikson T, Ventura J, Michalik DE, Nielsen-Saines K, Deville J, Kovacs A, Operskalski E, Church JA, Macey PM, Biswal B, Thomas MA. White matter of perinatally HIV infected older youths shows low frequency fluctuations that may reflect glial cycling. Sci Rep 2021; 11:3086. [PMID: 33542389 PMCID: PMC7862588 DOI: 10.1038/s41598-021-82587-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
In perinatally HIV-infected (PHIV) children, neurodevelopment occurs in the presence of HIV-infection, and even with combination antiretroviral therapy (cART) the brain can be a reservoir for latent HIV. Consequently, patients often demonstrate long-term cognitive deficits and developmental delay, which may be reflected in altered functional brain activity. Our objective was to examine brain function in PHIV on cART by quantifying the amplitude of low frequency fluctuations (ALFF) and regional homogeneity (ReHo). Further, we studied ALFF and ReHo changes with neuropsychological performance and measures of immune health including CD4 count and viral loads in the HIV-infected youths. We found higher ALFF and ReHo in cerebral white matter in the medial orbital lobe for PHIV (N = 11, age mean ± sd = 22.5 ± 2.9 years) compared to controls (N = 16, age = 22.5 ± 3.0 years), with age and gender as co-variates. Bilateral cerebral white matter showed increased spontaneous regional activity in PHIV compared to healthy controls. No brain regions showed lower ALFF or ReHo in PHIV compared to controls. Higher log10 viral load was associated with higher ALFF and ReHo in PHIV in bilateral cerebral white matter and right cerebral white matter respectively after masking the outcomes intrinsic to the brain regions that showed significantly higher ALFF and ReHo in the PHIV compared to the control. Reductions in social cognition and abstract thinking in PHIV were correlated with higher ALFF at the left cerebral white matter in the left medial orbital gyrus and higher ReHo at the right cerebral white matter in the PHIV patients. Although neuroinflammation and associated neuro repair were not directly measured, the findings support their potential role in PHIV impacting neurodevelopment and cognition.
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Affiliation(s)
- Manoj K Sarma
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA
| | - Amrita Pal
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Margaret A Keller
- Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tamara Welikson
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Ventura
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David E Michalik
- Infectious Diseases-Pediatrics, Miller Children's Hospital of Long Beach, Long Beach, CA, USA
| | | | - Jaime Deville
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrea Kovacs
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.,Los Angeles+USC Medical Center, Los Angeles, CA, USA
| | - Eva Operskalski
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.,Los Angeles+USC Medical Center, Los Angeles, CA, USA
| | - Joseph A Church
- Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bharat Biswal
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - M Albert Thomas
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA.
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10
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Cognition, Structural Brain Changes, and Systemic Inflammation in Adolescents Living With HIV on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2020; 84:114-121. [PMID: 32032303 DOI: 10.1097/qai.0000000000002314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between neurocognitive impairment, neuroimaging, and systemic inflammation in perinatally infected adolescents living with HIV (PHIV) on antiretroviral therapy (ART). Systemic inflammation may be one mechanism driving neurocognitive impairment despite ART, but this has not been investigated in adolescence when the brain is undergoing rapid development. SETTING Cape Town, South Africa. METHODS Baseline data were drawn from the Cape Town Adolescent Antiretroviral Cohort. PHIV on ART >6 months completed a comprehensive neurocognitive test battery. Diffusion tensor imaging and structural brain magnetic resonance imaging was done to determine whole brain fractional anisotropy, mean diffusion (MD), grey and white matter volumes, and cortical thickness. We examined how neurocognitive and neurostructural measures were associated with a concurrently measured marker of systemic inflammation, high-sensitive C-reactive protein (hs-CRP). RESULTS One hundred sixty-eight PHIV ages 9-12 years (mean CD4 980 cells/µL; 85.3% viral load <50 copies/mL) and 43 controls were included in the analysis. PHIV had similar hs-CRP (P = 0.17) to controls, after participants with hs-CRP >10 were excluded from the analysis. Forty-eight percent of the PHIV in this analysis have a neurocognitive disorder. Whole brain grey (P = 0.049) and white matter volumes (P = 0.044) were lowest in PHIV with a major neurocognitive disorder. Higher MD, was found in PHIV with a major neurocognitive disorder (P = 0.002). Among PHIV with a neurocognitive disorder, hs-CRP negatively correlated with general intelligence, visual spatial acuity, and executive function (all P = < 0.05). Whole brain MD correlated with higher hs-CRP values (P = < 0.01) in PHIV. CONCLUSIONS A marker of systemic inflammation was associated with both neurocognitive impairment and MD increases in PHIV.
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11
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Abstract
Human immunodeficiency virus (HIV) is a neurotropic virus that has a detrimental impact on the developing central nervous system (CNS) of children growing up with perinatal HIV (PHIV) due to a combination of pathophysiological processes related to direct viral cytopathic effects and immune activation. This leads to a spectrum of neurocognitive impairment ranging from severe encephalopathy to subtle domain-specific cognitive impairments, as well as psychological disorders that are compounded by HIV-related stigma and sociodemographic factors that disproportionately affect PHIV children. Early commencement and consistent use of combination antiretroviral therapy (cART) has resulted in a dramatic improvement in neuropsychological outcomes for PHIV children; however, they remain vulnerable to cognitive impairment and psychological disorders, as evidenced by imaging findings, randomised clinical trials and observational studies. An optimal neuroprotective cART regimen remains elusive in children, but systemic viral suppression, regular neurocognitive and psychological screening and ready access to neuropsychological management strategies are key components for optimising neuropsychological outcomes. However, a lack of standardised and validated screening tools, particularly in resource-limited settings, hinders a precise understanding of the nature, prevalence and associations between neuropsychological symptomatology and HIV health. This article reviews the natural history, cellular pathophysiology and structural and functional imaging findings for children growing up with HIV, as well as summarising management strategies related to antiretroviral therapy, screening tools and specific interventions for neurocognitive impairments and psychological disorders.
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12
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Raper J, Kovacs-Balint Z, Mavigner M, Gumber S, Burke MW, Habib J, Mattingly C, Fair D, Earl E, Feczko E, Styner M, Jean SM, Cohen JK, Suthar MS, Sanchez MM, Alvarado MC, Chahroudi A. Long-term alterations in brain and behavior after postnatal Zika virus infection in infant macaques. Nat Commun 2020; 11:2534. [PMID: 32439858 PMCID: PMC7242369 DOI: 10.1038/s41467-020-16320-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/21/2020] [Indexed: 12/18/2022] Open
Abstract
Zika virus (ZIKV) infection has a profound impact on the fetal nervous system. The postnatal period is also a time of rapid brain growth, and it is important to understand the potential neurobehavioral consequences of ZIKV infection during infancy. Here we show that postnatal ZIKV infection in a rhesus macaque model resulted in long-term behavioral, motor, and cognitive changes, including increased emotional reactivity, decreased social contact, loss of balance, and deficits in visual recognition memory at one year of age. Structural and functional MRI showed that ZIKV-infected infant rhesus macaques had persistent enlargement of lateral ventricles, smaller volumes and altered functional connectivity between brain areas important for socioemotional behavior, cognitive, and motor function (e.g. amygdala, hippocampus, cerebellum). Neuropathological changes corresponded with neuroimaging results and were consistent with the behavioral and memory deficits. Overall, this study demonstrates that postnatal ZIKV infection in this model may have long-lasting neurodevelopmental consequences.
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Affiliation(s)
- Jessica Raper
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Maud Mavigner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Sanjeev Gumber
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Mark W Burke
- Department of Physiology and Biophysics, Howard University, Washington, DC, USA
| | - Jakob Habib
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cameron Mattingly
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Damien Fair
- Oregon Health and Science University, Portland, OR, USA
| | - Eric Earl
- Oregon Health and Science University, Portland, OR, USA
| | - Eric Feczko
- Oregon Health and Science University, Portland, OR, USA
| | - Martin Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Sherrie M Jean
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Joyce K Cohen
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehul S Suthar
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, 30329, USA
| | - Mar M Sanchez
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria C Alvarado
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Ann Chahroudi
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA.
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13
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Ackermann C, Andronikou S, Saleh MG, Kidd M, Cotton MF, Meintjes EM, Laughton B. Diffusion tensor imaging point to ongoing functional impairment in HIV-infected children at age 5, undetectable using standard neurodevelopmental assessments. AIDS Res Ther 2020; 17:20. [PMID: 32430069 PMCID: PMC7236356 DOI: 10.1186/s12981-020-00278-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Perinatal HIV infection negatively impacts cognitive functioning of children, main domains affected are working memory, processing speed and executive function. Early ART, even when interrupted, improves neurodevelopmental outcomes. Diffusion tension imaging (DTI) is a sensitive tool assessing white matter damage. We hypothesised that white matter measures in regions showing HIV-related alterations will be associated with lower neurodevelopmental scores in specific domains related to the functionality of the affected tracts. Methods DTI was performed on children in a neurodevelopmental sub study from the Children with HIV Early Antiretroviral (CHER) trial. Voxel-based group comparisons to determine regions where fractional anisotropy and mean diffusion differed between HIV+ and uninfected children were done. Locations of clusters showing group differences were identified using the Harvard–Oxford cortical and subcortical and John Hopkins University WM tractography atlases provided in FSL. This is a second review of DTI data in this cohort, which was reported in a previous study. Neurodevelopmental assessments including GMDS and Beery-Buktenica tests were performed and correlated with DTI parameters in abnormal white matter. Results 38 HIV+ children (14 male, mean age 64.7 months) and 11 controls (4 male, mean age 67.7 months) were imaged. Two clusters with lower fractional anisotropy and 7 clusters with increased mean diffusion were identified in the HIV+ group. The only neurodevelopmental domain with a trend of difference between the HIV+ children and controls (p = 0.08), was Personal Social Quotient which correlated to improved myelination of the forceps minor in the control group. As a combined group there was a negative correlation between visual perception and radial diffusion in the right superior longitudinal fasciculus and left inferior longitudinal fasciculus, which may be related to the fact that these tracts, forming part of the visual perception pathway, are at a crucial state of development at age 5. Conclusion Even directed neurodevelopmental tests will underestimate the degree of microstructural white matter damage detected by DTI. The visual perception deficit detected in the entire study population should be further examined in a larger study.
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14
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Lewis-de Los Angeles CP, Williams PL, Jenkins LM, Huo Y, Malee K, Alpert KI, Uban KA, Herting MM, Csernansky JG, Nichols SL, Van Dyke RB, Sowell ER, Wang L. Brain morphometric differences in youth with and without perinatally-acquired HIV: A cross-sectional study. NEUROIMAGE-CLINICAL 2020; 26:102246. [PMID: 32251906 PMCID: PMC7132093 DOI: 10.1016/j.nicl.2020.102246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/20/2022]
Abstract
We performed vertex-wise analyses comparing grey matter in youth with and without perinatally-acquired HIV (PHIV). PHIV youth had reduced cortical thickness, surface area, and gyrification compared to control youth. PHIV youth did not exhibit the same pattern of inverse grey matter-age relationships that were observed in control youth.
Youth with perinatally-acquired HIV (PHIV) experience specific and global cognitive deficits at increased rates compared to typically-developing HIV-uninfected youth. In youth with PHIV, HIV infects the brain early in development. Neuroimaging studies have demonstrated altered grey matter morphometry in youth with PHIV compared to typically-developing youth. This study examined cortical thickness, surface area, and gyrification of grey matter in youth (age 11–20 years old) with PHIV (n = 40) from the Pediatric HIV/AIDS Cohort Study (PHACS) compared to typically-developing presumed HIV uninfected and unexposed youth (n = 80) from the Pediatric Imaging, Neurocognition and Genetics Study (PING) using structural magnetic resonance imaging. This study also examined the relationship between grey matter morphometry and age. Youth with PHIV had reduced cortical thickness, surface area, and gyrification compared to typically-developing youth. In addition, an inverse relationship between age and grey matter volume was found in typically-developing youth, but was not observed in youth with PHIV. Longitudinal studies are necessary to understand the neurodevelopmental trajectory of youth with PHIV.
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Affiliation(s)
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA, USA; Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lisanne M Jenkins
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathleen Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Kathryn I Alpert
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Kristina A Uban
- Department of Public Health, University of California Irvine, Irvine, CA, USA
| | - Megan M Herting
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John G Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Sharon L Nichols
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Russell B Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Elizabeth R Sowell
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA; Department of Radiology, Northwestern University, Chicago, IL, USA.
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15
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Brain microstructural changes support cognitive deficits in HIV uninfected children born to HIV infected mothers. Brain Behav Immun Health 2020; 2:100039. [PMID: 34589830 PMCID: PMC8474176 DOI: 10.1016/j.bbih.2020.100039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Antiretroviral therapy (ART) is considered the most effective way to prevent perinatal transmission of human immunodeficiency virus (HIV). However, there is little knowledge about the effect of ART on the brain of HIV uninfected children born to HIV infected mothers (HUC). The current study evaluated the brain's microstructural integrity, and cognitive function in HUC compared to healthy children born to normal mothers (CHNM) and HIV infected children born to HIV infected mothers (HIC) to investigate the effect of in-utero exposure of ART on cerebral gray and white matter. Materials and methods Forty nine HIC, 12 HUC and 18 CHNM underwent neuropsychological (NP) assessment and a brain MRI. Diffusion tensor imaging (DTI) data was used to generate fractional anisotropy (FA) and mean diffusivity (MD) maps. Voxel wise comparison for FA and MD was performed between three groups using an analysis of covariance (ANCOVA) including age and sex as covariates, and correction for multiple comparisons (false discovery rate (FDR), p < 0.05 with minimum extended cluster size, 150 voxels). NP test scores were also compared between three groups using ANOVA with Post Hoc Bonferroni multiple comparison corrections (p < 0.05). Significantly changed FA and MD values in different brain regions in HIC and HUC compared to CHNM were used for correlation analysis with NP test scores using Pearson's correlation. Results HIC and HUC groups showed significantly decreased NP test scores in various domain compared to CHNM. Significantly lower NP test scores was observed in HIC than those of HUC. HIC showed decreased FA and increased MD in multiple brain sites as compared to both CHNM and HUC. Decreased FA along with both increased and decreased MD in different brain regions was present in HUC compared to CHNM. Both positive and negative correlation of altered FA and MD values from different brain regions in HIC and HUC with NP test scores was observed. Conclusion The presence of brain tissue changes and neurocognitive function deficit in absence of HIV infection in HUC indicates that ART may have a detrimental impact on the developing brain. The findings of the current study underscore the need for screening of ART exposed children for neurodevelopment and cognitive abnormalities at an early stage and call for access to early interventions, and nutritional and care programs.
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16
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Chahroudi A, Wagner TA, Persaud D. CNS Persistence of HIV-1 in Children: the Untapped Reservoir. Curr HIV/AIDS Rep 2019; 15:382-387. [PMID: 30159813 DOI: 10.1007/s11904-018-0412-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The central nervous system (CNS) represents a potential HIV-1 reservoir that may need to be specifically targeted by remission strategies. Perinatally HIV-1-infected children and youth are exposed to HIV-1 at a critical period of brain development. This review summarizes the current literature regarding HIV-1 and the CNS in perinatal infection. RECENT FINDINGS HIV-1-associated encephalopathy is prevalent with perinatal infection and neurocognitive impairment persists even following antiretroviral treatment (ART)-mediated suppression of viremia. Compartmentalization of HIV-1 between plasma and CSF of ART-naïve, perinatally infected children suggests the presence of a CNS reservoir; however, similar studies have not yet been conducted with ART suppression. CSF viral escape where CSF and plasma virus concentrations are discordant has been reported in this population, but larger studies with well-defined virologic and immunologic parameters are needed. A better understanding of HIV-1 persistence in the CNS with perinatal infection is essential for improving long-term neurocognitive outcomes and for designing strategies to induce HIV-1 remission in this population.
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Affiliation(s)
- Ann Chahroudi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Thor A Wagner
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Deborah Persaud
- Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building 1170, Baltimore, MD, 21205, USA.
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17
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Systemic and intrathecal immune activation in association with cerebral and cognitive outcomes in paediatric HIV. Sci Rep 2019; 9:8004. [PMID: 31142789 PMCID: PMC6541601 DOI: 10.1038/s41598-019-44198-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/24/2019] [Indexed: 01/23/2023] Open
Abstract
Despite treatment, immune activation is thought to contribute to cerebral injury in children perinatally infected with human immunodeficiency virus (HIV). We aimed to characterize immune activation in relation to neuroimaging and cognitive outcomes. We therefore measured immunological, coagulation, and neuronal biomarkers in plasma and cerebrospinal fluid (CSF) samples of 34 perinatally HIV-infected children aged 8–18 years, and in plasma samples of 37 controls of comparable age, sex, ethnicity, and socio-economic status. We then compared plasma biomarker levels between groups, and explored associations between plasma/CSF biomarkers and neuroimaging and cognitive outcomes using network analysis. HIV-infected children showed higher plasma levels of C-reactive protein, interferon-gamma, interferon-gamma-inducible protein-10, and monocyte chemoattractant protein-1 than controls. In HIV-infected participants, plasma soluble CD14 was positively associated with microstructural white matter (WM) damage, and plasma D-dimer was negatively associated with WM blood flow. In CSF, IL-6 was negatively associated with WM volume, and neurofilament heavy-chain (NFH) was negatively associated with intelligence quotient and working memory. These markers of ongoing inflammation, immune activation, coagulation, and neuronal damage could be used to further evaluate the pathophysiology and clinical course of cerebral and cognitive deficits in perinatally acquired HIV.
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18
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Van den Hof M, Ter Haar AM, Caan MWA, Spijker R, van der Lee JH, Pajkrt D. Brain structure of perinatally HIV-infected patients on long-term treatment: A systematic review. Neurol Clin Pract 2019; 9:433-442. [PMID: 31750029 DOI: 10.1212/cpj.0000000000000637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
Abstract
Objective We aim to give an overview of the available evidence on brain structure and function in PHIV-infected patients (PHIV+) using long-term combination antiretroviral therapy (cART) and how differences change over time. Methods We conducted an electronic search using MEDLINE, Embase, and PsycINFO. We used the following selection criteria: cohort and cross-sectional studies that reported on brain imaging differences between PHIV+ of all ages who used cART for at least six months before neuroimaging and HIV-negative controls. Two reviewers independently selected studies, performed data extraction, and assessed quality of studies. Results After screening 1500 abstracts and 343 full-text articles, we identified 19 eligible articles. All included studies had a cross-sectional design and used MRI with different modalities: structural MRI (n = 7), diffusion tensor imaging (DTI) (n = 6), magnetic resonance spectroscopy (n = 5), arterial spin labeling (n = 1), and resting-state functional neuroimaging (n = 1). Studies showed considerable methodological limitations and heterogeneity, preventing us to perform meta-analyses. DTI data on white matter microstructure suggested poorer directional diffusion in cART-treated PHIV+ compared with controls. Other modalities were inconclusive. Conclusion Evidence may suggest brain structure and function differences in the population of PHIV+ on long-term cART compared with the HIV-negative population. Because of a small study population, and considerable heterogeneity and methodological limitations, the extent of brain structure and function differences on neuroimaging between groups remains unknown.
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Affiliation(s)
- Malon Van den Hof
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Anne Marleen Ter Haar
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Matthan W A Caan
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Rene Spijker
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Johanna H van der Lee
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Dasja Pajkrt
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
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19
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Wade BSC, Valcour VG, Puthanakit T, Saremi A, Gutman BA, Nir TM, Watson C, Aurpibul L, Kosalaraksa P, Ounchanum P, Kerr S, Dumrongpisutikul N, Visrutaratna P, Srinakarin J, Pothisri M, Narr KL, Thompson PM, Ananworanich J, Paul RH, Jahanshad N. Mapping abnormal subcortical neurodevelopment in a cohort of Thai children with HIV. NEUROIMAGE-CLINICAL 2019; 23:101810. [PMID: 31029050 PMCID: PMC6482384 DOI: 10.1016/j.nicl.2019.101810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
Alterations in subcortical brain structures have been reported in adults with HIV and, to a lesser extent, pediatric cohorts. The extent of longitudinal structural abnormalities in children with perinatal HIV infection (PaHIV) remains unclear. We modeled subcortical morphometry from whole brain structural magnetic resonance imaging (1.5 T) scans of 43 Thai children with PaHIV (baseline age = 11.09±2.36 years) and 50 HIV- children (11.26±2.80 years) using volumetric and surface-based shape analyses. The PaHIV sample were randomized to initiate combination antiretroviral treatment (cART) when CD4 counts were 15-24% (immediate: n = 22) or when CD4 < 15% (deferred: n = 21). Follow-up scans were acquired approximately 52 weeks after baseline. Volumetric and shape descriptors capturing local thickness and surface area dilation were defined for the bilateral accumbens, amygdala, putamen, pallidum, thalamus, caudate, and hippocampus. Regression models adjusting for clinical and demographic variables examined between and within group differences in morphometry associated with HIV. We assessed whether baseline CD4 count and cART status or timing associated with brain maturation within the PaHIV group. All models were adjusted for multiple comparisons using the false discovery rate. A pallidal subregion was significantly thinner in children with PaHIV. Regional thickness, surface area, and volume of the pallidum was associated with CD4 count in children with PaHIV. Longitudinal morphometry was not associated with HIV or cART status or timing, however, the trajectory of the left pallidum volume was positively associated with baseline CD4 count. Our findings corroborate reports in adult cohorts demonstrating a high predilection for HIV-mediated abnormalities in the basal ganglia, but suggest the effect of stable PaHIV infection on morphological aspects of brain development may be subtle.
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Affiliation(s)
- Benjamin S C Wade
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA; Ahmanson-Lovelace Brain Mapping Center University of California, Los Angeles, Los Angeles, CA, USA; Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, USA
| | - Victor G Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Arvin Saremi
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Boris A Gutman
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Talia M Nir
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Christa Watson
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Pope Kosalaraksa
- Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | | | - Stephen Kerr
- HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Jiraporn Srinakarin
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Monthana Pothisri
- Department of Radiology, Chulalongkorn University Medical Center, Bangkok, Thailand
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Jintanat Ananworanich
- HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, MD, USA; Department of Global Health, University of Amsterdam, Amsterdam, the Netherlands; Henry M. Jackson Foundation for the Advancement of Military Medicine, MD, USA
| | - Robert H Paul
- Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA.
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20
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Hoare J, Heany SJ, Fouche JP, Phillips N, Joska JA, Myer L, Zar HJ, Stein DJ. Initiation of antiretroviral therapy after the critical neuronal developmental period of the second postnatal year affects white matter microstructure in adolescents living with HIV. J Neurovirol 2019; 25:254-262. [PMID: 30617850 DOI: 10.1007/s13365-018-0712-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
Rapid maturation of major white matter pathways occurs in the first 2 years of life, indicating a critical neuronal developmental period. The impact of initiating antiretroviral therapy (ART) in children perinatally infected with HIV-1, after the age of 2 years on neurocognitive functioning and white matter development in adolescence has not been studied. Forty-six adolescents who initiated ART during the first 2 years of life (< 2 years) and 79 adolescents who initiated ART after 2 years of age (> 2 years), with perinatally acquired HIV were enrolled in the Cape Town Adolescent Antiretroviral Cohort. Adolescents completed a comprehensive neurocognitive battery testing a number of cognitive domains. Diffusion tensor imaging (DTI) was done to determine fractional anisotropy (FA), mean diffusivity (MD), axial diffusion (AD), and radial diffusion (RD) in a region of interest analysis. Neurocognitive performance was similar between adolescents who initiated ART < 2 years or > 2 years. There was a trend towards attention (p = .07) and working memory (p = .05) being poorer in the group who initiated ART > 2 years. FA was lower in the > 2-year group in the superior corona radiata (p = .03), and the external capsule (p = .04). MD was higher in the > 2-year group in the cerebral peduncle (p = .02), the superior corona radiata (p = .01), and the superior fronto-occipital fasciculus (p = .03). RD was higher in the > 2-year group in the superior corona radiata (p = .02), the cerebral peduncle (p = .01), and the superior fronto-occipital fasciculus (p = .01). However, the higher AD in the > 2-year group in the superior corona radiata was not in the expected direction (p = .01). Initiation of ART after the neuronal development period of the second postnatal year is associated with white matter alterations on neuroimaging.
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Affiliation(s)
- Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.
| | - Sarah J Heany
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Nicole Phillips
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, UCT, Cape Town, South Africa.,SA Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.,Medical Research Council Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
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21
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Sarma MK, Keller MA, Macey PM, Michalik DE, Hayes J, Nielsen-Saines K, Deville J, Church JA, Walot I, Albert Thomas M. White matter microstructure among perinatally HIV-infected youth: a diffusion tensor imaging study. J Neurovirol 2019; 25:313-323. [PMID: 30610741 DOI: 10.1007/s13365-018-0714-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
We evaluated white matter microstructure integrity in perinatally HIV-infected (PHIV) youths receiving cART compared to age- and gender-matched healthy youths through DTI metrics using voxel-based morphometry (VBM). We investigated 14 perinatally HIV-infected patients (age 17.9 ± 2.5 years) on cART and 17 healthy youths (HC) (age 18.0 ± 3.0 years) using a 3T MRI scanner. Four DTI-derived metrics were fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Statistical analysis was done with voxel-based analysis of covariance (ANCOVA), with age and gender as covariates. Region-of-interest secondary analyses in statistically significant regions were also performed. Regional increases in FA in the PHIV youths were found in left middle frontal gyrus, right precuneus, right lingual gyrus, and left supramarginal gyrus. Increased MD was found in the right precentral gyrus while decreased MD was found in the white matter of the right superior parietal lobule and right inferior temporal gyrus/fusiform gyrus. Regions of increased/decreased RD overlapped with regions of increased/decreased MD. Both increased and decreased AD were found in three to four regions respectively. The regional FA, MD, RD, and AD values were consistent with the voxel-based analysis findings. The findings are mostly consistent with previous literature, but increased FA has not been previously reported for perinatally HIV-infected youths. Potentially early and prolonged therapy in our population may have contributed to this new finding. Both toxicity of antiretroviral therapy and indolent infection must be considered as causative factors in the DTI metric changes that we have observed.
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Affiliation(s)
- Manoj K Sarma
- Radiological Sciences, David Geffen School of Medicine, UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA
| | - Margaret A Keller
- Pediatrics, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA.,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Paul M Macey
- Brain Research Institute, UCLA School of Medicine, Los Angeles, CA, USA.,UCLA School of Nursing, Los Angeles, CA, USA
| | - David E Michalik
- Infectious Diseases-Pediatrics, Miller Children's Hospital of Long Beach, Long Beach, CA, USA
| | - Judy Hayes
- Pediatrics, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Jaime Deville
- Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph A Church
- Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Irwin Walot
- Radiology, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - M Albert Thomas
- Radiological Sciences, David Geffen School of Medicine, UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1721, USA.
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22
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Hoare J, Fouche JP, Phillips N, Joska JA, Myer L, Zar HJ, Stein DJ. Structural brain changes in perinatally HIV-infected young adolescents in South Africa. AIDS 2018; 32:2707-2718. [PMID: 30234601 DOI: 10.1097/qad.0000000000002024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe the structural brain changes, neurocognitive and mental health associations in adolescents perinatally infected with HIV-1 infection. DESIGN Cross-sectional. METHODS Two hundred and four adolescents with perinatally acquired HIV and 44 uninfected frequency-matched controls aged 9-11 years were enrolled within the Cape Town Adolescent Antiretroviral Cohort. Diffusion tensor imaging and structural brain MRI was done to determine fractional anisotropy, mean diffusivity, grey and white matter volumes, cortical thickness and cortical surfractional anisotropy area. Correlation coefficients were calculated between total grey and white matter volume, cortical surface area, cortical thickness, whole brain fractional anisotropy and whole brain mean diffusivity and clinical and laboratory parameters including general intellectual functioning, Becks Youth Inventory, Child Motivation Scale and Child Behaviour Checklist. RESULTS HIV-infected adolescents performed worse than controls on the Wechsler Abbreviated Scale of Intelligence (WASI; P < 0.01). HIV-infected adolescents had significant fractional anisotropy decreases, mean diffusivity increases and decreases in cerebral grey matter volumes, cortical surface area and decreased gyrification. Whole-brain mean fractional anisotropy was significantly reduced in the HIV-infected group (P = 0.031). There were significant correlation coefficients between greater total grey (P = 0.008) and white matter volume (P = 0.004) with the WASI and the Becks self-concept subscale (P = 0.038). Lower whole brain fractional anisotropy was associated with higher scores on the Becks anger (P = 0.018) and disruptive behaviour subscales (P = 0.031). Higher whole brain mean diffusivity was associated with apathy (P = 0.046). CONCLUSION The pattern of increased risk of white matter microstructure alterations, smaller grey matter volumes, reduced cortical surface area and decreased gyrification, suggests abnormal neurodevelopment in perinatally infected younger adolescents.
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23
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Gómez LA, Crowell CS, Njuguna I, Cranmer LM, Wamalwa D, Chebet D, Otieno V, Maleche-Obimbo E, Gladstone M, John-Stewart G, Benki-Nugent S. Improved Neurodevelopment After Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus-infected Children. Pediatr Infect Dis J 2018; 37:916-922. [PMID: 29438131 PMCID: PMC6087680 DOI: 10.1097/inf.0000000000001942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Late human immunodeficiency virus (HIV) diagnosis after severe co-morbidity remains common in resource-limited settings. Neurodevelopmental recovery during antiretroviral therapy (ART) for late-diagnosed children is understudied. We determined 6-month neurodevelopmental trajectories in HIV-infected children initiating ART during hospitalization. METHODS HIV-infected children initiated ART after HIV diagnosis during hospitalization in Kenya. The Malawi Developmental Assessment Tool was administered after clinical stabilization within 1 month and at 6 months post-ART initiation. Baseline versus 6-month Z scores for each developmental domain were compared; cofactors for change in Z scores were evaluated using linear regression. RESULTS Among 74 children, median age was 1.7 years (interquartile range, 0.8-2.4) and median Z scores for gross motor, fine motor, social and language domains were -1.34, -1.04, -0.53 and -0.95, respectively. At baseline, children with higher plasma viremia had lower social Z scores (P = 0.008). Better nourished (weight-for-age Z score [WAZ] ≥-2) children had higher Z scores in all developmental domains (all P values ≤0.05). After 6 months on ART (n = 58), gross and fine motor Z scores improved significantly (mean change 0.39; P = 0.007 and 0.43; P = 0.001, respectively), but social and language did not. Children with better immune and growth response to ART had higher gains in gross motor (0.05 per unit-gain CD4%; P = 0.04; 0.34 per unit-gain WAZ; P = 0.006 and 0.44 per unit-gain height-for-age Z score; P = 0.005), social (0.37 per unit-gain WAZ; P = 0.002) and language (0.25 per unit-gain height-for-age Z score; P = 0.01). CONCLUSIONS Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.
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Affiliation(s)
- Laurén A. Gómez
- Dept. of Global Health, Univ. of Washington, Seattle, WA, USA
| | - Claudia S. Crowell
- Dept. of Pediatrics, Div. of Pediatric Infectious Diseases, Univ. of Washington and Seattle Children’s Hospital, Seattle, WA, USA
| | - Irene Njuguna
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | - Lisa M. Cranmer
- Dept. of Pediatrics, Emory Univ. and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Dalton Wamalwa
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | - Daisy Chebet
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | - Vincent Otieno
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | | | - Melissa Gladstone
- Dept. Of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
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24
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Abstract
BACKGROUND Children with vertically acquired HIV exhibit persistent cognitive impairments, yet the corresponding neuroimaging signature of vertical infection remains unclear. METHODS Fifty healthy control children and 51 vertically infected children were included in the study. The HIV-infected group consisted of survivors who had not received antiretroviral therapy at birth. The HIV-infected group averaged 11.4 (2.5) years of age, with a median CD4 count of 683 cells/mm(3). Most (71%) of the HIV-infected children were on antiretroviral therapy for a median of 34 months (range: 33-42) with HIV RNA <40 copies/mL in 89% of the sample. The HIV-uninfected group averaged 10.6 (2.6) years of age. Magnetic resonance imaging was acquired to determine volumes of the caudate, putamen, thalamus, pallidum, hippocampus, nucleus accumbens, total white matter, total gray matter and cortical gray matter. Correlational analyses examined the degree of shared variance between brain volumes and both cognitive performances and laboratory markers of disease activity (T cells and plasma viral load). RESULTS HIV-infected children exhibited larger volumes of the caudate, nucleus accumbens, total gray matter and cortical gray matter when compared with the controls. Volumetric differences were predominately evident in children under 12 years of age. HIV-infected children performed worse than controls on most neuropsychologic tests, though neither cognitive performances nor laboratory markers corresponded to brain volumes in the HIV-infected children. CONCLUSIONS Outcomes of the present study suggest abnormal brain maturation among HIV-infected pediatric survivors. Longitudinal studies of brain integrity and related resilience factors are needed to determine the impact of neuroimaging abnormalities on psychosocial function in pediatric HIV.
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25
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Nwosu EC, Robertson FC, Holmes MJ, Cotton MF, Dobbels E, Little F, Laughton B, van der Kouwe A, Meintjes EM. Altered brain morphometry in 7-year old HIV-infected children on early ART. Metab Brain Dis 2018; 33:523-535. [PMID: 29209922 PMCID: PMC5866746 DOI: 10.1007/s11011-017-0162-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
Abstract
Even with the increased roll out of combination antiretroviral therapy (cART), paediatric HIV infection is associated with neurodevelopmental delays and neurocognitive deficits that may be accompanied by alterations in brain structure. Few neuroimaging studies have been done in children initiating ART before 2 years of age, and even fewer in children within the critical stage of brain development between 5 and 11 years. We hypothesized that early ART would limit HIV-related brain morphometric deficits at age 7. Study participants were 7-year old HIV-infected (HIV+) children from the Children with HIV Early Antiretroviral Therapy (CHER) trial whose viral loads were supressed at a young age, and age-matched uninfected controls. We used structural magnetic resonance imaging (MRI) and FreeSurfer ( http://www.freesurfer.net/ ) software to investigate effects of HIV and age at ART initiation on cortical thickness, gyrification and regional brain volumes. HIV+ children showed reduced gyrification compared to controls in bilateral medial parietal regions, as well as reduced volumes of the right putamen, left hippocampus, and global white and gray matter and thicker cortex in small lateral occipital region. Earlier ART initiation was associated with lower gyrification and thicker cortex in medial frontal regions. Although early ART appears to preserve cortical thickness and volumes of certain brain structures, HIV infection is nevertheless associated with reduced gyrification in the parietal cortex, and lower putamen and hippocampus volumes. Our results indicate that in early childhood gyrification is more sensitive than cortical thickness to timing of ART initiation. Future work will clarify the implications of these morphometric effects for neuropsychological function.
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Affiliation(s)
- Emmanuel C Nwosu
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Frances C Robertson
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martha J Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Els Dobbels
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, Faculty of Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- A.A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Ernesta M Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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26
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Toich JTF, Taylor PA, Holmes MJ, Gohel S, Cotton MF, Dobbels E, Laughton B, Little F, van der Kouwe AJW, Biswal B, Meintjes EM. Functional Connectivity Alterations between Networks and Associations with Infant Immune Health within Networks in HIV Infected Children on Early Treatment: A Study at 7 Years. Front Hum Neurosci 2018; 11:635. [PMID: 29375341 PMCID: PMC5768628 DOI: 10.3389/fnhum.2017.00635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022] Open
Abstract
Although HIV has been shown to impact brain connectivity in adults and youth, it is not yet known to what extent long-term early antiretroviral therapy (ART) may alter these effects, especially during rapid brain development in early childhood. Using both independent component analysis (ICA) and seed-based correlation analysis (SCA), we examine the effects of HIV infection in conjunction with early ART on resting state functional connectivity (FC) in 7 year old children. HIV infected (HIV+) children were from the Children with HIV Early Antiretroviral Therapy (CHER) trial and all initiated ART before 18 months; uninfected children were recruited from an interlinking vaccine trial. To better understand the effects of current and early immune health on the developing brain, we also investigated among HIV+ children the association of FC at 7 years with CD4 count and CD4%, both in infancy (6–8 weeks) and at scan. Although we found no differences within any ICA-generated resting state networks (RSNs) between HIV+ and uninfected children (27 HIV+, 18 uninfected), whole brain connectivity to seeds located at RSN connectivity peaks revealed several loci of FC differences, predominantly from seeds in midline regions (posterior cingulate cortex, paracentral lobule, cuneus, and anterior cingulate). Reduced long-range connectivity and increased short-range connectivity suggest developmental delay. Within the HIV+ children, clinical measures at age 7 years were not associated with FC values in any of the RSNs; however, poor immune health during infancy was associated with localized FC increases in the somatosensory, salience and basal ganglia networks. Together these findings suggest that HIV may affect brain development from its earliest stages and persist into childhood, despite early ART.
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Affiliation(s)
- Jadrana T F Toich
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Paul A Taylor
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,African Institute for Mathematical Sciences, Muizenberg, South Africa.,Scientific and Statistical Computing Core, National Institutes of Health, Bethesda, MD, United States
| | - Martha J Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Suril Gohel
- Department of Health Informatics, School of Health Professions, Rutgers University, Newark, NJ, United States
| | - Mark F Cotton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Els Dobbels
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Bharat Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Ernesta M Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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27
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Abstract
Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or without a contrast agent). In addition, single-photon emission computed tomography with various tracers (e.g., thallium-201, Tc99-HMPAO) and positron emission tomography with various agents (e.g., [18F]-dexoyglucose, [11C]-PiB, and [11C]-TSPO tracers), were applied to study opportunistic infections or HIV-associated neurocognitive disorders. Neuroimaging provides diagnoses and biomarkers to quantitate the severity of brain injury or to monitor treatment effects, and may yield insights into the pathophysiology of HIV infection. As the majority of antiretroviral-stable HIV+ patients are living longer, age-related comorbid disorders (e.g., additional neuroinflammation, cerebrovascular disorders, or other dementias) will need to be considered. Other highly prevalent conditions, such as substance use disorders, psychiatric illnesses, and the long-term effects of combined antiretroviral therapy, all may lead to additional brain injury. Neuroimaging studies could provide knowledge regarding how these comorbid conditions impact the HIV-infected brain. Lastly, specific molecular imaging agents may be needed to assess the central nervous system viral reservoir.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Medicine and Department of Neurology, John A. Burns School of Medicine, University of Hawaii, Manoa, United States.
| | - Dinesh K Shukla
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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28
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Randall SR, Warton CMR, Holmes MJ, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM. Larger Subcortical Gray Matter Structures and Smaller Corpora Callosa at Age 5 Years in HIV Infected Children on Early ART. Front Neuroanat 2017; 11:95. [PMID: 29163068 PMCID: PMC5673662 DOI: 10.3389/fnana.2017.00095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Sub-Saharan Africa is home to 90% of HIV infected (HIV+) children. Since the advent of antiretroviral therapy (ART), HIV/AIDS has transitioned to a chronic condition where central nervous system (CNS) damage may be ongoing. Although, most guidelines recommend early ART to reduce CNS viral reservoirs, the brain may be more vulnerable to potential neurotoxic effects of ART during the rapid development phase in the first years of life. Here we investigate differences in subcortical volumes between 5-year-old HIV+ children who received early ART (before age 18 months) and uninfected children using manual tracing of Magnetic Resonance Images. Participants included 61 Xhosa children (43 HIV+/18 uninfected, mean age = 5.4 ± 0.3 years, 25 male) from the children with HIV early antiretroviral (CHER) trial; 27 children initiated ART before 12 weeks of age (ART-Before12Wks) and 16 after 12 weeks (ART-After12Wks). Structural images were acquired on a 3T Allegra MRI in Cape Town and manually traced using MultiTracer. Volumetric group differences (HIV+ vs. uninfected; ART-Before12Wks vs. ART-After12Wks) were examined for the caudate, nucleus accumbens (NA), putamen (Pu), globus pallidus (GP), and corpus callosum (CC), as well as associations within infected children of structure volumes with age at ART initiation and CD4/CD8 as a proxy for immune health. HIV+ children had significantly larger NA and Pu volumes bilaterally and left GP volumes than controls, whilst CC was smaller. Bilateral Pu was larger in both treatment groups compared to controls, while left GP and bilateral NA were enlarged only in ART-After12Wks children. CC was smaller in both treatment groups compared to controls, and smaller in ART-After12Wks compared to ART-Before12Wks. Within infected children, delayed ART initiation was associated with larger Pu volumes, effects that remained significant when controlling for sex and duration of treatment interruption (left β = 0.447, p = 0.005; right β = 0.325, p = 0.051), and lower CD4/CD8 with larger caudates controlling for sex (left β = -0.471, p = 0.002; right β = -0.440, p = 0.003). Volumetric differences were greater in children who initiated ART after 12 weeks. Results suggest damage is ongoing despite early ART and viral load suppression; however, earlier treatment is neuroprotective.
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Affiliation(s)
- Steven R. Randall
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher M. R. Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark F. Cotton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre J. W. van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ernesta M. Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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29
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Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning. J Acquir Immune Defic Syndr 2017; 75:455-464. [PMID: 28481783 DOI: 10.1097/qai.0000000000001441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known regarding effects of perinatally acquired HIV infection (PHIV) on longitudinal change in memory and executive functioning (EF) during adolescence despite the importance of these skills for independence in adulthood. METHODS PHIV (n = 144) and perinatally HIV-exposed uninfected youth (PHEU, n = 79), ages 12-17, completed standardized tests of memory and EF at baseline and 2 years later. Changes from baseline for each memory and EF outcome were compared between PHEU and PHIV youth with (PHIV/C, n = 39) and without (PHIV/non-C, n = 105) history of CDC class C (AIDS-defining) diagnoses. Among PHIV youth, associations of baseline and past disease severity with memory and EF performance at follow-up were evaluated using adjusted linear regression models. RESULTS Participants were primarily black (79%); 16% were Hispanic; 55% were female. Mean memory and EF scores at follow-up generally fell in the low-average to average range. Pairwise comparison of adjusted mean change from baseline to follow-up revealed significantly greater change for PHIV/non-C compared with PHEU youth in only one verbal recognition task, with a difference in mean changes for PHIV/non-C versus PHEU of -0.99 (95% CI: -1.80 to -0.19; P = 0.02). Among youth with PHIV, better immunologic status at baseline was positively associated with follow-up measures of verbal recall and recognition and cognitive inhibition/flexibility. Past AIDS-defining diagnoses and higher peak viral load were associated with lower performance across multiple EF tasks at follow-up. CONCLUSIONS Youth with PHIV demonstrated stable memory and EF during a 2-year period of adolescence, allowing cautious optimism regarding long-term outcomes.
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Jankiewicz M, Holmes MJ, Taylor PA, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM. White Matter Abnormalities in Children with HIV Infection and Exposure. Front Neuroanat 2017; 11:88. [PMID: 29033797 PMCID: PMC5627060 DOI: 10.3389/fnana.2017.00088] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Due to changes in guidelines and access to treatment, more children start combination antiretroviral therapy (ART) in infancy. With few studies examining the long-term effects of perinatal HIV infection and early ART on neurodevelopment, much is still unknown about brain maturation in the presence of HIV and ART. Follow-up studies of HIV infected (HIV+) children are important for monitoring brain development in the presence of HIV infection and ART. Methods: We use diffusion tensor imaging (DTI) to examine white matter (WM) in 65 HIV+ and 46 control (HIV exposed uninfected (HEU) and HIV unexposed uninfected (HU)) 7-year-old children. This is a follow up of a cohort studied at 5 years, where we previously reported lower fractional anisotropy (FA) in corticospinal tract (CST) and mean diffusivity (MD) increases in inferior/superior longitudinal fasciculi (ILF/SLF), inferior fronto-occipital fasciculus (IFOF) and uncinate fasciculus (UF) in HIV+ children compared to uninfected controls. In addition, we also found a difference in FA related to age at which ART was initiated. Results: At 7 years, we found two regions in the left IFOF and left ILF with lower FA in HIV+ children compared to controls. Higher MD was observed in a similar region in the IFOF, albeit bilaterally, as well as multiple clusters bilaterally in the superior corona radiata (SCR), the anterior thalamic radiation (ATR) and the right forceps minor. Unlike at 5 years, we found no impact on WM of ART initiation. In HEU children, we found a cluster in the right posterior corona radiata with higher FA compared to HU children, while bilateral regions in the CST demonstrated reduced MD. Conclusions: At age 7, despite early ART and viral load (VL) suppression, we continue to observe differences in WM integrity. WM damage observed at age 5 years persists, and new damage is evident. The continued observation of regions with lower FA and higher MD in HIV+ children point to disruptions in ongoing white matter development regardless of early ART. Lastly, in HEU children we find higher FA and lower MD in clusters in the CST tract suggesting that perinatal HIV/ART exposure has a long-term impact on WM development.
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Affiliation(s)
- Marcin Jankiewicz
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Martha J Holmes
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Paul A Taylor
- Scientific and Statistical Computing Core, National Institutes of Health, Bethesda, MD, United States
| | | | | | - André J W van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ernesta M Meintjes
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
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Hermetet-Lindsay KD, Correia KF, Williams PL, Smith R, Malee KM, Mellins CA, Rutstein RM. Contributions of Disease Severity, Psychosocial Factors, and Cognition to Behavioral Functioning in US Youth Perinatally Exposed to HIV. AIDS Behav 2017; 21:2703-2715. [PMID: 27475941 DOI: 10.1007/s10461-016-1508-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Among perinatally HIV-infected (PHIV) and perinatally HIV-exposed, uninfected (PHEU) youth, we evaluated the contributions of home environment, psychosocial, and demographic factors and, among PHIV only, HIV disease severity and antiretroviral treatment (ART), to cognitive functioning (CF) and behavioral functioning (BF). A structural equation modeling (SEM) approach was utilized. Exploratory factor analysis was used to reduce predictor variables to major latent factors. SEMs were developed to measure associations between the latent factors and CF and BF outcomes. Participants included 231 PHIV and 151 PHEU youth (mean age = 10.9 years) enrolled in the PHACS adolescent master protocol. Youth and caregivers completed assessments of CF, BF, psychosocial factors and HIV health. Medical data were also collected. Clusters of predictors were identified, establishing four parsimonious SEMs: child-assessed and caregiver-assessed BF in PHIV and PHEU youth. Among both groups, higher caregiver-child stress predicted worse BF. Caregiver resources and two disease severity variables, late presenter and better past HIV health, were significant predictors of CF in PHIV youth. Higher youth CF was associated with better caregiver-reported BF in both groups. Caregiver resources predicted caregiver-reported BF in PHEU youth, which was mediated via youth CF. Among PHIV youth, better past HIV health and caregiver resources mediated the effects of CF on caregiver-assessed BF. Using SEMs, we found a deleterious impact of caregiver and child stress on BF in both groups and of HIV disease factors on the CF of PHIV youth, reinforcing the importance of early comprehensive intervention to reduce risks for impairment.
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Affiliation(s)
- Katrina D Hermetet-Lindsay
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Lehigh University School Psychology Program, Bethlehem, PA, USA.
- Division of Neurobehavioral Health, Akron Children's Hospital, 215 W. Bowery St. Suite 4500, Akron, OH, 44308-1062, USA.
| | - Katharine F Correia
- Department of Biostatistics, Harvard. T. H. Chan School of Public Health, Boston, MA, USA
| | - Paige L Williams
- Department of Biostatistics, Harvard. T. H. Chan School of Public Health, Boston, MA, USA
| | - Renee Smith
- Department of Pediatrics, University of Illinois at Chicago Children's Hospital, Chicago, IL, USA
| | - Kathleen M Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Claude A Mellins
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, USA
| | - Richard M Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Weber V, Radeloff D, Reimers B, Salzmann-Manrique E, Bader P, Schwabe D, Königs C. Neurocognitive development in HIV-positive children is correlated with plasma viral loads in early childhood. Medicine (Baltimore) 2017; 96:e6867. [PMID: 28591025 PMCID: PMC5466203 DOI: 10.1097/md.0000000000006867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Because of neurocognitive impairments in perinatally human immunodeficiency virus (HIV)-infected children and adolescents, this study aimed to demonstrate the effect of plasma viral loads and early initiation of sufficient combined antiretroviral therapy (cART) on neurocognitive development.In total, 14 perinatally infected HIV-positive children (median age 8.24 years [range: 6.0-16.74]) receiving lopinavir/ritonavir (LPV/r)-based ART underwent neurocognitive testing using the Wechsler Intelligence Score for Children, 4th Edition (WISC-IV). All 14 patients participated in a pharmacokinetic study in which they were hospitalized for an entire day. As a child's ability to concentrate varies over the course of the day, all tests were performed in the morning.The patients' neurocognitive development did not significantly differ from the normative collective pattern for any of the following composite scores that were examined: full-scale intelligence quotient (IQ) (mean: 106.5, P = .1060), verbal comprehension index (mean: 106.0, P = .1356), perceptual reasoning index (mean: 106.0, P = .1357), working memory index (mean: 106.3, P = .1171), and processing speed index (mean: 98.1, P = .6313). The overall full-scale IQ scores were significantly higher in children who began ART within the first year of life (P = .0379), whereas low lopinavir/r plasma levels (P = .0070) and high viral load area under the curves (AUCs) in the first 3 years of life, but not later, significantly correlated with reduced neurocognitive performance (Spearman r = -0.64, P = .0278).In this cohort of cART treated HIV-positive children and adolescents, neurocognitive performance correlated with early and sufficient viral load suppression within the first 3 years of life.
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Affiliation(s)
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University, Frankfurt am Main
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | | | | | - Peter Bader
- Department of Pediatrics and Adolescent Medicine
| | - Dirk Schwabe
- Department of Pediatrics and Adolescent Medicine
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ANGELES CPLEWISDELOS, WILLIAMS PL, HUO Y, WANG SD, UBAN KA, HERTING MM, MALEE K, YOGEV R, CSERNANSKY JG, NICHOLS S, VAN DYKE RB, SOWELL ER, WANG L. Lower total and regional grey matter brain volumes in youth with perinatally-acquired HIV infection: Associations with HIV disease severity, substance use, and cognition. Brain Behav Immun 2017; 62:100-109. [PMID: 28089557 PMCID: PMC5373952 DOI: 10.1016/j.bbi.2017.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 12/21/2022] Open
Abstract
Despite improved survival due to combination antiretroviral therapy (cART), youth with perinatally-acquired HIV (PHIV) show cognitive deficits and developmental delay at increased rates. HIV affects the brain during critical periods of development, and the brain may be a persistent reservoir for HIV due to suboptimal blood brain barrier penetration of cART. We conducted structural magnetic resonance imaging (sMRI) and cognitive testing in 40 PHIV youth (mean age=16.7years) recruited from the NIH Pediatric HIV/AIDS Cohort Study (PHACS) who are part of the first generation of PHIV youth surviving into adulthood. Historical and current HIV disease severity and substance use measures were also collected. Total and regional cortical grey matter brain volumes were compared to a group of 334 typically-developing, HIV-unexposed and uninfected youth (frequency-matched for age and sex) from the Pediatric Imaging, Neurocognition, and Genetics (PING) study (mean age=16.1years). PHIV youth had smaller (2.8-5.1%) total and regional grey matter volumes than HIV-unexposed and uninfected youth, with smallest volumes seen among PHIV youth with higher past peak viral load (VL) and recent unsuppressed VL. In PHIV youth, worse cognitive performance correlated with smaller volumes. This pattern of smaller grey matter volumes suggests that PHIV infection may influence brain development and underlie cognitive dysfunction seen in this population. Among PHIV youth, smaller volumes were also linked to substance use (alcohol use: 9.0-13.4%; marijuana use: 10.1-16.0%). In this study, collection of substance use information was limited to the PHIV cohort; future studies should also collect substance use information in controls to further address interactions between HIV and substance use on brain volume.
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Affiliation(s)
- C. Paula LEWIS-DE LOS ANGELES
- Northwestern University Interdepartmental Neuroscience Program, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Paige L. WILLIAMS
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Yanling HUO
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Shirlene D. WANG
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kristina A. UBAN
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Megan M. HERTING
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Kathleen MALEE
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ram YOGEV
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - John G. CSERNANSKY
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sharon NICHOLS
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Russell B. VAN DYKE
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA
| | - Elizabeth R. SOWELL
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lei WANG
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Tang Z, Liu Z, Li R, Yang X, Cui X, Wang S, Yu D, Li H, Dong E, Tian J. Identifying the white matter impairments among ART-naïve HIV patients: a multivariate pattern analysis of DTI data. Eur Radiol 2017; 27:4153-4162. [PMID: 28396994 DOI: 10.1007/s00330-017-4820-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/04/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify the white matter (WM) impairments of the antiretroviral therapy (ART)-naïve HIV patients by conducting a multivariate pattern analysis (MVPA) of Diffusion Tensor Imaging (DTI) data METHODS: We enrolled 33 ART-naïve HIV patients and 32 Normal controls in the current study. Firstly, the DTI metrics in whole brain WM tracts were extracted for each subject and feed into the Least Absolute Shrinkage and Selection Operators procedure (LASSO)-Logistic regression model to identify the impaired WM tracts. Then, Support Vector Machines (SVM) model was constructed based on the DTI metrics in the impaired WM tracts to make HIV-control group classification. Pearson correlations between the WM impairments and HIV clinical statics were also investigated. RESULTS Extensive HIV-related impairments were observed in the WM tracts associated with motor function, the corpus callosum (CC) and the frontal WM. With leave-one-out cross validation, accuracy of 83.08% (P=0.002) and the area under the Receiver Operating Characteristic curve of 0.9110 were obtained in the SVM classification model. The impairments of the CC were significantly correlated with the HIV clinic statics. CONCLUSION The MVPA was sensitive to detect the HIV-related WM changes. Our findings indicated that the MVPA had considerable potential in exploring the HIV-related WM impairments. KEY POINTS • WM impairments along motor pathway were detected among the ART-naïve HIV patients • Prominent HIV-related WM impairments were observed in CC and frontal WM • The impairments of CC were significantly related to the HIV clinic statics • The CC might be susceptible to immune dysfunction and HIV replication • Multivariate pattern analysis had potential for studying the HIV-related white matter impairments.
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Affiliation(s)
- Zhenchao Tang
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, Shandong Province, 264209, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Ruili Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Xin Yang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Xingwei Cui
- Cooperative Innovation Center of Internet Healthcare, Zhengzhou University, Zhengzhou, China, 450052
| | - Shuo Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Dongdong Yu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China.
| | - Enqing Dong
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, Shandong Province, 264209, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China.
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Eckard AR, Thierry-Palmer M, Silvestrov N, Rosebush JC, O'Riordan MA, Daniels JE, Uribe-Leitz M, Labbato D, Ruff JH, Singh RJ, Tangpricha V, McComsey GA. Effects of cholecalciferol supplementation on serum and urinary vitamin D metabolites and binding protein in HIV-infected youth. J Steroid Biochem Mol Biol 2017; 168:38-48. [PMID: 28161530 PMCID: PMC5385603 DOI: 10.1016/j.jsbmb.2017.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 01/23/2017] [Accepted: 01/29/2017] [Indexed: 12/15/2022]
Abstract
Vitamin D insufficiency is widespread in HIV-infected patients. HIV and/or antiretroviral therapy (ART), particularly efavirenz (EFV), may interfere with vitamin D metabolism. However, few data from randomized, controlled trials exist. Here, we investigate changes in vitamin D metabolites and binding protein (VDBP) after 6 months of supplementation in a randomized, active-control, double-blind trial investigating 2 different monthly cholecalciferol (vitamin D3) doses [60,000 (medium) or 120,000 (high) IU/month] vs. a control arm of 18,000 IU/month in 8-25year old HIV-infected youth on ART with HIV-1 RNA <1000 copies/mL and baseline 25-hydroxycholecalciferol (25(OH)D3) ≤30ng/mL. A matched healthy uninfected group was enrolled in a similar parallel study for comparison. Changes after 6 months were analyzed as intent-to-treat within/between groups [control group (low dose) vs. combined supplementation doses (medium+high)]. At 6 months, 55% vs. 82% of subjects in control and supplementation groups, respectively, reached 25(OH)D3 ≥30ng/mL (P=0.01) with no difference between medium and high doses (both 82% ≥30ng/mL). There were few differences for those on EFV vs. no-EFV, except serum VDBP decreased in EFV-treated subjects (both within- and between-groups P≤0.01). There were no significant differences between the HIV-infected vs. healthy uninfected groups. The major finding of the present study is that cholecalciferol supplementation (60,000 or 120,000 IU/month) effectively raises serum 25(OH)D3 in the majority of HIV-infected subjects, regardless of EFV use. Notably, response to supplementation was similar to that of uninfected subjects.
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Affiliation(s)
- Allison Ross Eckard
- Medical University of South Carolina, Charleston, SC, United States; Emory University School of Medicine, Atlanta, GA, United States.
| | | | | | | | | | - Julie E Daniels
- Emory University School of Medicine, Atlanta, GA, United States
| | | | | | - Joshua H Ruff
- Emory University School of Medicine, Atlanta, GA, United States
| | | | - Vin Tangpricha
- Emory University School of Medicine, Atlanta, GA, United States
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Blokhuis C, Mutsaerts HJ, Cohen S, Scherpbier HJ, Caan MW, Majoie CB, Kuijpers TW, Reiss P, Wit FW, Pajkrt D. Higher subcortical and white matter cerebral blood flow in perinatally HIV-infected children. Medicine (Baltimore) 2017; 96:e5891. [PMID: 28207506 PMCID: PMC5319495 DOI: 10.1097/md.0000000000005891] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This study aimed to evaluate cerebral blood flow (CBF) in pediatric human immunodeficiency virus (HIV)-infection, and its role in HIV-related cerebral injury and cognitive impairment.This cross-sectional observational study compared 28 perinatally HIV-infected children (8-18 years) to 34 healthy controls matched for age, sex, ethnicity, and socio-economic status. All participants underwent 3-Tesla magnetic resonance imaging, using arterial spin labeling to assess CBF in gray matter (GM), white matter (WM), basal ganglia, and thalamus. We used linear regression analysis to evaluate group differences and associations with HIV disease and treatment characteristics, macrostructural (volume loss, WM lesions) or microstructural injury (increased WM diffusivity, neurometabolite alterations), or poorer cognitive performance.HIV-infected children had higher CBF in WM (+10.2%; P = 0.042), caudate nucleus (+4.8%; P = 0.002), putamen (+3.6%; P = 0.017), nucleus accumbens (+3.9%; P = 0.031), and thalamus (+5.5%; P = 0.032). Thalamus CBF was highest in children with a Centers for Disease Control and Prevention stage B (Coef. = 6.45; P = 0.005) or C (Coef. = 8.52; P = 0.001) diagnosis. Lower GM CBF was associated with higher WM lesion volume in HIV-infected children (Coef. = -0.053; P = 0.001). No further associations with HIV-related cognitive impairment or cerebral injury were found.CBF was higher in WM, basal ganglia, and thalamus in combination antiretroviral therapy (cART)-treated perinatally HIV-infected children, but this was not associated with cerebral injury or cognitive impairment. HIV-infected children with lower GM CBF had a higher volume of WM lesions, which could reflect vascular disease as potential contributing factor to white matter injury. Lifelong exposure to HIV and cART in this population warrants longitudinal assessment of CBF and how it relates to (neuro)inflammation, vascular dysfunction, and cerebral injury in pediatric HIV.
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Affiliation(s)
- Charlotte Blokhuis
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital/Academic Medical Center, University of Amsterdam
| | - Henri J.M.M. Mutsaerts
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Cognitive Neurology Research Unit, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Sophie Cohen
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital/Academic Medical Center, University of Amsterdam
| | - Henriëtte J. Scherpbier
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital/Academic Medical Center, University of Amsterdam
| | - Matthan W.A. Caan
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles B.L.M. Majoie
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital/Academic Medical Center, University of Amsterdam
| | - Peter Reiss
- Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute for Global Health and Development
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Ferdinand W.N.M. Wit
- Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute for Global Health and Development
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital/Academic Medical Center, University of Amsterdam
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Abstract
BACKGROUND Immune activation and exhaustion drive several comorbidities and disease progression in HIV-infected adults; however, they are not well studied in HIV-infected youth. Thus, this study sought to examine levels of immune activation and exhaustion in this population, investigate associated HIV- and non-HIV-related variables and compare results with a matched healthy control group. METHODS HIV-infected youth 8-25 years of age on stable antiretroviral therapy with an HIV-1 RNA level <1000 copies/mL were enrolled, along with matched healthy controls. We measured T-cell and monocyte immune activation and exhaustion markers in cryopreserved peripheral blood mononuclear cell and plasma samples. RESULTS A total of 136 subjects (80 HIV+: 66% male; 91% black) were enrolled. Markers of CD4+ and CD8+ T-cell activation were higher in the HIV-infected group versus controls [mean % CD4+CD38+HLA-DR+ and CD8+CD38+HLA-DR+ = 2.2 versus 1.5 (P=0.002) and 4.9 versus 2.2 (P<0.0001), respectively], as were exhausted CD4+ and CD8+ T-cells [mean % CD4+CD38+HLA-DR+PD-1+ and CD8+CD38+HLA-DR+PD-1+ = 1.0 versus 0.5 (P<0.0001) and 1.6 versus 0.7 (P<0.0001), respectively]. There were no differences in proportions of inflammatory or patrolling monocytes between groups (P>0.05); however, soluble CD14 was higher in HIV-infected compared with controls (1.6 versus 1.4 µg/mL; P=0.01). Current CD4 count, low-density lipoprotein cholesterol and age were the variables most associated with CD4+ and CD8+ T-cell activation. CONCLUSIONS CD4+ and CD8+ T-cell immune activation and exhaustion are higher in HIV-infected youth compared with matched controls, while monocyte subpopulations are not altered despite a high soluble CD14 level. The clinical significance of the increased immune activation and exhaustion should be further explored.
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Malee KM, Smith RA, Mellins CA. Brain and Cognitive Development Among U.S. Youth With Perinatally Acquired Human Immunodeficiency Virus Infection. J Pediatric Infect Dis Soc 2016; 5:S1-S5. [PMID: 27856670 PMCID: PMC5181541 DOI: 10.1093/jpids/piw041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/16/2016] [Indexed: 11/14/2022]
Affiliation(s)
- Kathleen M. Malee
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Renee A. Smith
- Department of Pediatrics, University of Illinois at Chicago
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York
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Ackermann C, Andronikou S, Saleh MG, Laughton B, Alhamud AA, van der Kouwe A, Kidd M, Cotton MF, Meintjes EM. Early Antiretroviral Therapy in HIV-Infected Children Is Associated with Diffuse White Matter Structural Abnormality and Corpus Callosum Sparing. AJNR Am J Neuroradiol 2016; 37:2363-2369. [PMID: 27538904 DOI: 10.3174/ajnr.a4921] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/04/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Fractional anisotropy in the frontal white matter, corpus callosum, and internal capsule is abnormal in human immunodeficiency virus-positive (HIV+) adults. We describe the distribution and nature of white matter abnormalities in a cohort of children who started antiretroviral therapy within the first year of life and the benefit of early treatment by using DTI measures (fractional anisotropy and mean, axial, and radial diffusion). MATERIALS AND METHODS DTI was performed on children in a neurodevelopmental substudy from the Children with HIV Early Antiretroviral trial. Voxel-based group comparisons were obtained to determine regions where fractional anisotropy and mean diffusion differed between HIV+ and uninfected children. Associations of DTI parameters with the timing of antiretroviral therapy initiation were examined. RESULTS Thirty-nine HIV+ children (15 boys; mean age, 5.4 years) and 13 controls (5 boys; mean age, 5.7 years) were scanned. Two clusters with lower fractional anisotropy and 7 clusters with increased mean diffusion were identified in the HIV+ group, with symmetric distribution predominantly due to increased radial diffusion, suggestive of decreased myelination. Corticospinal tracts rather than the corpus callosum were predominantly involved. Children on early-interrupted antiretroviral therapy had lower fractional anisotropy compared with those receiving continuous treatment. CONCLUSIONS HIV+ children at 5 years of age have white matter abnormalities measured by fractional anisotropy, despite early antiretroviral therapy, suggesting that early antiretroviral therapy does not fully protect the white matter from either peripartum or in utero infection. In contrast to adults, the corticospinal tracts are predominantly involved rather than the corpus callosum, possibly due to early antiretroviral therapy. Continuous early antiretroviral therapy can limit white matter damage.
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Affiliation(s)
- C Ackermann
- From the Departments of Radiodiagnosis (C.A.)
| | - S Andronikou
- Clinical Research and Imaging Centre, Bristol (S.A.), University of Bristol, Bristol, UK
- Department of Paediatric Radiology (S.A.), Bristol Royal Hospital for Children, Bristol, UK
| | - M G Saleh
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
| | - B Laughton
- Paediatrics and Child Health (B.L., M.F.C.), Faculty of Medicine and Health Sciences
| | - A A Alhamud
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
| | - A van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging (A.v.d.K.), Massachusetts General Hospital, Charlestown, Massachusetts
| | - M Kidd
- Centre for Statistical Consultation (M.K.), Stellenbosch University, Tygerberg, South Africa
| | - M F Cotton
- Paediatrics and Child Health (B.L., M.F.C.), Faculty of Medicine and Health Sciences
| | - E M Meintjes
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
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40
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Lewis-de los Angeles CP, Alpert KI, Williams PL, Malee K, Huo Y, Csernansky JG, Yogev R, Van Dyke RB, Sowell ER, Wang L. Deformed Subcortical Structures Are Related to Past HIV Disease Severity in Youth With Perinatally Acquired HIV Infection. J Pediatric Infect Dis Soc 2016; 5:S6-S14. [PMID: 27856671 PMCID: PMC5181545 DOI: 10.1093/jpids/piw051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/25/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Combination antiretroviral therapy has led to increased survival among youth with perinatally acquired HIV (PHIV). However, cognitive deficits continue to be common. Histopathological studies in adults have found HIV concentrated in subcortical structures, which are involved in sensory processing, movement, and higher-order cognition that emerges with development. METHODS We conducted magnetic resonance imaging and cognitive testing in 40 youth with PHIV at one site of the Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study. We collected HIV disease-severity measures and substance-use reports. Subcortical volume and shape deformation were generated with FreeSurfer-Initiated Large Deformation Diffeomorphic Metric Mapping. Inward shape deformation was defined as negative displacement. We evaluated associations of subcortical shape deformation with past HIV severity after adjustment for sex, age at neuroimaging, age at HIV severity marker, and substance use. We examined associations between subcortical deformation and cognitive function. RESULTS Negative correlations between shape deformation and peak HIV viral load (VL) were found in clusters in the caudate tail, globus pallidus, lateral putamen, and anterior and medial thalamus. Positive correlations between shape deformation and nadir CD4-positive T-lymphocyte percentage (CD4%) were found in clusters in the medial and posterior thalamus. Inward deformation in caudate and thalamic clusters correlated with worse cognition. CONCLUSIONS Youth with PHIV have demonstrable subcortical shape deformation related to past HIV severity and cognition; inward deformation was associated with higher peak VL, lower nadir CD4%, and worse cognition. Identifying subcortical deformation may inform clinical practice for early intervention to help improve cognitive outcomes and assess the neuroefficacy of combination antiretroviral therapy in youth with PHIV.
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Affiliation(s)
| | | | - Paige L. Williams
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Yanling Huo
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ram Yogev
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Russell B. Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Elizabeth R. Sowell
- Department of Pediatrics, Children's Hospital Los Angeles
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, and
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41
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Liu H, Xu E, Liu J, Xiong H. Oligodendrocyte Injury and Pathogenesis of HIV-1-Associated Neurocognitive Disorders. Brain Sci 2016; 6:brainsci6030023. [PMID: 27455335 PMCID: PMC5039452 DOI: 10.3390/brainsci6030023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/12/2016] [Accepted: 07/20/2016] [Indexed: 02/07/2023] Open
Abstract
Oligodendrocytes wrap neuronal axons to form myelin, an insulating sheath which is essential for nervous impulse conduction along axons. Axonal myelination is highly regulated by neuronal and astrocytic signals and the maintenance of myelin sheaths is a very complex process. Oligodendrocyte damage can cause axonal demyelination and neuronal injury, leading to neurological disorders. Demyelination in the cerebrum may produce cognitive impairment in a variety of neurological disorders, including human immunodeficiency virus type one (HIV-1)-associated neurocognitive disorders (HAND). Although the combined antiretroviral therapy has markedly reduced the incidence of HIV-1-associated dementia, a severe form of HAND, milder forms of HAND remain prevalent even when the peripheral viral load is well controlled. HAND manifests as a subcortical dementia with damage in the brain white matter (e.g., corpus callosum), which consists of myelinated axonal fibers. How HIV-1 brain infection causes myelin injury and resultant white matter damage is an interesting area of current HIV research. In this review, we tentatively address recent progress on oligodendrocyte dysregulation and HAND pathogenesis.
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Affiliation(s)
- Han Liu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
| | - Enquan Xu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
| | - Jianuo Liu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
| | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
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42
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Herting MM, Uban KA, Williams PL, Gautam P, Huo Y, Malee K, Yogev R, Csernansky J, Wang L, Nichols S, Van Dyke R, Sowell ER. Default Mode Connectivity in Youth With Perinatally Acquired HIV. Medicine (Baltimore) 2015; 94:e1417. [PMID: 26376381 PMCID: PMC4635795 DOI: 10.1097/md.0000000000001417] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Youth with perinatally acquired human immunodeficiency virus (PHIV+) survive longer with combination antiretroviral therapy, but remain at risk for poor cognitive outcomes. We evaluated whether markers of HIV disease severity relate to default mode resting-state functional connectivity in PHIV+ youth. We conducted resting-state functional neuroimaging and cognitive testing in a subset of 40 PHIV+ youth recruited from a single study site of the Adolescent Master Protocol study conducted by the Pediatric HIV/AIDS Cohort Study (PHACS) network. Current and past HIV disease severity measures (nadir CD4 lymphocyte percentages and peak HIV RNA plasma levels) were obtained from medical charts. We evaluated associations of both HIV disease severity measures and cognitive functioning with between- and within- default mode network (DMN) connectivity using Analysis of Functional NeuroImaging multiple regression analyses, controlling for multiple comparisons. Of the 40 youth, 31 (mean age = 16.5 years) with minimal motion during scans were included. We observed global alterations in DMN within- and between-network connectivity, with significant associations between disease severity and DMN BOLD correlations. Furthermore, patterns of connectivity with the posterior cingulate cortex (PCC) and medial prefrontal cortex (mPFC) that varied as a function of peak HIV RNA were found to predict processing speed ability. Alterations in within- and between-network DMN connectivity in PHIV+ youth may reflect global reorganization of the DMN; this could lead to compensatory alterations in both the within- and between-connectivity of large-scale networks, which may ultimately relate to known cognitive processing difficulties in PHIV+ youth.
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Affiliation(s)
- Megan M Herting
- From the Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA (MMH, KAU, PG, ERS); Department of Biostatistics, Harvard School of Public Health, Boston, MA (PLW, YH); Feinberg School of Medicine, Northwestern University, Chicago, IL (KM, RY, JC, LW); Department of Neurosciences, Division of Pediatric Neurology, University of California San Diego, La Jolla, CA (SN); Tulane University School of Medicine, New Orleans, LA (RVD); and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (ERS)
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