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Visual evoked and event-related brain potentials in HIV-infected adults: a longitudinal study over 2.5 years. Doc Ophthalmol 2019; 139:83-97. [PMID: 30993574 DOI: 10.1007/s10633-019-09697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this neurophysiological study was to monitor changes in the visual and cognitive function of HIV-infected patients treated with combination antiretroviral therapy. METHODS Eleven adult Czech HIV+ patients, with a mean age of 35 years and CD4 cell count ≥ 230 × 106 cells/L of blood at the time of enrollment, underwent four to six examinations over the course of 2.5 years to evaluate pattern-reversal and motion-onset visual evoked potentials (P-VEPs and M-VEPs), visually driven oddball event-related potentials (ERPs) and Montreal Cognitive Assessments. In addition to evaluating the intraindividual change in the observed parameters, we also compared patient data to data from eleven age- and gender-matched controls. RESULTS We did not find any significant differences in P-VEPs between the patients and controls or in the paired comparison of the first and last visit. The only significant finding for P-VEPs was a linear trend in prolongation of the 20' P-VEP P100 peak time. In M-VEPs, we found a significant intergroup difference in the N160 peak time recorded during the first visit for peripheral M-VEPs only. During the last visit, all N160 peak times for patients differed significantly from those of the control group. The only intervisit difference close to the level of significance was for peripheral M-VEPs, which confirmed the trend analysis. No significant differences between patients and controls were found in the ERPs, but the P300 peak time showed a significant difference between the first and last visits, as confirmed by the trend. Patient reaction time was not significantly delayed at the first visit; however, it was prolonged with time, as confirmed by the trend. CONCLUSION Our aim was to evaluate whether antiretroviral treatment in HIV+ patients is sufficient to preserve brain visual function. The optic nerve and primary visual cortex function tested by the P-VEPs seem to be preserved. The prolongation of the M-VEPs suggests an individually detectable decline in CNS function, but these changes did not show a progression during the follow-up. From a longitudinal perspective, the trends in peak time prolongation of the 20' P-VEP, peripheral M-VEP, ERP and reaction time suggest a faster decline than that caused by aging in healthy populations, as previously described in a cross-sectional study.
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Abstract
Despite long-term successful treatment with cART, impairments in cognitive functioning are still being reported in HIV-infected patients. Since changes in cognitive function may be preceded by subtle changes in brain function, neuroimaging techniques, such as resting-state functional magnetic resonance imaging (rs-fMRI) have become useful tools in assessing HIV-associated abnormalities in the brain. The purpose of the current study was to examine the extent to which HIV infection in virologically suppressed patients is associated with disruptions in subcortical regions of the brain in comparison to a matched HIV-negative control group. The sample consisted of 72 patients and 39 controls included between January 2012 and January 2014. Resting state functional connectivity was determined between fourteen regions-of-interest (ROI): the left and right nucleus accumbens, amygdala, caudate nucleus, hippocampus, putamen, pallidum and thalamus. A Bayesian method was used to estimate resting-state functional connectivity, quantified in terms of partial correlations. Both groups showed the strongest partial correlations between the left and right caudate nucleus and the left and right thalamus. However, no differences between the HIV patients and controls were found between the posterior expected network densities (control network density = 0.26, SD = 0.05, patient network density = 0.26, SD = 0.04, p = 0.58). The results of the current study show that HIV does not affect subcortical connectivity in virologically controlled patients who are otherwise healthy.
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Szanyi J, Kremlacek J, Kubova Z, Kuba M, Gebousky P, Kapla J, Szanyi J, Vit F, Langrova J. Pattern- and motion-related visual evoked potentials in HIV-infected adults. Doc Ophthalmol 2017; 134:45-55. [PMID: 28074347 DOI: 10.1007/s10633-016-9570-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 12/28/2016] [Indexed: 02/03/2023]
Abstract
PURPOSE The goal of the current study was to explore visual function in virally suppressed HIV patients undergoing combined antiretroviral therapy (cART) by using pattern-reversal and motion-onset visual evoked potentials (VEPs). METHODS The pattern-reversal and motion-onset VEPs were recorded in 20 adult HIV+ patients with a mean age of 38 years and CD4 cell counts ≥230 × 106 cells/L of blood. RESULTS Nine out of 20 patients displayed VEP abnormalities. Pattern-reversal VEPs pathology was observed in 20% of subjects, and 45% HIV patients had impaired motion-onset VEPs. Five out of 16 neurologically asymptomatic HIV patients had prolonged motion-onset VEP latencies in both eyes. Four neurologically symptomatic patients displayed simultaneously abnormal motion-onset and pattern-reversal VEP latencies: monocular involvement was observed in two patients with Lyme and cytomegalovirus unilateral optic neuritis. Binocular involvement was noted in two patients with cognitive deficits. Correlation analysis between disease duration, CD4 cell count, HIV copies in plasma, MoCA and electrophysiological parameters did not show any significant relationships. CONCLUSIONS The functional changes of the visual system in neurologically asymptomatic virally suppressed HIV patients displayed higher motion-onset VEP sensitivity than in standard pattern-reversal VEP examinations. This promising marker, however, has no significant association with clinical conditions. Further exploration is warranted.
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Affiliation(s)
- Jana Szanyi
- Department of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 500 03, Hradec Kralove, Czech Republic.
| | - Jan Kremlacek
- Department of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 500 03, Hradec Kralove, Czech Republic
| | - Zuzana Kubova
- Department of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 500 03, Hradec Kralove, Czech Republic
| | - Miroslav Kuba
- Department of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 500 03, Hradec Kralove, Czech Republic
| | - Pavel Gebousky
- Department of Infectious Diseases, Faculty Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jaroslav Kapla
- Department of Infectious Diseases, Faculty Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Juraj Szanyi
- Department of Infectious Diseases, Faculty Hospital in Hradec Kralove, Hradec Kralove, Czech Republic.,Department of Epidemiology, Faculty of Military Health Sciences, University of Defence in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Frantisek Vit
- Department of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 500 03, Hradec Kralove, Czech Republic
| | - Jana Langrova
- Department of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 500 03, Hradec Kralove, Czech Republic
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The Role of Nuclear Medicine in the Staging and Management of Human Immune Deficiency Virus Infection and Associated Diseases. Nucl Med Mol Imaging 2016; 51:127-139. [PMID: 28559937 DOI: 10.1007/s13139-016-0422-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023] Open
Abstract
Human immune deficiency virus (HIV) is a leading cause of death. It attacks the immune system, thereby rendering the infected host susceptible to many HIV-associated infections, malignancies and neurocognitive disorders. The altered immune system affects the way the human host responds to disease, resulting in atypical presentation of these disorders. This presents a diagnostic challenge and the clinician must use all diagnostic avenues available to diagnose and manage these conditions. The advent of highly active antiretroviral therapy (HAART) has markedly reduced the mortality associated with HIV infection but has also brought in its wake problems associated with adverse effects or drug interaction and may even modulate some of the HIV-associated disorders to the detriment of the infected human host. Nuclear medicine techniques allow non-invasive visualisation of tissues in the body. By using this principle, pathophysiology in the body can be targeted and the treatment of diseases can be monitored. Being a functional imaging modality, it is able to detect diseases at the molecular level, and thus it has increased our understanding of the immunological changes in the infected host at different stages of the HIV infection. It also detects pathological changes much earlier than conventional imaging based on anatomical changes. This is important in the immunocompromised host as in some of the associated disorders a delay in diagnosis may have dire consequences. Nuclear medicine has played a huge role in the management of many HIV-associated disorders in the past and continues to help in the diagnosis, prognosis, staging, monitoring and assessing the response to treatment of many HIV-associated disorders. As our understanding of the molecular basis of disease increases nuclear medicine is poised to play an even greater role. In this review we highlight the functional basis of the clinicopathological correlation of HIV from a metabolic view and discuss how the use of nuclear medicine techniques, with particular emphasis of F-18 fluorodeoxyglucose, may have impact in the setting of HIV. We also provide an overview of the role of nuclear medicine techniques in the management of HIV-associated disorders.
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5
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Corrêa DG, Zimmermann N, Tukamoto G, Doring T, Ventura N, Leite SCB, Cabral RF, Fonseca RP, Bahia PRV, Gasparetto EL. Longitudinal assessment of subcortical gray matter volume, cortical thickness, and white matter integrity in HIV-positive patients. J Magn Reson Imaging 2016; 44:1262-1269. [PMID: 27079832 DOI: 10.1002/jmri.25263] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/18/2016] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To longitudinally evaluate the cortical thickness and deep gray matter structures volume, measured from T1 three-dimensional (3D) Gradient echo-weighted imaging, and white matter integrity, assessed from diffusion tensor imaging (DTI) of HIV-positive patients. MATERIALS AND METHODS Twenty-one HIV-positive patients on stable highly active antiretroviral therapy (HAART) with CD4+ T lymphocytes count >200 cells/mL and viral load <50 copies/mL underwent two magnetic resonance imaging (MRI) scans with a median interval of 26.6 months. None of the patients had HIV-related dementia. T1 3D magnetization prepared rapid gradient echo-weighted imaging and DTI along 30 noncolinear directions were performed using a 1.5 Tesla MR scanner. FreeSurfer was used to perform cortical volumetric reconstruction and segmentation of deep gray matter structures. For tract-based spatial statistics analysis, a white matter skeleton was created, and a permutation-based inference with 5000 permutations, with a threshold of P < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The median, radial, and axial diffusivities were also projected onto the mean FA skeleton. RESULTS There were no significant differences in cortical thickness, deep gray matter structures volumes or diffusivity parameters between scans at the two time points (considering P < 0.05). CONCLUSION No longitudinal differences in cortical thickness, deep gray matter volumes, or white matter integrity were observed in an HIV-positive population on stable HAART, with undetectable viral load and high CD4+ T lymphocytes count. J. Magn. Reson. Imaging 2016;44:1262-1269.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil. .,Clínica de Diagnóstico por Imagem (CDPI), Barra da Tijuca, Rio de Janeiro, RJ, Brazil.
| | - Nicolle Zimmermann
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil.,Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Partenon, Porto Alegre, RS, Brazil
| | - Gustavo Tukamoto
- Clínica de Diagnóstico por Imagem (CDPI), Barra da Tijuca, Rio de Janeiro, RJ, Brazil
| | - Thomas Doring
- Clínica de Diagnóstico por Imagem (CDPI), Barra da Tijuca, Rio de Janeiro, RJ, Brazil
| | - Nina Ventura
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil.,Clínica de Diagnóstico por Imagem (CDPI), Barra da Tijuca, Rio de Janeiro, RJ, Brazil
| | - Sarah C B Leite
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil
| | - Rafael Ferracini Cabral
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil
| | - Rochele Paz Fonseca
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil.,Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Partenon, Porto Alegre, RS, Brazil
| | - Paulo R V Bahia
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil
| | - Emerson Leandro Gasparetto
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil.,Clínica de Diagnóstico por Imagem (CDPI), Barra da Tijuca, Rio de Janeiro, RJ, Brazil
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Shen LL, Jiang ML, Liu SS, Cai MC, Hong ZQ, Lin LQ, Xing YY, Chen GL, Pan R, Yang LJ, Xu Y, Dong J. Curcumin improves synaptic plasticity impairment induced by HIV-1gp120 V3 loop. Neural Regen Res 2015. [PMID: 26199609 PMCID: PMC4498354 DOI: 10.4103/1673-5374.158358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Curcumin has been shown to significantly improve spatial memory impairment induced by HIV-1 gp120 V3 in rats, but the electrophysiological mechanism remains unknown. Using extracellular microelectrode recording techniques, this study confirmed that the gp120 V3 loop could suppress long-term potentiation in the rat hippocampal CA1 region and synaptic plasticity, and that curcumin could antagonize these inhibitory effects. Using a Fura-2/AM calcium ion probe, we found that curcumin resisted the effects of the gp120 V3 loop on hippocampal synaptosomes and decreased Ca2+ concentration in synaptosomes. This effect of curcumin was identical to nimodipine, suggesting that curcumin improved the inhibitory effects of gp120 on synaptic plasticity, ameliorated damage caused to the central nervous system, and might be a potential neuroprotective drug.
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Affiliation(s)
- Ling-Ling Shen
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China
| | - Ming-Liang Jiang
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
| | - Si-Si Liu
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
| | - Min-Chun Cai
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China
| | - Zhong-Qiu Hong
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China
| | - Li-Qing Lin
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
| | - Yan-Yan Xing
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
| | - Gui-Lin Chen
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
| | - Rui Pan
- Department of Orthopedics, First Affiliated Hospital, Medical College of Jinan University, Guangzhou, Guangdong Province, China
| | - Li-Juan Yang
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
| | - Ying Xu
- GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
| | - Jun Dong
- Department of Pathophysiology, Key Laboratory of the State Administration of Traditional Chinese Medicine, Medical College of Jinan University, Guangzhou, Guangdong Province, China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China
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Abstract
HIV-associated neurocognitive disorders (HAND) remain among the most common clinical disorders encountered in people infected with HIV despite widespread use of antiretroviral therapy. There is an enormous need for further evaluation and early diagnosis of HAND. The variety of PET agents such as FDG, C-PiB and [C]-R-PK11195 as well as SPECT agents Tc-HMPAO, I-FP-CIT and I-IBZM have been investigated for the diagnosis of HAND, for distinguishing between demented and nondemented HIV patients, for differentiation between HAND and nonHIV related dementia, as well as for assessing the influence of coinfection with the other viral pathogens on the brain functionality. In spite of some interesting results, none of these tracers have been specifically created for HAND and none can be recommended for HAND diagnosis. Specialized tracers need to be developed for better diagnosis and management of HAND. The potential role of therapeutic nuclear medicine as part of the curative strategies for HIV is also discussed.
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Affiliation(s)
- Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa
| | - Alicia McFarren
- Department of Pediatrics, Montefiore Medical Center, Bronx, NY, USA
| | - Ekaterina Dadachova
- Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA
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Pirskanen-Matell R, Grützmeier S, Nennesmo I, Sandström E, Ehrnst A. Impairment of short-term memory and Korsakoff syndrome are common in AIDS patients with cytomegalovirus encephalitis. Eur J Neurol 2012; 16:48-53. [PMID: 19087150 DOI: 10.1111/j.1468-1331.2008.02337.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The diagnosis of cytomegalovirus encephalitis (CMV-E) in AIDS patients is challenging as other illnesses may obscure the symptoms. Here, we characterize the clinical symptoms of CMV-E and link them to post-mortem findings. Patients and methods In 254 homosexual men with AIDS, followed from HIV diagnosis to death before the antiretroviral combination therapy era, CMV-E was suspected in 93 cases. All were CMV-positive in blood. Neurological examination, including cognitive testing was performed in 34 of them within 6 months before death. CMV-E was diagnosed by CMV-PCR in cerebrospinal fluid (n = 24) or by post-mortem (n = 24). RESULTS The majority complained of forgetfulness (91%), balance difficulties (85%) and impotence (85%). Impaired short-term memory was present in 29 patients. It was extreme in 17, justifying the diagnosis of Korsakoff's syndrome. This was often associated with infectious CMV in blood (P = 0.01). Brainstem symptoms were found in 19 patients. Post-mortem examination often revealed ventriculoencephalitis. CMV was found primarily around the ventricles and in other structures, described in Korsakoff's syndrome. CONCLUSION The location of CMV in the brain corresponded well to the clinical findings, demonstrating the close relationship between the neurological symptoms and the neuroanatomical lesions.
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Affiliation(s)
- R Pirskanen-Matell
- Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Towgood KJ, Pitkanen M, Kulasegaram R, Fradera A, Kumar A, Soni S, Sibtain NA, Reed L, Bradbeer C, Barker GJ, Kopelman MD. Mapping the brain in younger and older asymptomatic HIV-1 men: Frontal volume changes in the absence of other cortical or diffusion tensor abnormalities. Cortex 2012; 48:230-41. [DOI: 10.1016/j.cortex.2011.03.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/08/2011] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
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10
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Miller C, Bielefeldt-Ohmann H, MacMillan M, Huitron-Resendiz S, Henriksen S, Elder J, VandeWoude S. Strain-specific viral distribution and neuropathology of feline immunodeficiency virus. Vet Immunol Immunopathol 2011; 143:282-91. [PMID: 21715019 DOI: 10.1016/j.vetimm.2011.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Feline immunodeficiency virus (FIV) is a naturally occurring lentivirus of domestic cats, and is the causative agent of feline AIDS. Similar to human immunodeficiency virus (HIV), the pathogenesis of FIV involves infection of lymphocytes and macrophages, and results in chronic progressive immune system collapse and death. Neuropathologic correlates of FIV infection have not yet been elucidated, and may be relevant to understanding HIV-associated neurologic disease (neuroAIDS). As in HIV, FIV strains have been shown to express differential tendencies towards development of clinical neuroAIDS. To interrogate viral genetic determinants that might contribute to neuropathogenicity, cats were exposed to two well-characterized FIV strains with divergent clinical phenotypes and a chimeric strain as follows: FIV(PPR) (PPR, relatively apathogenic but associated with neurologic manifestations), FIV(C36) (C36, immunopathogenic but without associated neurologic disease), and Pcenv (a chimeric virus consisting of a PPR backbone with substituted C36 env region). A sham inoculum control group was also included. Peripheral nerve conduction velocity, CNS imaging studies, viral loads and hematologic analysis were performed over a 12 month period. At termination of the study (350 days post-inoculation), brain sections were obtained from four anatomic locations known to be involved in human and primate lentiviral neuroAIDS. Histological and immunohistochemical evaluation with seven markers of inflammation revealed that Pcenv infection resulted in mild inflammation of the CNS, microglial activation, neuronal degeneration and apoptosis, while C36 and PPR strains induced minimal neuropathologic changes. Conduction velocity aberrations were noted peripherally in all three groups at 63 weeks post-infection. Pcenv viral load in this study was intermediate to the parental strains (C36 demonstrating the highest viral load and PPR the lowest). These results collectively suggest that (i) 3' C36 genomic elements contribute to viral replication characteristics, and (ii) 5' PPR genomic elements contribute to CNS manifestations. This study illustrates the potential for FIV to provide valuable information about neuroAIDS pathogenesis related to genotype and viral kinetics, as well as to identify strains useful to evaluation of therapeutic intervention.
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Affiliation(s)
- Craig Miller
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523-1619, USA.
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11
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Abstract
With the introduction of combination antiretroviral therapy AIDS dementia complex or HIV-associated dementia, as it was termed later, largely disappeared in clinical practice. However, in the past few years, patients, long-term infected and treated, including those with systemically well controlled infection, started to complain about milder memory problems and slowness, difficulties in concentration, planning, and multitasking. Neuropsychological studies have confirmed that cognitive impairment occurs in a substantial (15-50%) proportion of patients. Among HIV-1-infected patients cognitive impairment was and is one of the most feared complications of HIV-1 infection. In addition, neurocognitive impairment may affect adherence to treatment and ultimately result in increased morbidity for systemic disease. So what may be going on in the CNS after so many years of apparently controlled HIV-1 infection is an urgent and important challenge in the field of HIV medicine. In this review we summarize the key currently available data. We describe the clinical neurological and neuropsychological findings, the preferred diagnostic approach with new imaging techniques and cerebrospinal fluid analysis. We try to integrate data on pathogenesis and finally discuss possible therapeutic interventions.
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12
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Gericke GS. Does HIV-1/AIDS-associated frontotemporal neuropathology following perinatal infection influence the development of moral behaviour? Med Hypotheses 2008; 70:1139-46. [PMID: 18255237 DOI: 10.1016/j.mehy.2006.05.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 05/23/2006] [Indexed: 11/16/2022]
Abstract
While HIV encephalopathy and the AIDS dementia complex are considered hallmark neurologic manifestations of HIV-1 infection, increasing evidence of a continuum of nervous system involvement indicates the existence of an unrecognized number of individuals with milder, mostly cognitive and/or behavioural effects. Questions are raised whether HIV-related frontotemporal neuropathology during critical developmental stages could affect development of the brain networks documented to be involved in moral decisions, and whether this could contribute to the phenomenon of delinquency in an unknown percentage of the current generation of approximately 18-25 year old survivors of early childhood or vertically acquired HIV infection. Carefully planned and executed long term, prospective controlled studies using environmental, clinical, neurological, behavioural, genetic, immune and functional neuroimaging correlates would be required to elucidate whether HIV-specific neuropathology could indeed act as an independent risk factor for the development of a frontotemporal sociopathy syndrome. If such an association is proven, the accelerated development of neurospecific therapies should be a priority, especially for clinically and immunologically stable HIV-infected children. It may be necessary to institute such treatment as early as possible in perinatally infected cases, and maybe even during intrauterine life if HIV-1 is demonstrated to also act as a neurobehavioural teratogen for the developing fetal brain. It may, however, prove to be difficult to separate primary neurobiological from environmental factors, since the epigenetic effects on the host genome of retroviral insertion influencing behavioural gene expression characteristics, and altered gene expression following early life stresses may involve overlapping neurodevelopmental gene regulatory networks. In the meantime it remains necessary to prevent or ameliorate frequent neuropsychiatric morbidity from whatever causes.
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Affiliation(s)
- G S Gericke
- Department of Biomedical Sciences, Tshwane University of Technology, PO Box 2040, Brooklyn Square, 0075 Pretoria, Gauteng, South Africa.
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