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Tyrberg E, Hagberg L, Andersson LM, Nilsson S, Yilmaz A, Mellgren Å, Blennow K, Zetterberg H, Gisslén M. The effect of vitamin B supplementation on neuronal injury in people living with HIV: a randomized controlled trial. Brain Commun 2022; 4:fcac259. [PMID: 36337345 PMCID: PMC9631976 DOI: 10.1093/braincomms/fcac259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/21/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Effective antiretroviral therapy has radically changed the course of the HIV pandemic. However, despite efficient therapy, milder forms of neurocognitive symptoms are still present in people living with HIV. Plasma homocysteine is a marker of vitamin B deficiency and has been associated with cognitive impairment. People living with HIV have higher homocysteine concentrations than HIV-negative controls, and we have previously found an association between plasma homocysteine concentration and CSF concentration of neurofilament light protein, a sensitive marker for ongoing neuronal injury in HIV. This prompted us to perform this randomized controlled trial, to evaluate the effect of vitamin B supplementation on neuronal injury in a cohort of people living with HIV on stable antiretroviral therapy. At the Department of Infectious Diseases at Sahlgrenska University Hospital in Gothenburg, Sweden, 124 virally suppressed people living with HIV were screened to determine eligibility for this study. Sixty-one fulfilled the inclusion criteria by having plasma homocysteine levels at or above 12 μmol/l. They were randomized (1:1) to either active treatment (with cyanocobalamin 0.5 mg, folic acid 0.8 mg and pyridoxine 3.0 mg) q.d. or to a control arm with a cross over to active treatment after 12 months. Cognitive function was measured repeatedly during the trial, which ran for 24 months. We found a significant correlation between plasma neurofilament light protein and plasma homocysteine at screening (n = 124, r = 0.35, P < 0.0001). Plasma homocysteine levels decreased by 35% from a geometric mean of 15.7 μmol/l (95% confidence interval 14.7–16.7) to 10.3 μmol/l (95% confidence interval 9.3–11.3) in the active treatment arm between baseline and Month 12. No significant change was detected in the control arm during the same time period [geometric mean 15.2 (95% confidence interval 14.3–16.2) versus geometric mean 16.5 μmol/l (95% confidence interval 14.7–18.6)]. A significant difference in change in plasma homocysteine levels was seen between arms at 12 months [−40% (95% confidence interval −48 to −30%), P < 0.001]. However, no difference between arms was seen in either plasma neurofilament light protein levels [−6.5% (−20 to 9%), P = 0.39], or cognitive measures [−0.08 (−0.33 to 0.17), P = 0.53]. Our results do not support a vitamin B–dependent cause of the correlation between neurofilament light protein and homocysteine. Additional studies are needed to further elucidate this matter.
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Affiliation(s)
- Erika Tyrberg
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Lars Hagberg
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Staffan Nilsson
- Department of Mathematical Sciences, Chalmers University of Technology , Gothenburg , Sweden
- Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg , Gothenburg , Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Mölndal , Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal , Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Mölndal , Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal , Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology , Queen Square, London , UK
- UK Dementia Research Institute at UCL , London , UK
- Hong Kong Center for Neurodegenerative Diseases , Hong Kong , China
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital , Gothenburg , Sweden
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Deminice R, Oliveira VHF, Webel AR, Erlandson KM. Sarcopenia Related to Human Immunodeficiency Virus: Protective Effects of Exercise. Exerc Sport Sci Rev 2022; 50:73-80. [PMID: 35029356 PMCID: PMC8917999 DOI: 10.1249/jes.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We discuss recent evidence supporting the hypothesis that sarcopenia is an emerging health concern among people with human immunodeficiency virus (HIV) because of increasing life expectancy and HIV- and treatment-related comorbidities. We also hypothesize that combined exercise at higher intensity has a key role in managing sarcopenia in this population because it directly (increases muscle strength and stimulates hypertrophy) and indirectly (prevents mitochondrial dysfunction, oxidative stress, and persistent inflammation) counteracts sarcopenia hallmarks.
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Affiliation(s)
- Rafael Deminice
- Department of Physical Education, Londrina State University, Londrina, Paraná, Brazil
| | - Vitor H F Oliveira
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, Washington, United States
| | - Allison R Webel
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, Washington, United States
| | - Kristine M Erlandson
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
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