1
|
Yang NY, Hsieh AYY, Chen Z, Campbell AR, Gadawska I, Kakkar F, Sauve L, Bitnun A, Brophy J, Murray MCM, Pick N, Krajden M, Côté HCF. Chronic and Latent Viral Infections and Leukocyte Telomere Length across the Lifespan of Female and Male Individuals Living with or without HIV. Viruses 2024; 16:755. [PMID: 38793637 PMCID: PMC11125719 DOI: 10.3390/v16050755] [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: 04/05/2024] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Chronic/latent viral infections may accelerate immunological aging, particularly among people living with HIV (PLWH). We characterized chronic/latent virus infections across their lifespan and investigated their associations with leukocyte telomere length (LTL). METHODS Participants enrolled in the CARMA cohort study were randomly selected to include n = 15 for each decade of age between 0 and >60 y, for each sex, and each HIV status. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 8 (HHV-8), herpes simplex virus 1 (HSV-1), and HSV-2 infection were determined serologically; HIV, hepatitis C (HCV), and hepatitis B (HBV) were self-reported. LTLs were measured using monochrome multiplex qPCR. Associations between the number of viruses, LTL, and sociodemographic factors were assessed using ordinal logistic and linear regression modeling. RESULTS The study included 187 PLWH (105 female/82 male) and 190 HIV-negative participants (105 female/84 male), ranging in age from 0.7 to 76.1 years. Living with HIV, being older, and being female were associated with harbouring a greater number of chronic/latent non-HIV viruses. Having more infections was in turn bivariately associated with a shorter LTL. In multivariable analyses, older age, living with HIV, and the female sex remained independently associated with having more infections, while having 3-4 viruses (vs. 0-2) was associated with a shorter LTL. CONCLUSIONS Our results suggest that persistent viral infections are more prevalent in PLWH and females, and that these may contribute to immunological aging. Whether this is associated with comorbidities later in life remains an important question.
Collapse
Affiliation(s)
- Nancy Yi Yang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; (N.Y.Y.); (A.Y.Y.H.); (M.K.)
- Centre for Blood Research, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Anthony Y. Y. Hsieh
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; (N.Y.Y.); (A.Y.Y.H.); (M.K.)
- Centre for Blood Research, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Zhuo Chen
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Amber R. Campbell
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; (N.Y.Y.); (A.Y.Y.H.); (M.K.)
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC V6H 2N9, Canada; (L.S.); (M.C.M.M.)
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, BC V5Z 0C9, Canada
| | - Izabella Gadawska
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; (N.Y.Y.); (A.Y.Y.H.); (M.K.)
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada;
| | - Laura Sauve
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC V6H 2N9, Canada; (L.S.); (M.C.M.M.)
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, BC V5Z 0C9, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada;
| | - Jason Brophy
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - Melanie C. M. Murray
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC V6H 2N9, Canada; (L.S.); (M.C.M.M.)
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, BC V5Z 0C9, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia Faculty of Medicine, Vancouver, BC V5Z 1M9, Canada
| | - Neora Pick
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC V6H 2N9, Canada; (L.S.); (M.C.M.M.)
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, BC V5Z 0C9, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia Faculty of Medicine, Vancouver, BC V5Z 1M9, Canada
| | - Mel Krajden
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; (N.Y.Y.); (A.Y.Y.H.); (M.K.)
- British Columbia Center for Disease Control, Vancouver, BC V5Z 4R4, Canada
| | - Hélène C. F. Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; (N.Y.Y.); (A.Y.Y.H.); (M.K.)
- Centre for Blood Research, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, BC V6H 2N9, Canada; (L.S.); (M.C.M.M.)
| | | |
Collapse
|
2
|
Kelebie MA, Tinsae T, Alemayehu BF, Walelign GK, Takelle GM. Prevalence and associated factors of neurocognitive disorder among people living with HIV/AIDS in the South Gondar zone primary hospitals, North-West Ethiopia: an institution-based cross-sectional study. BMJ Open 2024; 14:e082773. [PMID: 38697760 PMCID: PMC11086442 DOI: 10.1136/bmjopen-2023-082773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To assess the prevalence and associated factors of neurocognitive disorder among people living with HIV/AIDS in South Gondar primary hospitals, North-West Ethiopia, 2023. DESIGN Institution-based cross-sectional study design. SETTING South Gondar primary hospitals, North-West Ethiopia. PARTICIPANTS 608 participants were recruited using the systematic random sampling technique. MEASUREMENT Data were collected using an interviewer-administered questionnaire and medical chart reviews. The International HIV Dementia Scale was used to screen for neurocognitive disorder. The data were entered through EPI-DATA V.4.6 and exported to SPSS V.21 statistical software for analysis. In the bivariable logistic regression analyses, variables with a value of p<0.25 were entered into a multivariable logistic regression analysis to identify factors independently associated with neurocognitive disorder. Statistical significance was declared at a value of p<0.05. RESULTS The prevalence of neurocognitive disorder among HIV-positive participants was 39.1%. In multivariable logistic regression, lower level of education (adjusted OR (AOR)=2.94; 95% CI 1.29 to 6.82), unemployment (AOR=2.74; 95% CI 1.29 to 6.84) and comorbid medical illness (AOR=1.80; 95% CI 1.03 to 3.14) were significantly associated with neurocognitive disorder. CONCLUSION HIV-associated neurocognitive problems affected over a third of the participants. According to the current study, comorbid medical conditions, unemployment and low educational attainment are associated with an increased risk of neurocognitive disorder. Therefore, early detection and treatment are essential.
Collapse
Affiliation(s)
- Mulualem Admasu Kelebie
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Biruk Fanta Alemayehu
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Getasew Kibralew Walelign
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, School of Medicine and Health Sciences, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara, Ethiopia
| |
Collapse
|
3
|
2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
Collapse
|
4
|
Naranjo O, Torices S, Clifford PR, Rodriguez T, Osborne OM, Tiburcio D, Fattakhov N, Park M, Stevenson M, Toborek M. AKT signaling modulates latent viral reservoir viability in HIV-1-infected blood-brain barrier pericytes. J Biol Chem 2024; 300:105526. [PMID: 38043797 PMCID: PMC10777012 DOI: 10.1016/j.jbc.2023.105526] [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: 07/26/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023] Open
Abstract
Despite antiretroviral therapy (ART), chronic forms of HIV-associated neurocognitive disorders (HAND) affect an estimated 50% of individuals living with HIV, greatly impacting their quality of life. The prevailing theory of HAND progression posits that chronic inflammation arising from the activation of latent viral reservoirs leads to progressive damage in the central nervous system (CNS). Recent evidence indicates that blood-brain barrier (BBB) pericytes are capable of active HIV-1 infection; however, their latent infection has not been defined. Given their location and function, BBB pericytes are poised to be a key viral reservoir in the development of HAND. We present the first transcriptional analysis of uninfected, active, and latent human BBB pericytes, revealing distinct transcriptional phenotypes. In addition, we demonstrate that latent infection of BBB pericytes relies on AKT signaling for reservoir survival. These findings provide insight into the state of reservoir maintenance in the CNS during HIV-1 infection and provide novel targets for reservoir clearance.
Collapse
Affiliation(s)
- Oandy Naranjo
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
| | - Silvia Torices
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Paul R Clifford
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Thaidy Rodriguez
- Department of Urology, University of California San Francisco, San Francisco, California, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Olivia M Osborne
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Destiny Tiburcio
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Nikolai Fattakhov
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Minseon Park
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Mario Stevenson
- Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
| |
Collapse
|
5
|
Nader S, Karlovich E, Cortes EP, Insausti R, Meloni G, Jacobs M, Crary JF, Morgello S. Predictors of hippocampal tauopathy in people with and at risk for human immunodeficiency virus infection. J Neurovirol 2023; 29:647-657. [PMID: 37926797 DOI: 10.1007/s13365-023-01181-9] [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: 09/13/2023] [Revised: 09/13/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
Combination antiretroviral therapy (cART) has extended lifespans of people living with HIV (PWH), increasing both the risk for age-related neuropathologies and the importance of distinguishing effects of HIV and its comorbidities from neurodegenerative disorders. The accumulation of hyperphosphorylated tau (p-tau) in hippocampus is a common degenerative change, with specific patterns of hippocampal subfield vulnerability observed in different disease contexts. Currently, associations between chronic HIV, its comorbidities, and p-tau burden and distribution in the hippocampus are unexplored. We used immunohistochemistry with antibody AT8 to analyze hippocampal p-tau in brain tissues of PWH (n = 71) and HIV negative controls (n = 25), for whom comprehensive clinical data were available. Using a morphology-based neuroanatomical segmentation protocol, we annotated digital slide images to measure percentage p-tau areas in the hippocampus and its subfields. Factors predicting p-tau burden and distribution were identified in univariate analyses, and those with significance at p ≤ 0.100 were advanced to multivariable regression. The patient sample had a mean age of 61.5 years. Age predicted overall hippocampal p-tau burden. Subfield p-tau predictors were for Cornu Ammonis (CA)1, age; for CA2 and subiculum, seizure history; for CA3, seizure history and head trauma; and for CA4/dentate, history of hepatitis C virus (HCV) infection. In this autopsy sample, hippocampal p-tau burden and distribution were not predicted by HIV, viral load, or immunologic status, with viral effects limited to associations between HCV and CA4/dentate vulnerability. Hippocampal p-tau pathologies in cART-era PWH appear to reflect age and comorbidities, but not direct effects of HIV infection.
Collapse
Affiliation(s)
- Sophie Nader
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Esma Karlovich
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Etty P Cortes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo Insausti
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
| | - Gregory Meloni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Jacobs
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John F Crary
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA.
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Susan Morgello
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA.
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
6
|
Sharma A, Mohanty M, Salan T, Aggarwal D, Mandell L, Jones DL, Arheart K, Sharma A, Vyas S, Singh P, Govind V, Kumar M. Sex differences in cognitive function among people with HIV-1 clade C infection in Northern India. J Neurovirol 2023; 29:614-625. [PMID: 37698788 DOI: 10.1007/s13365-023-01166-8] [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: 05/08/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023]
Abstract
Human immunodeficiency virus-1 (HIV-1) clade C is the most prevalent form of HIV-1 comprising nearly 46% of global infections and is the dominant subtype in India. Despite its predominance, the impact of HIV-1 clade C infection on cognitive function has been understudied in comparison with other subtypes, notably clade B, which is primarily found in Europe and North America. Few studies have assessed cognitive impairment in antiretroviral therapy (ART) naïve men and women with HIV-1 clade C infection. In this study conducted in Northern India, differences in neuropsychological functioning were compared between 109 participants (70 men, 39 women) with untreated HIV-1 clade C infection and 110 demographically matched healthy controls (74 men, 36 women). A comprehensive neuropsychological battery was used to examine depression, self-assessment of functioning, and cognitive performance in six domains of functioning. Group differences were assessed by HIV-1 status and sex, controlling for age and education. Results indicated that cognitive deficits were substantially greater among male participants with HIV-1 clade C compared to male controls in all domains of cognitive functioning; in contrast, women with HIV-1 clade C had only minor deficits compared to healthy female participants. In addition, a larger proportion of men with HIV-1 clade C exhibited high levels of depression than women with HIV-1 clade C. These findings suggest that untreated HIV-1 clade C infection in men can have debilitating effects on neuropsychological function and depression, and stress the importance of facilitating rapid access to treatment to reduce the impact of HIV-1 infection.
Collapse
Affiliation(s)
- Anchal Sharma
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Manju Mohanty
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Teddy Salan
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deepika Aggarwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Lissa Mandell
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristopher Arheart
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aman Sharma
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Sameer Vyas
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Paramjeet Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Varan Govind
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Mahendra Kumar
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
7
|
Rodrigues J, Lowton K. Neurocognitive improvement in HIV-positive patients treated with dolutegravir-based regimens. S Afr J Psychiatr 2023; 29:2071. [PMID: 37795459 PMCID: PMC10546244 DOI: 10.4102/sajpsychiatry.v29i0.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Neurocognitive disorders due to human immunodeficiency virus (HIV) remain highly prevalent, specifically mild forms despite effective antiretroviral therapy (ART). Dolutegravir-based regimens are the first line of treatment for adult HIV-positive patients. Controversies exist regarding the neurocognitive effects of dolutegravir. Evidence regarding the neurocognitive effects of dolutegravir is important, in support of its use in patients with HIV-associated neurocognitive disorders (HAND). Aim This study aimed to describe the change in cognitive function using the International HIV Dementia Scale (IHDS) and Brief Neuropsychological Cognitive Examination (BNCE) in HIV positive, treatment naïve patients before and 3 months after initiation of ART using a dolutegravir-based regimen. Setting The HIV initiation clinic of Hillbrow Community Health Centre in Johannesburg. Methods This prospective, quantitative cohort study assessed adult HIV-positive patients who were ART naïve being initiated on a dolutegravir-based regimen, using the BNCE and IHDS at baseline and after 3 months of treatment. Results Neurocognitive test results of 26 participants showed significant improvements for IHDS (Z = 1.84, p = 0.033) and time to complete BNCE (Z = 2.47, p = 0.007). BNCE total results showed improvements that were not significant (Z = 1.44, p = 0.075); however, Part 2 of the BNCE reflecting that of executive function showed significant improvements (Z = 66.5, p = 0.043). Conclusion The trend of neurocognitive function is towards improvement in HIV-positive treatment naïve patients who receive 3 months of dolutegravir-based ART. Contribution The findings support the use of dolutegravir-based regimens in the treatment of patients with HIV-associated neurocognitive disorders. Keywords HIV-associated neurocognitive disorders; BNCE; IHDS; dolutegravir; neurocognitive screening; neurocognitive impairment; South Africa.
Collapse
Affiliation(s)
- Janine Rodrigues
- Department of Psychiatry, Faculty of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Karishma Lowton
- Department of Psychiatry, Faculty of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
8
|
Rodriguez MT, McLaurin KA, Shtutman M, Kubinak JL, Mactutus CF, Booze RM. Therapeutically targeting the consequences of HIV-1-associated gastrointestinal dysbiosis: Implications for neurocognitive and affective alterations. Pharmacol Biochem Behav 2023; 229:173592. [PMID: 37390973 PMCID: PMC10494709 DOI: 10.1016/j.pbb.2023.173592] [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: 02/09/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
Approximately 50 % of the individuals living with human immunodeficiency virus type 1 (HIV-1) are plagued by debilitating neurocognitive impairments (NCI) and/or affective alterations. Sizeable alterations in the composition of the gut microbiome, or gastrointestinal dysbiosis, may underlie, at least in part, the NCI, apathy, and/or depression observed in this population. Herein, two interrelated aims will be critically addressed, including: 1) the evidence for, and functional implications of, gastrointestinal microbiome dysbiosis in HIV-1 seropositive individuals; and 2) the potential for therapeutically targeting the consequences of this dysbiosis for the treatment of HIV-1-associated NCI and affective alterations. First, gastrointestinal microbiome dysbiosis in HIV-1 seropositive individuals is characterized by decreased alpha (α) diversity, a decreased relative abundance of bacterial species belonging to the Bacteroidetes phylum, and geographic-specific alterations in Bacillota (formerly Firmicutes) spp. Fundamentally, changes in the relative abundance of Bacteroidetes and Bacillota spp. may underlie, at least in part, the deficits in γ-aminobutyric acid and serotonin neurotransmission, as well as prominent synaptodendritic dysfunction, observed in this population. Second, there is compelling evidence for the therapeutic utility of targeting synaptodendritic dysfunction as a method to enhance neurocognitive function and improve motivational dysregulation in HIV-1. Further research is needed to determine whether the therapeutics enhancing synaptic efficacy exert their effects by altering the gut microbiome. Taken together, understanding gastrointestinal microbiome dysbiosis resulting from chronic HIV-1 viral protein exposure may afford insight into the mechanisms underlying HIV-1-associated neurocognitive and/or affective alterations; mechanisms which can be subsequently targeted via novel therapeutics.
Collapse
Affiliation(s)
- Mason T Rodriguez
- Cognitive and Neural Science Program, Department of Psychology, Barnwell College, 1512 Pendleton Street, University of South Carolina, Columbia, SC 29208, United States of America
| | - Kristen A McLaurin
- Cognitive and Neural Science Program, Department of Psychology, Barnwell College, 1512 Pendleton Street, University of South Carolina, Columbia, SC 29208, United States of America
| | - Michael Shtutman
- Drug Discovery and Biomedical Sciences, College of Pharmacy, 715 Sumter Street, University of South Carolina, Columbia, SC 29208, United States of America
| | - Jason L Kubinak
- Pathology, Microbiology & Immunology, School of Medicine Columbia, 6311 Garners Ferry Road, Building 2, Columbia, SC 29209, United States of America
| | - Charles F Mactutus
- Cognitive and Neural Science Program, Department of Psychology, Barnwell College, 1512 Pendleton Street, University of South Carolina, Columbia, SC 29208, United States of America
| | - Rosemarie M Booze
- Cognitive and Neural Science Program, Department of Psychology, Barnwell College, 1512 Pendleton Street, University of South Carolina, Columbia, SC 29208, United States of America.
| |
Collapse
|
9
|
Sundermann EE, Campbell LM, Villers O, Bondi MW, Gouaux B, Salmon DP, Galasko D, Soontornniyomkij V, Ellis RJ, Moore DJ. Alzheimer's Disease Pathology in Middle Aged and Older People with HIV: Comparisons with Non-HIV Controls on a Healthy Aging and Alzheimer's Disease Trajectory and Relationships with Cognitive Function. Viruses 2023; 15:1319. [PMID: 37376619 PMCID: PMC10305373 DOI: 10.3390/v15061319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
We determined the prevalence of Alzheimer's disease (AD) pathological hallmarks, amyloid-β and phosphorylated-Tau, in autopsied brains of 49 people with HIV (PWH) (ages: 50-68; mean age = 57.0) from the National NeuroAIDS Tissue Consortium and in a comparative cohort of 55 people without HIV (PWoH) from the UC San Diego Alzheimer's Disease Research Center (17 controls, 14 mild cognitive impairment, 24 AD; ages: 70-102, mean age = 88.7). We examined how AD pathology relates to domain-specific cognitive functions in PWH overall and in sex-stratified samples. Amyloid-β and phosphorylated-Tau positivity (presence of pathology of any type/density) was determined via immunohistochemistry in AD-sensitive brain regions. Among PWH, amyloid-β positivity ranged from 19% (hippocampus) to 41% (frontal neocortex), and phosphorylated-Tau positivity ranged from 47% (entorhinal cortex) to 73% (transentorhinal cortex). Generally, AD pathology was significantly less prevalent, and less severe when present, in PWH versus PWoH regardless of cognitive status. Among PWH, positivity for AD pathology related most consistently to memory-related domains. Positivity for p-Tau pathology related to memory-related domains in women with HIV only, although the sample size of women with HIV was small (n = 10). Results indicate that AD pathology is present in a sizable portion of middle aged and older PWH, although not to the extent in older PWoH. Studies with better age-matched PWoH are needed to examine the effect of HIV status on AD pathology.
Collapse
Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Laura M. Campbell
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Olivia Villers
- School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - David P. Salmon
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Virawudh Soontornniyomkij
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| |
Collapse
|
10
|
Nyundo AA. Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region, central Tanzania: A cross-sectional study. PLoS One 2023; 18:e0285761. [PMID: 37228133 PMCID: PMC10212098 DOI: 10.1371/journal.pone.0285761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorders (HAND) continue to manifest despite advancements and improved antiretroviral therapy coverage. Neurocognitive impairment is a significant predictor of poor prognosis related to poor antiretroviral therapy adherence and retention in HIV care. METHODS This cross-sectional study examined 397 participants attending cared for and treatment at Dodoma Regional Referral Hospital (DRRH) and selected by systematic sampling. The combination of Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), and The Lawton Instrumental Activity of Daily Living (IADL) were used to assess HIV-associated neurocognitive disorders. Factors associated with HAND were determined using univariate and multivariable logistic regression. RESULTS Of 397 participants, 234(59.1%) met the criteria for HAND with 231(58.2%) comprising asymptomatic neurocognitive disorder (ANI) or mild neurocognitive disorders (MND), and 3 (0.76%) HIV- associated dementia (HAD). Participants with HAND had significantly poorer performance in each cognitive domain on both MoCA and IHDS. Under multivariable regression, age of 55 years or above with Adjusted Odds Ratio (AOR): 3.5 (95%CI: 1.1, 11.6), p = 0.041 and female gender (AOR): 2.7 (95%CI: 1, 6, 4.5), p<0.001 were significantly associated with HAND. Adherence to antiretroviral therapy AOR: 0.4(95%CI: 0.2, 1.0), p = 0.044, and attaining primary education AOR: 0.3(95%CI: 0.1, 0.8), p = 0.01 or secondary education AOR: 0.1(95%CI: 0.03, 0.2), p<0.001 compared to having no formal education showed good cognitive performance. CONCLUSION HIV-associated neurocognitive disorders are common in HIV, especially ANI and MND, are common in HIV infected Tanzanians. Both socio-demographic and clinical variables influence neurocognitive functioning in this population. Screening for mild neurocognitive disorders may be indicated if effective treatment becomes available.
Collapse
Affiliation(s)
- Azan A. Nyundo
- Department of Psychiatry and Mental Health, School of Medicine, The University of Dodoma, Dodoma, Tanzania
| |
Collapse
|
11
|
Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
Collapse
|
12
|
Duran-Castells C, Llano A, Kawana-Tachikawa A, Prats A, Martinez-Zalacain I, Kobayashi-Ishihara M, Oriol-Tordera B, Peña R, Gálvez C, Silva-Arrieta S, Clotet B, Riveira-Muñoz E, Ballana E, Prado JG, Martinez-Picado J, Sanchez J, Mothe B, Hartigan-O'Connor D, Wyss-Coray T, Meyerhans A, Gisslén M, Price RW, Soriano-Mas C, Muñoz-Moreno JA, Brander C, Ruiz-Riol M. Sirtuin-2, NAD-Dependent Deacetylase, Is a New Potential Therapeutic Target for HIV-1 Infection and HIV-Related Neurological Dysfunction. J Virol 2023; 97:e0165522. [PMID: 36719240 PMCID: PMC9972991 DOI: 10.1128/jvi.01655-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/20/2022] [Indexed: 02/01/2023] Open
Abstract
The implementation and access to combined antiretroviral treatment (cART) have dramatically improved the quality of life of people living with HIV (PLWH). However, some comorbidities, such as neurological disorders associated with HIV infection still represent a serious clinical challenge. Soluble factors in plasma that are associated with control of HIV replication and neurological dysfunction could serve as early biomarkers and as new therapeutic targets for this comorbidity. We used a customized antibody array for determination of blood plasma factors in 40 untreated PLWH with different levels of viremia and found sirtuin-2 (SIRT2), an NAD-dependent deacetylase, to be strongly associated with elevated viral loads and HIV provirus levels, as well as with markers of neurological damage (a-synuclein [SNCA], brain-derived neurotrophic factor [BDNF], microtubule-associated protein tau [MAPT], and neurofilament light protein [NFL]). Also, longitudinal analysis in HIV-infected individuals with immediate (n = 9) or delayed initiation (n = 10) of cART revealed that after 1 year on cART, SIRT2 plasma levels differed between both groups and correlated inversely with brain orbitofrontal cortex involution. Furthermore, targeting SIRT2 with specific small-molecule inhibitors in in vitro systems using J-LAT A2 and primary glial cells led to diminished HIV replication and virus reactivation from latency. Our data thus identify SIRT2 as a novel biomarker of uncontrolled HIV infection, with potential impact on neurological dysfunction and offers a new therapeutic target for HIV treatment and cure. IMPORTANCE Neurocognitive disorders are frequently reported in people living with HIV (PLWH) even with the introduction of combined antiretroviral treatment (cART). To identify biomarkers and potential therapeutic tools to target HIV infection in peripheral blood and in the central nervous system (CNS), plasma proteomics were applied in untreated chronic HIV-infected individuals with different levels of virus control. High plasma levels of sirtuin-2 (SIRT2), an NAD+ deacetylase, were detected in uncontrolled HIV infection and were strongly associated with plasma viral load and proviral levels. In parallel, SIRT2 levels in the peripheral blood and CNS were associated with markers of neurological damage and brain involution and were more pronounced in individuals who initiated cART later in infection. In vitro infection experiments using specific SIRT2 inhibitors suggest that specific targeting of SIRT2 could offer new therapeutic treatment options for HIV infections and their associated neurological dysfunction.
Collapse
Affiliation(s)
- Clara Duran-Castells
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- Departament de Biologia, Cel·lular, Fisiologia i d'immunologia, Facultat de Medicina, Universitat Autonoma de Barcelona, Cerdanyola del Valles, Spain
| | - Anuska Llano
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ai Kawana-Tachikawa
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Anna Prats
- Fundació Lluita contra la Sida and Infectious Diseases Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Mie Kobayashi-Ishihara
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Bruna Oriol-Tordera
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- Departament de Biologia, Cel·lular, Fisiologia i d'immunologia, Facultat de Medicina, Universitat Autonoma de Barcelona, Cerdanyola del Valles, Spain
| | - Ruth Peña
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Cristina Gálvez
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Sandra Silva-Arrieta
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita contra la Sida and Infectious Diseases Department, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Spain
| | - Eva Riveira-Muñoz
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Esther Ballana
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Julia G Prado
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Spain
- ICREA, Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Sanchez
- Centro de Investigaciones Tecnologicas Biomedicas y Medioambientales, CITBM, Lima, Peru
| | - Beatriz Mothe
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita contra la Sida and Infectious Diseases Department, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Dennis Hartigan-O'Connor
- Department of Medical Microbiology and Immunology, University of California, Davis, California, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Andreas Meyerhans
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - José Antonio Muñoz-Moreno
- Fundació Lluita contra la Sida and Infectious Diseases Department, Hospital Germans Trias i Pujol, Badalona, Spain
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Christian Brander
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Spain
- ICREA, Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Ruiz-Riol
- IrsiCaixa AIDS Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
13
|
Eke UA, Mohanty K, Gruber-Baldini AL, Ryan AS. Frailty and Aging in HIV- Status Post 13 Years of National Awareness. J Frailty Aging 2023; 12:49-58. [PMID: 36629084 PMCID: PMC10082638 DOI: 10.14283/jfa.2022.45] [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] [Indexed: 01/13/2023]
Abstract
The People aged 50 years and above comprise over 50% of people living with HIV (PLWH) in the US. Despite the advances made with anti-retroviral therapy in increasing their life span, PLWH are plagued with non-AIDS associated conditions which increase their risk for morbidity and mortality. Frailty, a decline in physical and functional reserve, is one of the manifestations of aging, has a prevalence of 5-30%, and occurs up to 2 decades earlier in people aging with HIV (PAWH). The majority of providers for PAWH have minimal experience with the concept of gerontology, frailty, and aging. Hence, there is a gap in clinicians' knowledge on how to address frailty and aging in PAWH. This review will focus on the clinical interventions that mitigate frailty and aging in PAWH as well as highlight areas of investigation towards achieving these mediations. Beyond the identification of the roles of exercise and nutrition, more studies are needed on the pragmatic approach to apply these resources to routine care. There should be continued reinforcement of the proven strategy of combination antiretroviral therapy as well as treatment of co-infections and age-appropriate health and cancer screening in PAWH.
Collapse
Affiliation(s)
- U A Eke
- Uzoamaka A Eke, University of Maryland School of Medicine, Baltimore, USA,
| | | | | | | |
Collapse
|
14
|
Low incidence of advanced neurological burden but high incidence of age-related conditions that are dementia risk factors in aging people living with HIV: a data-linkage 10-year follow-up study. J Neurovirol 2022; 29:141-155. [PMID: 36508059 DOI: 10.1007/s13365-022-01104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/15/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Although increasing research is focusing on age-related comorbidities (ARC) among people living with HIV (PLHIV), no studies have concomitantly assessed non-HIV age-related neurological disorders (e.g., Alzheimer’s dementia). A total of 254 PLHIV and 69 HIV-negative controls completed baseline medical history and cognitive testing. ARC data were collected from medical records over the subsequent 9-10 years and included all types of strokes, all types of dementia, mild cognitive impairment, Parkinson's disease, motor neuron disease (grouped into a non-HIV age-related neurological category), cardiovascular disease, chronic kidney disease, chronic liver disease, chronic lung disease, non-AIDS cancers, osteoporosis, and diabetes. Kaplan–Meier curves assessed differences in the incident rates (per 1000 person year) of groups of ARC as defined above and combined ARC (i.e., development of any of the ARC) among younger (baseline age < 50) and older (baseline age ≥ 50) PLHIV and younger and older controls. Cox-proportional hazard models assessed the individual and interaction effects of HIV status and chronological age, in addition to a range of demographic and clinical variables including historical and baseline HIV brain involvement on the risk of developing combined ARC. Older PLHIV had a higher incidence of cardiovascular disease, osteoporosis, and combined ARC compared to other groups (p < 0.05). Incident rate of non-HIV age-related neurological disorders was 2.3 [0.93, 4.79] per 1000 person year. While this incident rate was higher in older PLHIV (5.37 [1.97, 11.92]) than older HIV-negative participants (3.58 [0.18-17.67]), this was not significant. In multivariate analyses, HIV status and chronological age, but not their interaction, and smoking were associated with higher risk of combined ARC (p < 0.05). In analyses focusing on PLHIV, older age and taking abacavir/efavirenz/atazanavir/darunavir containing antiretroviral treatments at the time of diagnosis were associated with greater ARC (p < 0.05). Non-HIV age-related neurological disorders are uncommon in older PLHIV, where the majority were < 70 years of age at the end of follow-up. However, the greater burden of ARC among older PLHIV, most of which are established dementia risk factors, warrants the establishment of commensurate prevention strategies and greater attention to neurocognitive screening.
Collapse
|
15
|
Hawes CE, Elizaldi SR, Beckman D, Diniz GB, Shaan Lakshmanappa Y, Ott S, Durbin-Johnson BP, Dinasarapu AR, Gompers A, Morrison JH, Iyer SS. Neuroinflammatory transcriptional programs induced in rhesus pre-frontal cortex white matter during acute SHIV infection. J Neuroinflammation 2022; 19:250. [PMID: 36203187 PMCID: PMC9535930 DOI: 10.1186/s12974-022-02610-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Immunosurveillance of the central nervous system (CNS) is vital to resolve infection and injury. However, immune activation within the CNS in the setting of chronic viral infections, such as HIV-1, is strongly linked to progressive neurodegeneration and cognitive decline. Establishment of HIV-1 in the CNS early following infection underscores the need to delineate features of acute CNS immune activation, as these early inflammatory events may mediate neurodegenerative processes. Here, we focused on elucidating molecular programs of neuroinflammation in brain regions based on vulnerability to neuroAIDS and/or neurocognitive decline. To this end, we assessed transcriptional profiles within the subcortical white matter of the pre-frontal cortex (PFCw), as well as synapse dense regions from hippocampus, superior temporal cortex, and caudate nucleus, in rhesus macaques following infection with Simian/Human Immunodeficiency Virus (SHIV.C.CH505). Methods We performed RNA extraction and sequenced RNA isolated from 3 mm brain punches. Viral RNA was quantified in the brain and cerebrospinal fluid by RT-qPCR assays targeting SIV Gag. Neuroinflammation was assessed by flow cytometry and multiplex ELISA assays. Results RNA sequencing and flow cytometry data demonstrated immune surveillance of the rhesus CNS by innate and adaptive immune cells during homeostasis. Following SHIV infection, viral entry and integration within multiple brain regions demonstrated vulnerabilities of key cognitive and motor function brain regions to HIV-1 during the acute phase of infection. SHIV-induced transcriptional alterations were concentrated to the PFCw and STS with upregulation of gene expression pathways controlling innate and T-cell inflammatory responses. Within the PFCw, gene modules regulating microglial activation and T cell differentiation were induced at 28 days post-SHIV infection, with evidence for stimulation of immune effector programs characteristic of neuroinflammation. Furthermore, enrichment of pathways regulating mitochondrial respiratory capacity, synapse assembly, and oxidative and endoplasmic reticulum stress were observed. These acute neuroinflammatory features were substantiated by increased influx of activated T cells into the CNS. Conclusions Our data show pervasive immune surveillance of the rhesus CNS at homeostasis and reveal perturbations of important immune, neuronal, and synaptic pathways within key anatomic regions controlling cognition and motor function during acute HIV infection. These findings provide a valuable framework to understand early molecular features of HIV associated neurodegeneration. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02610-y.
Collapse
Affiliation(s)
- Chase E Hawes
- Graduate Group in Immunology, University of California, Davis, CA, 95616, USA.,Center for Immunology and Infectious Diseases, University of California, Davis, CA, 95616, USA
| | - Sonny R Elizaldi
- Graduate Group in Immunology, University of California, Davis, CA, 95616, USA.,Center for Immunology and Infectious Diseases, University of California, Davis, CA, 95616, USA
| | - Danielle Beckman
- California National Primate Research Center, University of California, Davis, CA, 95616, USA
| | - Giovanne B Diniz
- California National Primate Research Center, University of California, Davis, CA, 95616, USA
| | | | - Sean Ott
- California National Primate Research Center, University of California, Davis, CA, 95616, USA
| | - Blythe P Durbin-Johnson
- Division of Biostatistics, School of Medicine, University of California, Davis, CA, 95616, USA
| | | | - Andrea Gompers
- Center for Immunology and Infectious Diseases, University of California, Davis, CA, 95616, USA
| | - John H Morrison
- California National Primate Research Center, University of California, Davis, CA, 95616, USA. .,Department of Neurology, School of Medicine, University of California, Davis, CA, 95616, USA.
| | - Smita S Iyer
- Center for Immunology and Infectious Diseases, University of California, Davis, CA, 95616, USA. .,California National Primate Research Center, University of California, Davis, CA, 95616, USA. .,Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA.
| |
Collapse
|
16
|
Nigro SE, Wu M, Juliano AC, Napier TC, Landay AL, French AL, Yang S. Impaired verbal memory in individuals living with HIV and cocaine dependence. J Clin Exp Neuropsychol 2022; 44:134-145. [PMID: 35786160 DOI: 10.1080/13803395.2022.2086219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Our study aimed to understand the independent and combined effects of cocaine dependence and HIV status across aspects of verbal memory. METHOD Our sample consisted of a total of 102 individuals: 28 individuals living with HIV and cocaine dependence (HIV+/CD), 28 individuals who are HIV-negative with cocaine dependence (HIV-/CD), 20 individuals living with HIV without cocaine dependence (HIV+/ND), and 26 individuals who are HIV-negative without cocaine dependence (HIV-/ND). We utilized the Hopkins Verbal Learning Test-Revised Version (HVLT-R) to assess components of verbal memory, including encoding, recall, and recognition. A 2 (HIV: Yes/No) × 2 (Cocaine: Yes/No) MANCOVA on Total and Delayed Recall while controlling for premorbid intelligence was conducted. We used a Kruskal-Wallis H test to examine retrieval and recognition. RESULTS The combination of HIV and cocaine dependence amplified deficits on Total Recall. We found comparably poor performance across Delayed Recall between all three clinical groups. People living with HIV without cocaine dependence demonstrated intact recognition, whereas those with cocaine dependence had poor recognition. CONCLUSIONS HIV and cocaine both impacted verbal memory. However, there are potential subtle differences in the role cocaine versus HIV has on the memory process. People living with HIV without cocaine dependence recognized significantly more words than they could freely recall. In contrast, cocaine dependence impacted recognition in HIV and non-HIV groups. These performance patterns suggest HIV may be associated with retrieval deficits, whereas cocaine dependence may be associated with encoding deficits. Further research assessing these specific components of the memory process will help clarify these potential differences.
Collapse
Affiliation(s)
- Sarah E Nigro
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Minjie Wu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony C Juliano
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - T Celeste Napier
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Audrey L French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, IL, USA
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
17
|
Abstract
OBJECTIVE Given the aging population of people with HIV (PWH), along with increasing rates of binge drinking among both PWH and the general older adult population, this study examined the independent and interactive effects of HIV, binge drinking, and age on neurocognition. METHOD Participants were 146 drinkers stratified by HIV and binge drinking status (i.e., ≥4 drinks for women and ≥5 drinks for men within approximately 2 h): HIV+/Binge+ (n = 30), HIV-/Binge+ (n = 23), HIV+/Binge- (n = 55), HIV-/Binge- (n = 38). All participants completed a comprehensive neuropsychological battery measuring demographically-corrected global and domain-specific neurocognitive T scores. ANCOVA models examined independent and interactive effects of HIV and binge drinking on neurocognitive outcomes, adjusting for overall alcohol consumption, lifetime substance use, sex, and age. Subsequent multiple linear regressions examined whether HIV/Binge group moderated the relationship between age and neurocognition. RESULTS HIV+/Binge+ participants had worse global neurocognition, processing speed, delayed recall, and working memory than HIV-/Binge- participants (p's < .05). While there were significant main effects of HIV and binge drinking, their interaction did not predict any of those neurocognitive outcomes (p's > .05). Significant interactions between age and HIV/Binge group showed that HIV+/Binge+ participants demonstrated steeper negative relationships between age and neurocognitive outcomes of learning, delayed recall, and motor skills compared to HIV-/Binge- participants (p's < .05). CONCLUSIONS Results showed adverse additive effects of HIV and binge drinking on neurocognitive functioning, with older adults demonstrating the most vulnerability to these effects. Findings support the need for interventions to reduce binge drinking, especially among older PWH.
Collapse
|
18
|
Spence AB, Liu C, Rubin L, Aouizerat B, Vance DE, Bolivar H, Lahiri CD, Adimora AA, Weber K, Gustafson D, Sosanya O, Turner RS, Kassaye S. Class-Based Antiretroviral Exposure and Cognition Among Women Living with HIV. AIDS Res Hum Retroviruses 2022; 38:561-570. [PMID: 35109713 PMCID: PMC9297324 DOI: 10.1089/aid.2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Neurologic complications of the human immunodeficiency virus (HIV) are common in treated individuals, and toxicity of certain antiretroviral therapies (ART) may contribute to cognitive impairment. We investigated exposures to specific ART and cognition among women living with HIV (WLWH). Virologically suppressed (viral load <200 copies/mL during at least two semi-annual visits) WLWH and age/race matched HIV-seronegative controls enrolled in the Women's Interagency HIV Study who completed at least two biennial cognitive assessments were included. Analysis of WLWH was restricted to those with exposure to the drug class of interest and a nucleoside reverse transcriptase inhibitor (NRTI) backbone. Generalized estimating equations were used to evaluate repeated measures of cognition over time in association with ART class exposure. Among 1,242 eligible WLWH, 20% (n = 247) had isolated drug exposure to non-nucleoside reverse transcriptase inhibitors (NNRTI), 18% (n = 219) to protease inhibitors (PIs), and 6% (n = 79) to integrase inhibitors with a NRTI backbone. Cognitive assessments were performed at a median of 3 biennial visits {IQR 2-4 visits}. At the index assessment, 21% of WLWH demonstrated global cognitive impairment versus 29% at their last cognitive assessment. In multivariable analyses adjusted for hypertension, depression, diabetes mellitus, history of AIDS-defining illness, alcohol use, number of medications, and time on ART, WLWH exposed to NNRTIs demonstrated verbal learning improvements (mean T-score change 1.3, p = .020) compared to other treated women. Compared to HIV-seronegative women, WLWH exposed to PIs had worse verbal learning (mean T-score difference -2.62, p = .002) and verbal memory performance (mean T-score difference -1.74, p = .032) at baseline. Compared to HIV-seronegative women, WLWH exposed to PIs had improvements in verbal learning (mean T-score slope difference 0.36, p = .025) and verbal memory (mean T-score slope difference 0.32, p = .042). The index T-score and slope of change in the T-score were similar among other treated groups and the HIV-seronegative group. We noted emerging trends in cognition in WLWH exposed to specific drug classes. Ongoing study of this relatively young group is important to characterize long-term cognitive outcomes and effect of antiretrovirals as treatment guidelines evolve.
Collapse
Affiliation(s)
- Amanda Blair Spence
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA.,Address correspondence to: Amanda Blair Spence, Division of Infectious Diseases, Georgetown University Medical Center, 3800 Reservoir Road NW, 5th Floor PHC, Washington, DC 20007, USA
| | - Chenglong Liu
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Leah Rubin
- Department of Neurology and John Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, and John Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychiatry, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bradley Aouizerat
- Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, New York, USA.,Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, New York, USA
| | - David Eugene Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hector Bolivar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cecile Delille Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Grady Healthcare System, Atlanta, Georgia, USA
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York-Downstate Health Sciences University, Brooklyn, New York, USA
| | - Oluwakemi Sosanya
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Raymond Scott Turner
- Department of Neurology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
| |
Collapse
|
19
|
Saloner R, Lobo JD, Paolillo EW, Campbell LM, Letendre SL, Cherner M, Grant I, Heaton RK, Ellis RJ, Roesch SC, Moore DJ, Grant I, Letendre SL, Ellis RJ, Marcotte TD, Franklin D, McCutchan JA, Smith DM, Heaton RK, Atkinson JH, Dawson M, Fennema-Notestine C, Taylor MJ, Theilmann R, Gamst AC, Cushman C, Abramson I, Vaida F, Sacktor N, Rogalski V, Morgello S, Simpson D, Mintz L, McCutchan JA, Collier A, Marra C, Storey S, Gelman B, Head E, Clifford D, Al-Lozi M, Teshome M. Identification of Youthful Neurocognitive Trajectories in Adults Aging with HIV: A Latent Growth Mixture Model. AIDS Behav 2022; 26:1966-1979. [PMID: 34878634 PMCID: PMC9046348 DOI: 10.1007/s10461-021-03546-9] [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] [Accepted: 11/22/2021] [Indexed: 11/12/2022]
Abstract
Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1–5 years of follow-up. Classes were defined using ‘peak-age’ global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1Stable Elite (n = 31 [16.8%], high baseline peak-age T-scores with flat trajectory); Class 2Quadratic Average (n = 100 [54.3%], intermediate baseline peak-age T-scores with u-shaped trajectory); Class 3Quadratic Low (n = 53 [28.8%], low baseline peak-age T-scores with u-shaped trajectory). Baseline predictors of Class 1Stable Elite included SA status, younger age, higher cognitive and physiologic reserve, and fewer subjective cognitive difficulties. This GMM analysis supports the construct validity of SuperAging in older PWH through identification of a subgroup with longitudinally-stable, youthful neurocognition and robust biopsychosocial health.
Collapse
|
20
|
Reversibility of Central Nervous System Adverse Events in Course of Art. Viruses 2022; 14:v14051028. [PMID: 35632768 PMCID: PMC9147522 DOI: 10.3390/v14051028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study is to evaluate the frequency of central nervous system adverse events (CNS-AE) on dolutegravir (DTG) and non-DTG containing ART, and their reversibility, in the observational prospective SCOLTA cohort. Factors associated with CNS-AE were estimated using a Cox proportional-hazards model. 4939 people living with HIV (PLWH) were enrolled in DTG (n = 1179) and non-DTG (n = 3760) cohorts. Sixty-six SNC-AE leading to ART discontinuation were reported, 39/1179 (3.3%) in DTG and 27/3760 (0.7%) in non-DTG cohort. PLWH naïve to ART, with higher CD4 + T count and with psychiatric disorders were more likely to develop a CNS-AE. The risk was lower in non-DTG than DTG-cohort (aHR 0.33, 95% CI 0.19−0.55, p < 0.0001). One-year follow-up was available for 63/66 PLWH with CNS-AE. AE resolution was reported in 35/39 and 23/24 cases in DTG and non-DTG cohorts, respectively. The probability of AE reversibility was not different based on ART class, sex, ethnicity, CDC stage, or baseline psychiatric disorder. At the same time, a lower rate of event resolution was found in PLWH older than 50 years (p = 0.017). In conclusion, CNS-AE leading to ART discontinuation was more frequent in DTG than non-DTG treated PLWH. Most CNS-AE resolved after ART switch, similarly in both DTG and non-DTG cohorts.
Collapse
|
21
|
Azadian A, Gunn-Moore DA. Age-related cognitive impairments in domestic cats naturally infected with feline immunodeficiency virus. Vet Rec 2022; 191:e1683. [PMID: 35512238 DOI: 10.1002/vetr.1683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 03/01/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Age-related dementia has been documented in domestic cats; however, its interaction with naturally occurring feline immunodeficiency virus (FIV) infection has been investigated minimally. METHODS Visuospatial working memory (VSWM) and problem-solving (PS) ability were evaluated in FIV-infected (n = 37) and control cats (n = 39) using two cognitive tasks tested serially, which assessed the ability of cats to remember the location of a baited container after a set delay, then evaluated the capability of the cats to manipulate the container to obtain the food within a time limit. Cats were categorized using 7 years of age as a cut-off to determine age-related differences. The relationship between cognitive performance and FIV viral load was investigated using real-time PCR cycle threshold (Ct ) values. RESULTS Age significantly affected VSWM and PS ability. Younger cats had better VSWM performance and PS ability compared to older cats with the same FIV status. There was no difference between younger FIV-positive and negative cats in either part of the task. While older FIV-positive cats had significantly worse VSWM than older FIV-negative cats, no differences were found in PS ability. Additionally, Ct values predicted VSWM but not PS ability. CONCLUSION Age-related cognitive impairments and FIV infection appear synergetic, causing greater cognitive deficits in older FIV-infected cats.
Collapse
Affiliation(s)
- Amin Azadian
- Animal Welfare Program, Faculty of Land and Food System, The University of British Columbia, Vancouver, Canada.,Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Danièlle A Gunn-Moore
- Division of Companion Animals, Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK.,Division of Infection & Immunity, The Roslin Institute, University of Edinburgh, Midlothian, UK
| |
Collapse
|
22
|
Wu F, Liu YZ, Ling B. MTD: a unique pipeline for host and meta-transcriptome joint and integrative analyses of RNA-seq data. Brief Bioinform 2022; 23:6563416. [PMID: 35380623 PMCID: PMC9116375 DOI: 10.1093/bib/bbac111] [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: 12/04/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 11/13/2022] Open
Abstract
Ribonucleic acid (RNA)-seq data contain not only host transcriptomes but also nonhost information that comprises transcripts from active microbiota in the host cells. Therefore, joint and integrative analyses of both host and meta-transcriptome can reveal gene expression of the microbial community in a given sample as well as the correlative and interactive dynamics of the host response to the microbiome. However, there are no convenient tools that can systemically analyze host-microbiota interactions through simultaneously quantifying the host and meta-transcriptome in the same sample at the tissue and the single-cell level. This poses a challenge for interested researchers with limited expertise in bioinformatics. Here, we developed a software pipeline that can comprehensively and synergistically analyze and correlate the host and meta-transcriptome in a single sample using bulk and single-cell RNA-seq data. This pipeline, named meta-transcriptome detector (MTD), can extensively identify and quantify microbiome, including viruses, bacteria, protozoa, fungi, plasmids and vectors, in the host cells and correlate the microbiome with the host transcriptome. MTD is easy to install and run, involving only a few lines of simple commands. It offers researchers with unique genomics insights into host responses to microorganisms.
Collapse
Affiliation(s)
- Fei Wu
- Host-Pathogen Interaction Program, Texas Biomedical Research Institute, 8715 W Military Dr, San Antonio, TX 78227, USA.,Tulane Center for Aging, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Yao-Zhong Liu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Binhua Ling
- Host-Pathogen Interaction Program, Texas Biomedical Research Institute, 8715 W Military Dr, San Antonio, TX 78227, USA
| |
Collapse
|
23
|
Neurofunctional characteristics of executive control in older people with HIV infection: a comparison with Parkinson's disease. Brain Imaging Behav 2022; 16:1776-1793. [PMID: 35294979 PMCID: PMC10124990 DOI: 10.1007/s11682-022-00645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/02/2022]
Abstract
Expression of executive dysfunctions is marked by substantial heterogeneity in people living with HIV infection (PLWH) and attributed to neuropathological degradation of frontostriatal circuitry with age and disease. We compared the neurophysiology of executive function in older PLWH and Parkinson's disease (PD), both affecting frontostriatal systems. Thirty-one older PLWH, 35 individuals with PD, and 28 older healthy controls underwent executive task-activated fMRI, neuropsychological testing, and a clinical motor exam. fMRI task conditions distinguished cognitive control operations, invoking a lateral frontoparietal network, and motor control operations, activating a cerebellar-precentral-medial prefrontal network. HIV-specific findings denoted a prominent sensorimotor hypoactivation during cognitive control and striatal hypoactivation during motor control related to CD4+ T cell count and HIV disease duration. Activation deficits overlapped for PLWH and PD, relative to controls, in dorsolateral frontal, medial frontal, and middle cingulate cortices for cognitive control, and in limbic, frontal, parietal, and cerebellar regions for motor control. Thus, despite well-controlled HIV infection, frontostriatal and sensorimotor activation deficits occurred during executive control in older PLWH. Overlapping activation deficits in posterior cingulate and hippocampal regions point toward similarities in mesocorticolimbic system aberrations among older PLWH and PD. The extent of pathophysiology in PLWH was associated with variations in immune system health, neural signature consistent with subclinical parkinsonism, and mild neurocognitive impairment. The failure to adequately engage these pathways could be an early sign for cognitive and motor functional decline in the aging population of PLWH.
Collapse
|
24
|
Lam JO, Lee C, Gilsanz P, Hou CE, Leyden WA, Satre DD, Flamm JA, Towner WJ, Horberg MA, Silverberg MJ. Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016. AIDS 2022; 36:437-445. [PMID: 34816805 PMCID: PMC8892590 DOI: 10.1097/qad.0000000000003134] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare dementia incidence and prevalence after age 50 years by HIV status. DESIGN Observational cohort, 2000-2016. METHODS People with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington DC). Dementia diagnoses were obtained from electronic health records. Incidence and prevalence of dementia, overall and by time period (i.e. 2000-2002, 2003-2004, …, 2015-2016), were calculated using Poisson regression. Trends were examined using Joinpoint regression. Rate ratios were used to compare dementia by HIV status with adjustment for sociodemographics, substance use, and clinical factors. RESULTS The study included 13 296 PWH and 155 354 PWoH (at baseline: for both, mean age = 54 years, 89% men; for PWH, 80% with HIV RNA <200 copies/ml). From 2000 to 2016, overall incidence of dementia was higher among PWH [adjusted incidence rate ratio (aIRR) = 1.80, 95% confidence interval (CI) = 1.60-2.04]. Dementia incidence decreased among both PWH and PWoH (-8.0 and -3.1% per period, respectively) but remained higher among PWH in the most recent time period, 2015-2016 (aIRR = 1.58, 95% CI = 1.18-2.12). The overall prevalence of dementia from 2000 to 2016 was higher among PWH [adjusted prevalence ratio (aPR) = 1.86, 95% CI = 1.70-2.04] and was also higher among PWH in 2015-2016 (aPR = 1.75, 95% CI = 1.56-1.97). CONCLUSION Reductions in dementia incidence are encouraging and may reflect ART improvement, but PWH are still more likely to have dementia than PWoH. Monitoring the burden of dementia among PWH is important as this population ages.
Collapse
Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
| | - Jason A Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | | |
Collapse
|
25
|
Ghare S, Singhal R, Bryant V, Gautam S, Tirumala CC, Srisailam PK, Reyes-Vega A, Ghooray D, McClain CJ, Hoffman K, Petrosino J, Bryant K, Govind V, Cohen R, Cook RL, Barve S. Age-Associated Gut Dysbiosis, Marked by Loss of Butyrogenic Potential, Correlates With Altered Plasma Tryptophan Metabolites in Older People Living With HIV. J Acquir Immune Defic Syndr 2022; 89:S56-S64. [PMID: 35015746 PMCID: PMC8751293 DOI: 10.1097/qai.0000000000002866] [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: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Imbalance in tryptophan (TRP) metabolism and its neuroactive metabolites, serotonin and kynurenine (KYN), is a known pathogenic mechanism underlying neurocognitive impairment. Gut microbiota plays an important role in TRP metabolism, and the production of these neuroactive molecules affects neurocognitive function. Although both HIV infection and normal aging independently induce gut dysbiosis and influence TRP metabolism, their interactive effects on compositional/functional changes in gut microbiota and consequent alterations in TRP metabolites remain largely undetermined. METHODS Older people living with HIV infection (PLWH, aged 50-70 years, n = 22) were enrolled in this cross-sectional pilot study. Metagenomic analysis of fecal microbiome using 16S Ribosomal ribonucleic acid gene sequencing and metabolomics analysis of plasma using mass spectrometry with a reverse-phase iquid chromatography tandem mass spectrometry were performed. Statistical analyses included the univariate linear regression and Spearman correlation analyses. RESULTS Age-associated changes in plasma levels of key neuroactive TRP metabolites, serotonin and KYN, were seen in PLWH. Specifically, we observed age-dependent decreases in serotonin and increases in KYN and KYN-to-TRP ratio, indicative of dysfunctional TRP metabolism. Furthermore, the gut dysbiosis seen in older PLWH is characterized by a reduction of Firmicutes/Bacteroidetes ratio and butyrate-producing microbial families Lachnospiraceae and Lactobacillaceae. Of importance, correspondent with gut dysbiosis, increasing age was significantly associated with decreased plasma butyrate levels, which in turn correlated positively with serotonin and negatively with KYN/TRP ratio. CONCLUSIONS Age-dependent gut microbial dysbiosis distinguished by a decrease in butyrogenic potential is a key pathogenic feature associated with the shift in TRP metabolism from serotonin to KYN in older PLWH.
Collapse
Affiliation(s)
- Smita Ghare
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| | - Richa Singhal
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| | - Vaughn Bryant
- Department of Epidemiology, Center for Cognitive Aging and Memory, Gainesville, University of Florida, FL
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, Gainesville, University of Florida, FL
| | - Sabina Gautam
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| | - Chanakya Charan Tirumala
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| | - Praneet Kumar Srisailam
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| | - Andrea Reyes-Vega
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| | - Dushan Ghooray
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| | - Craig J. McClain
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
- Robley Rex VAMC, Louisville, KY
| | - Kristi Hoffman
- Department of Molecular Virology and Microbiology, Baylor College of Medicine
- Baylor College of Medicine Center for Metagenomics and Microbiome Research
| | - Joseph Petrosino
- Department of Molecular Virology and Microbiology, Baylor College of Medicine
- Baylor College of Medicine Center for Metagenomics and Microbiome Research
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD; and
| | - Varan Govind
- Department of Radiology, University of Miami, FL
| | - Ronald Cohen
- Department of Epidemiology, Center for Cognitive Aging and Memory, Gainesville, University of Florida, FL
| | - Robert L. Cook
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, Gainesville, University of Florida, FL
| | - Shirish Barve
- Department of Medicine, University of Louisville, KY
- Alcohol Research Center, University of Louisville, KY
| |
Collapse
|
26
|
Tareke M, Belete T, Ergetie T, Tadesse M, Menberu M, Ketemaw A. Triple Burden of Neurocognitive Impairment and Co-occurring Depression and Anxiety Among People Living With HIV in Bahir Dar, Ethiopia: A Multicenter Study. Front Psychiatry 2022; 13:732229. [PMID: 35558427 PMCID: PMC9087279 DOI: 10.3389/fpsyt.2022.732229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neurocognitive impairment is associated with psychological morbidities, such as depression and anxiety, among people living with HIV. The presence of these comorbidities affects viral load suppression, treatment adherence, quality of life, treatment outcomes, and functionality. Despite this fact, there is a dearth of studies that examined the triple burden of neurocognitive impairment and co-occurring depression and anxiety among antiretroviral therapy attendees in Ethiopia. This study aimed to assess the magnitude of HIV-associated neurocognitive impairment and co-occurring depression and anxiety at the same time among people living with HIV/AIDS. METHOD We conducted an institution-based multicenter cross-sectional study in Bahir Dar, Northwest Ethiopia. A total of 410 study participants were selected using a systematic random sampling technique. Neurocognitive impairment was assessed using the International HIV Dementia Scale. Co-occurring depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. A semi-structured questionnaire was applied to collect data on sociodemographic and clinical-related characteristics. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. RESULTS Two-thirds (66.8%) of the people living with HIV had neurocognitive impairment. The prevalence of co-occurring depression and anxiety was found in 39.8%. Women with HIV, people with comorbid chronic medical illness, and those under a second-line treatment regimen were factors associated with neurocognitive impairment. Furthermore, pill burden, second-line treatment regimen, HIV clinical stages, social support, HIV-perceived stigma, and neurocognitive impairment were associated factors with co-occurring depression and anxiety. CONCLUSIONS We found a high prevalence of neurocognitive impairment and co-occurring depression and anxiety among people living with HIV/AIDs. Further research is needed to assess the clinical course of neurocognitive impairment and co-occurring depression and anxiety.
Collapse
Affiliation(s)
- Minale Tareke
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Ergetie
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Meseret Tadesse
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melak Menberu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Asmamaw Ketemaw
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
27
|
Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, Abouo FN, Tanon A, Messou E, Seydi M, Dabis F, Dartigues JF, de Rekeneire N. Effects of Age, Level of Education and HIV Status on Cognitive Performance in West African Older Adults: The West Africa IeDEA Cohort Collaboration. AIDS Behav 2021; 25:3316-3326. [PMID: 34050826 DOI: 10.1007/s10461-021-03309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/28/2022]
Abstract
An in-depth understanding of the impact of aging, cognitive reserve, and HIV status on cognitive function is needed in older West African adults. Ninety-nine HIV-negative and 334 HIV-positive adults aged ≥ 50 years were enrolled in three clinics (Senegal and Côte d'Ivoire) participating in the IeDEA West Africa collaboration. All subjects underwent the Free and Cued Selective Reminding Test (FCSRT) and the Isaacs Set Test (IST). Age (both linear and quadratic), education level, and HIV status effects on Z-scores were assessed using multivariate linear regression models. Interactions between HIV status and age or educational level were tested. In the present cohort of older West African adults, the role of age and educational level on episodic memory and verbal fluency was observed without revealing an interaction between HIV status and age effect. As age had quadratic effects, older HIV-positive adults should not be considered as a unique group irrespective of their age. Low-educated HIV-positive patients had the lowest verbal fluency performance compared to others. Further studies are needed to duplicate these results. In clinical settings, screening and adapted programs focusing on improving cognition in those patients are needed.
Collapse
|
28
|
Thames AD, Nunez R, Slavich GM, Irwin MR, Senturk D. Racial differences in health and cognition as a function of HIV among older adults. Clin Neuropsychol 2021; 36:367-387. [PMID: 34429015 DOI: 10.1080/13854046.2021.1967449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study investigated the contribution of health risk factors (using the Charlson Comorbidity Index [CCI]) on cognitive outcomes in a sample of 380 HIV-positive (HIV+; n = 221) and HIV-seronegative (HIV-; n = 159) African American and European American adults aged 50+. Participants were recruited from HIV clinics and community advertisements. HIV status was confirmed by serological testing. Self-report and chart history review was used to gather information about medical ssscomorbidities. The Charlson Comorbidity Index (CCI) was used to create a comorbidity score. Participants were administered a brief cognitive test battery. As expected, health risks were greater among those with HIV. There was a HIV × Race interaction on CCI scores, such that in the HIV + group, European Americans had significantly higher CCI scores (M = 3.74; SD = 2.1) than African American HIV + participants (M = 2.70; SD = 1.9). However, in the HIV - group, African Americans had significantly higher CCI scores (M = 2.20; SD = 1.1) than HIV - European American participants (M = 1.80; SD = 1.2). Also, consistent with hypotheses, across the entire sample CCI score was significantly associated with global cognition (β = -.24, p = .02). Study results underscore the importance of considering HIV serostatus in studies examining racial disparities in health, and how multiple medical risks relate to cognitive outcomes. Neuropsychologists evaluating patients living with HIV should consider how the presence of multiple medical comorbidities may contribute to the course of cognitive decline as people age.
Collapse
Affiliation(s)
- April D Thames
- Department of Psychology, University of Southern California, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Rodolfo Nunez
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Damla Senturk
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
29
|
Ganapathy A, Achappa B, Kulkarni V, Madi D, Holla R, Bhaskaran U, Rathi P, Mahalingam S, Dsouza NV. Association between Veterans Aging Cohort Study (VACS) index and neurocognitive function among people living with HIV-a cross sectional study in coastal South India. AIDS Res Ther 2021; 18:47. [PMID: 34348754 PMCID: PMC8336242 DOI: 10.1186/s12981-021-00368-6] [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: 04/09/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background HIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients. Methods In our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment. Results We found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p < 0.01), specifically in the domains of attention (p < 0.01) and fine motor skills (p = 0.01). Our study also showed that among all the VACS components, older age (p = 0.02) and lower hemoglobin (p < 0.01) values were associated with global NCI. After plotting an ROC curve, a VACS cut-off score of 11.00 was identified as it had good sensitivity (87.0%) and specificity (71.4%) in identifying Global NCI. Conclusion Our findings extend prior research on the use of VACS Index to predict global and domain-wise NCI in HIV-positive patients. However, further research with more comprehensive neurocognitive testing is required in our setting before VACS Index can be used as a tool to screen for neurocognitive dysfunction among PLHIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00368-6.
Collapse
|
30
|
Samboju V, Cobigo Y, Paul R, Naasan G, Hillis M, Tsuei T, Javandel S, Valcour V, Milanini B. Cerebrovascular Disease Correlates With Longitudinal Brain Atrophy in Virally Suppressed Older People Living With HIV. J Acquir Immune Defic Syndr 2021; 87:1079-1085. [PMID: 34153014 PMCID: PMC8547347 DOI: 10.1097/qai.0000000000002683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mild cognitive difficulties and progressive brain atrophy are observed in older people living with HIV (PLWH) despite persistent viral suppression. Whether cerebrovascular disease (CVD) risk factors and white matter hyperintensity (WMH) volume correspond to the observed progressive brain atrophy is not well understood. METHODS Longitudinal structural brain atrophy rates and WMH volume were examined among 57 HIV-infected participants and 40 demographically similar HIV-uninfected controls over an average (SD) of 3.4 (1.7) years. We investigated associations between CVD burden (presence of diabetes, hypertension, hyperlipidemia, obesity, smoking history, and atrial fibrillation) and WMH with atrophy over time. RESULTS The mean (SD) age was 64.8 (4.3) years for PLWH and 66.4 (3.2) years for controls. Participants and controls were similar in age and sex (P > 0.05). PLWH were persistently suppressed (VL <375 copies/mL with 93% <75 copies/mL). The total number of CVD risk factors did not associate with atrophy rates in any regions of interests examined; however, body mass index independently associated with progressive atrophy in the right precentral gyrus (β = -0.30; P = 0.023), parietal lobe (β = -0.28; P = 0.030), and frontal lobe atrophy (β = -0.27; P = 0.026) of the HIV-infected group. No associations were found in the HIV-uninfected group. In both groups, baseline WMH was associated with progressive atrophy rates bilaterally in the parietal gray in the HIV-infected group (β = -0.30; P = 0.034) and the HIV-uninfected participants (β = -0.37; P = 0.033). CONCLUSIONS Body mass index and WMH are associated with atrophy in selective brain regions. However, CVD burden seems to partially contribute to progressive brain atrophy in older individuals regardless of HIV status, with similar effect sizes. Thus, CVD alone is unlikely to explain accelerated atrophy rates observed in virally suppressed PLWH. In older individuals, addressing modifiable CVD risk factors remains important to optimize brain health.
Collapse
Affiliation(s)
- Vishal Samboju
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Yann Cobigo
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Robert Paul
- Missouri Institute of Mental Health, University of
Missouri, St. Louis, MO, USA
| | - Georges Naasan
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
- Global Brain Health Institute, University of California,
San Francisco, CA, USA
- The Barbara and Maurice Deanne Center for Wellness and
Cognitive Health, Department of Neurology, Mount Sinai, Icahn School of Medicine,
NY, USA
| | - Madeline Hillis
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Torie Tsuei
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Shireen Javandel
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
- Global Brain Health Institute, University of California,
San Francisco, CA, USA
| | - Benedetta Milanini
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| |
Collapse
|
31
|
Abstract
Long-term effective use of antiretroviral therapy (ART) among people with HIV (PWH) has significantly reduced the burden of disease, yet a cure for HIV has not been universally achieved, likely due to the persistence of an HIV reservoir. The central nervous system (CNS) is an understudied HIV sanctuary. Importantly, due to viral persistence in the brain, cognitive disturbances persist to various degrees at high rates in PWH despite suppressive ART. Given the complexity and accessibility of the CNS compartment and that it is a physiologically and anatomically unique immune site, human studies to reveal molecular mechanisms of viral entry, reservoir establishment, and the cellular and structural interactions leading to viral persistence and brain injury to advance a cure and either prevent or limit cognitive impairments in PWH remain challenging. Recent advances in human brain organoids show that they can mimic the intercellular dynamics of the human brain and may recapitulate many of the events involved in HIV infection of the brain (neuroHIV). Human brain organoids can be produced, spontaneously or with addition of growth factors and at immature or mature states, and have become stronger models to study neurovirulent viral infections of the CNS. While organoids provide opportunities to study neuroHIV, obstacles such as the need to incorporate microglia need to be overcome to fully utilize this model. Here, we review the current achievements in brain organoid biology and their relevance to neuroHIV research efforts.
Collapse
|
32
|
Harrington KR, Staitieh BS, Nguyen MLT, Colasanti JA, Sumitani J, Marconi VC, Auld SC. Diagnosis and Management of HIV-Associated Pulmonary Diseases in a Ryan White-Funded Primary Care Setting. AIDS Patient Care STDS 2021; 35:239-248. [PMID: 34242091 PMCID: PMC8418444 DOI: 10.1089/apc.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Despite widespread use of antiretroviral therapy (ART), people with HIV (PWH) continue to suffer substantial morbidity and mortality from pulmonary diseases. We sought to evaluate the prevalence of pulmonary symptoms, evaluations, and diagnoses (both infectious and noninfectious) among PWH receiving care at one of the largest HIV clinics in the United States. All PWH seen at the Infectious Disease Program in Atlanta, Georgia, from July 2013 to June 2018 were included. Multivariable logistic regression was used to assess the odds of all-cause mortality. Among 8387 patients, median age was 48 years, 35% had documented smoking, 74% were male, and the 47% with ≥1 pulmonary symptom or diagnosis were older and had higher rates of smoking compared to those without any symptoms or diagnoses (p-values <0.0001). Percent on ART was 97% and 81% for individuals with and without symptoms or diagnoses, respectively (p-value <0.0001). Patients with an infectious diagnosis were more likely to have a diagnostic test ordered than those with a noninfectious diagnosis (p-value <0.0001). After adjustment for demographic and clinical risk factors, odds of death were 2.1 times greater [95% confidence interval (CI) = 1.3-3.5] among those with a pulmonary symptom or diagnosis compared to those without. Despite a high prevalence of pulmonary symptoms and diagnoses in this large cohort of PWH, many did not have a complete diagnostic evaluation, particularly those with noninfectious diagnoses. Greater awareness of evaluation and treatment of noninfectious pulmonary diseases among HIV care providers will be critical to improving long-term outcomes for PWH.
Collapse
Affiliation(s)
- Kristin R.V. Harrington
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Address correspondence to: Kristin R.V. Harrington, BS, Department of Epidemiology, Rollins School of Public Health, 3rd Floor, Claudia Nance Rollins Building, 1518 Clifton Road, Atlanta, GA 30322, USA
| | - Bashar S. Staitieh
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
| | - Minh Ly T. Nguyen
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A. Colasanti
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jieri Sumitani
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
| | - Vincent C. Marconi
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Infectious Diseases Clinic, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.,The Emory Vaccine Center, Atlanta, Georgia, USA
| | - Sara C. Auld
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
33
|
Vecchio A, Nakigozi G, Nakasujja N, Kisakye A, Batte J, Mayanja R, Anok A, Robertson K, Wawer MJ, Sacktor N, Rubin LH, Saylor D. Assessment, prevalence, and correlates of frailty among middle-aged adults with HIV in rural Uganda. J Neurovirol 2021; 27:487-492. [PMID: 33788138 DOI: 10.1007/s13365-021-00969-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
We investigated the prevalence and risk factors for frailty among people with HIV (PWH) in rural Uganda (n = 55, 47% male, mean age 44 years). Frailty was defined according to the Fried criteria with self-reported physical activity level replacing the Minnesota Leisure Time Activity Questionnaire. Alternate classifications for physical activity utilized were the sub-Saharan Africa Activity Questionnaire and the International Physical Activity Questionnaire. Eleven participants (19%) were frail. Frail participants were older (p < 0.001), less likely to be on antiretroviral therapy (p = 0.03), and had higher rates of depression (p < .001) and HIV-associated neurocognitive disorder (p = 0.003). Agreement between physical activity measures was sub-optimal. Prevalence of frailty was high among PWH in rural Uganda, but larger sample sizes and local normative data are needed.
Collapse
Affiliation(s)
- Alyssa Vecchio
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | | | | | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Kevin Robertson
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Maria J Wawer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ned Sacktor
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Leah H Rubin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Deanna Saylor
- Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
34
|
Abstract
Significant advances have been observed in the field of cell biology, with numerous studies exploring the molecular genetic pathways that have contributed to species evolution and disease development. The current study adds to the existing body of research evidence by reviewing information related to the role of leftover viruses and/or viral remnants in human physiology. To explore leftover viruses, their incorporation, and their roles in human physiology. The study entailed conducting a systematic search in the PsycINFO, PubMed, Web of Science, and CINAHL databases to locate articles related to the topic of investigation. The search terms included “leftovers,” “viruses,” “genome sequences,” “transposable elements,” “immune response,” and “evolution.” Additional articles were selected from the references of the studies identified in the electronic databases. Evidence showed that both retroviruses and nonretroviruses can be integrated into the human germline via various mechanisms. The role of leftover viruses in human physiology has been explored by studying the activation of human retroviral genes in the human placenta, RNA transfer between neurons through virus-like particles, and RNA transfer through extracellular vesicles. Research evidence suggested that leftover viruses play key roles in human physiology. A more complete understanding of the underlying pathways may provide an avenue for studying human evolution and allow researchers to determine the pathogenesis of some viral infections. Evidence obtained in this review shows that leftover viruses may be incorporated into the human genome. Retroviral genes are critical for the development of different parts of the body, such as the placenta in mammals.
Collapse
Affiliation(s)
- Borros Arneth
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, University Hospital of the Universities of Giessen and Marburg UKGM, Justus Liebig University Giessen, Feulgenstr. 12, 35392, Giessen, Germany.
| |
Collapse
|
35
|
Waldrop D, Irwin C, Nicholson WC, Lee CA, Webel A, Fazeli PL, Vance DE. The Intersection of Cognitive Ability and HIV: A Review of the State of the Nursing Science. J Assoc Nurses AIDS Care 2021; 32:306-321. [PMID: 33449578 PMCID: PMC8091162 DOI: 10.1097/jnc.0000000000000232] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Neurocognitive problems have been endemic to the HIV epidemic since its beginning. Four decades later, these problems persist, but currently, they are attributed to HIV-induced inflammation, the long-term effects of combination antiretroviral therapy, lifestyle (i.e., physical activity, drug use), psychiatric, and age-associated comorbidities (i.e., heart disease, hypertension). In many cases, persons living with HIV (PLWH) may develop cognitive problems as a function of accelerated or accentuated normal aging and lifestyle rather than HIV itself. Nonetheless, such cognitive impairments can interfere with HIV care, including medication adherence and attending clinic appointments. With more than half of PLWH 50 years and older, and 30%-50% of all PLWH meeting the criteria for HIV-associated neurocognitive disorder, those aging with HIV may be more vulnerable to developing cognitive problems. This state of the science article provides an overview of current issues and provides implications for practice, policy, and research to promote successful cognitive functioning in PLWH.
Collapse
Affiliation(s)
- Drenna Waldrop
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Crista Irwin
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - W. Chance Nicholson
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cheryl A. Lee
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison Webel
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E. Vance
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
36
|
Theofilidis A, Karakasi MV, Sofologi M, Konstantinidis G, Pavlidis P, Tegos T, Nimatoudis J. Frontal Assessment Battery in the evaluation of patients with neurocognitive disorder due to the human immunodeficiency virus. ACTA ACUST UNITED AC 2021; 50:66-69. [PMID: 34099253 DOI: 10.1016/j.rcpeng.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Antonios Theofilidis
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece; Laboratory of Forensic Sciences, Democritus University of Thrace-School of Medicine, Dragana, Alexandroupolis, Greece.
| | - Maria-Valeria Karakasi
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece; Laboratory of Forensic Sciences, Democritus University of Thrace-School of Medicine, Dragana, Alexandroupolis, Greece
| | - Maria Sofologi
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| | - Galaktion Konstantinidis
- 1st University Neurology Department, AHEPA University General Hospital-Neuroscience Section, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, Democritus University of Thrace-School of Medicine, Dragana, Alexandroupolis, Greece
| | - Thomas Tegos
- 1st University Neurology Department, AHEPA University General Hospital-Neuroscience Section, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| | - John Nimatoudis
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| |
Collapse
|
37
|
Lam JO, Hou CE, Hojilla JC, Anderson AN, Gilsanz P, Alexeeff SE, Levine-Hall T, Hood N, Lee C, Satre DD, Silverberg MJ. Comparison of dementia risk after age 50 between individuals with and without HIV infection. AIDS 2021; 35:821-828. [PMID: 33394681 PMCID: PMC7969394 DOI: 10.1097/qad.0000000000002806] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare risk of dementia after age 50 by HIV status among individuals in a primary care setting. DESIGN Observational cohort study; participants were identified from 2013 to 2017 and followed through 2019. METHODS Participants were people with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWOH), all at least 50 years old and with no prior diagnosis of dementia. The study setting was Kaiser Permanente Northern California, an integrated healthcare delivery system in the United States. Incident dementia diagnoses and baseline data on sociodemographics, smoking, alcohol use, other substance use, and clinical factors were gathered from the electronic health record. Cumulative proportion of incident dementia by HIV status was assessed using Kaplan--Meier curves. Unadjusted and adjusted hazard ratios for incident dementia by HIV status were generated using Cox proportional hazards models with age as the time scale. RESULTS The study included 5381 PWH and 119 022 PWOH (average age at baseline: 57 and 58 years, respectively). Incident dementia was diagnosed in 117 PWH and 2427 PWOH. By age 80, 25.8% of PWH and 13.8% of PWOH had been diagnosed with dementia, corresponding with an unadjusted hazard ratio of 1.98 (95% CI 1.64-2.39). After adjustment for sociodemographic, substance use, and clinical factors, including frequency of outpatient visits, the risk of dementia among PWH remained elevated (vs. PWOH, adjusted hazard ratio = 1.58, 95% CI 1.31-1.92). CONCLUSION Compared with PWOH, PWH were at 58% higher risk for dementia despite HIV treatment with ART. Research is needed to investigate the potential benefits of targeted risk factor management or earlier cognitive screening in this population.
Collapse
Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco
| | - J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Nicole Hood
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
38
|
Theofilidis A, Karakasi MV, Sofologi M, Konstantinidis G, Pavlidis P, Tegos T, Nimatoudis J. Frontal Assessment Battery in the evaluation of patients with neurocognitive disorder due to the human immunodeficiency virus. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 50:66-69. [PMID: 33735028 DOI: 10.1016/j.rcp.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/09/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Antonios Theofilidis
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece; Laboratory of Forensic Sciences, Democritus University of Thrace-School of Medicine, Dragana, Alexandroupolis, Greece.
| | - Maria-Valeria Karakasi
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece; Laboratory of Forensic Sciences, Democritus University of Thrace-School of Medicine, Dragana, Alexandroupolis, Greece
| | - Maria Sofologi
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| | - Galaktion Konstantinidis
- 1st University Neurology Department, AHEPA University General Hospital-Neuroscience Section, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, Democritus University of Thrace-School of Medicine, Dragana, Alexandroupolis, Greece
| | - Thomas Tegos
- 1st University Neurology Department, AHEPA University General Hospital-Neuroscience Section, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| | - John Nimatoudis
- 3rd University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki, Greece
| |
Collapse
|
39
|
Aung HL, Bloch M, Vincent T, Quan D, Jayewardene A, Liu Z, Gates TM, Brew B, Mao L, Cysique LA. Cognitive ageing is premature among a community sample of optimally treated people living with HIV. HIV Med 2021; 22:151-164. [PMID: 33085207 PMCID: PMC7984032 DOI: 10.1111/hiv.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evidence of premature cognitive ageing amongst people living with HIV (PLHIV) remains controversial due to previous research limitations including underpowered studies, samples with suboptimal antiretroviral access, varying rate of virological control, high rate of AIDS, over-representation of non-community samples, and inclusion of inappropriate controls. The current study addresses these limitations, while also considering mental health and non-HIV comorbidity burden to determine whether PLHIV showed premature cognitive ageing compared with closely comparable HIV-negative controls. METHODS This study enrolled 254 PLHIV [92% on antiretroviral therapy; 84% with HIV RNA < 50 copies/mL; 15% with AIDS) and 72 HIV-negative gay and bisexual men [mean (SD) age = 49 (10.2) years] from a single primary care clinic in Sydney, Australia. Neurocognitive function was evaluated with the Cogstate Computerized Battery (CCB) at baseline and 6 months after. Linear mixed-effects (LME) models examined main and interaction effects of HIV status and chronological age on the CCB demographically uncorrected global neurocognitive z-score (GZS), adjusting for repeated testing, and then adjusting sequentially for HIV disease markers, mental health and comorbidities. RESULTS HIV status and age interacted with a lower GZS (β = -0.43, P < 0.05). Higher level of anxiety symptoms (β = -0.11, P < 0.01), historical AIDS (β = -0.12, P < 0.05) and historical HIV brain involvement (β = -0.12, P < 0.05) were associated with lower GZS. CONCLUSIONS We found a robust medium-sized premature ageing effect on cognition in a community sample with optimal HIV care. Our study supports routine screening of cognitive and mental health among PLHIV aged ≥ 50 years.
Collapse
Affiliation(s)
- HL Aung
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
| | - M Bloch
- Faculty of MedicineUNSWSydneyNSWAustralia
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - T Vincent
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - D Quan
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - A Jayewardene
- Holdsworth House Medical PracticeSydneyNSWAustralia
- Charles Perkins CentreUniversity of SydneySydneyNSWAustralia
| | - Z Liu
- Stats CentralUNSWSydneyNSWAustralia
| | - TM Gates
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
| | - B Brew
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
- Faculty of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - L Mao
- Centre for Social Research in HealthUNSWSydneyNSWAustralia
| | - LA Cysique
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
| |
Collapse
|
40
|
Aung HL, Aghvinian M, Gouse H, Robbins RN, Brew BJ, Mao L, Cysique LA. Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review. AIDS Behav 2021; 25:917-960. [PMID: 33025390 PMCID: PMC7886778 DOI: 10.1007/s10461-020-03053-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
Despite evidence of premature, accentuated and accelerated aging for some age-related conditions such as cardiovascular diseases in people living with HIV (PLHIV), the evidence for these abnormal patterns of aging on neurocognition remains unclear. Further, no systematic review has been dedicated to this issue. Using PRISMA guidelines, we searched standard databases (PubMed, EMBASE, CINAHL and PsycINFO). Articles were included if they analyzed and reported the effect of age on neurocognition among PLHIV as one of their major findings, if they were conducted in the combination anti-retroviral therapy era (after 1996) and published in a peer-reviewed journal in English. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) appraisal tools. To systematically target the abnormal patterns of neurocognitive aging, we define premature cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive test performance covering both the normal and abnormal performance range; accentuated cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive impairment (NCI) rate, thus covering the abnormal performance range only; accelerated cognitive aging as significant interaction effect of HIV status and age on longitudinal neurocognitive test performance or incidence of NCI. Because these definitions require an age-comparable HIV-negative (HIV-) control group, when no controls were included, we determined the range of the age effect on neurocognitive test performance or NCI among PLHIV. A total of 37 studies originating from the US (26), UK (2), Italy (2), Poland (2), China (2), Japan (1), Australia (1), and Brazil (1) were included. Six studies were longitudinal and 14 included HIV- controls. The quality appraisal showed that 12/37 studies neither used an age-matched HIV- controls nor used demographically corrected cognitive scores. A meta-analysis was not possible because study methods and choice of neurocognitive measurement methods and outcomes were heterogeneous imposing a narrative synthesis. In studies with an HIV- control sample, premature neurocognitive aging was found in 45% of the cross-sectional analyses (9/20), while accelerated neurocognitive aging was found in 75% of the longitudinal analyses (3/4). There was no evidence for accentuated aging, but this was tested only in two studies. In studies without an HIV- control sample, the age effect was always present but wide (NCI OR = 1.18-4.8). While large sample size (> 500) was associated with abnormal patterns of cognitive aging, most of the studies were under powered. Other study characteristics such as longitudinal study design and higher proportion of older participants were also associated with the findings of abnormal cognitive aging. There is some support for premature and accelerated cognitive aging among PLHIV in the existing literature especially among large and longitudinal studies and those with higher proportion of older samples. Future HIV and cognitive aging studies need to harmonize neuropsychological measurement methods and outcomes and use a large sample from collaborative multi-sites to generate more robust evidences.
Collapse
Affiliation(s)
- Htein Linn Aung
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Neuroscience Research Australia, Sydney, Australia.
- Faculty of Medicine, UNSW, Sydney, Australia.
| | | | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Lucette A Cysique
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
| |
Collapse
|
41
|
Neurocognitive status and risk of mortality among people living with human immunodeficiency virus: an 18-year retrospective cohort study. Sci Rep 2021; 11:3738. [PMID: 33580123 PMCID: PMC7881128 DOI: 10.1038/s41598-021-83131-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022] Open
Abstract
HIV-related neurocognitive impairment (NCI) may increase the risk of death. However, a survival disadvantage for patients with NCI has not been well studied in the post-combination antiretroviral therapy (cART) era. Specifically, limited research has been conducted considering the reversible nature and variable progression of the impairment and this area demands further evaluation. We performed multivariable Cox proportional hazards modeling to assess the association between baseline NCI (global T scores) and mortality. A joint modeling approach was then used to model the trajectory of global neurocognitive functioning over time and the association between neurocognitive trajectory and mortality. Among the National NeuroAIDS Tissue Consortium's (NNTC) HIV-infected participants, we found a strong negative association between NCI and mortality in the older age groups (e.g., at age = 55, HR = 0.79; 95% CI 0.64-0.99). Three neurocognitive sub-domains (abstraction and executive functioning, speed of information processing, and motor) had the strongest negative association with mortality. Joint modelling indicated a 33% lower hazard for every 10-unit increase in global T scores (HR = 0.67; 95% CI 0.56-0.80). The study identified older HIV-infected individuals with NCI as a group needing special attention for the longevity of life. The study has considerable prognostic utility by not only predicting mortality hazard, but also future cognitive status.
Collapse
|
42
|
Qrareya AN, Mahdi F, Kaufman MJ, Ashpole NM, Paris JJ. HIV-1 Tat promotes age-related cognitive, anxiety-like, and antinociceptive impairments in female mice that are moderated by aging and endocrine status. GeroScience 2021; 43:309-327. [PMID: 32940828 PMCID: PMC8050151 DOI: 10.1007/s11357-020-00268-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Hypogonadism is a common comorbidity associated with HIV-1 that is more prevalent among infected individuals over the age of 45. The underlying mechanisms are unknown, but both combined antiretroviral therapeutics and HIV-1 proteins, such as trans-activator of transcription protein (Tat), dysregulate steroid-synthetic mechanisms including lipid storage/synthesis and mitochondrial function. Thus, Tat expression may accelerate age-related comorbidities partly by impairing endocrine function. Few studies exist of Tat-mediated behavioral deficits in aged animals and effects of endocrine status have not been investigated. Accordingly, we tested whether conditional Tat expression in aged (~ 1.5 years old), female, Tat-transgenic [Tat(+)] mice increases anxiety-like behavior, impairs cognition, and augments mechanical allodynia, when compared to age-matched controls that do not express Tat protein [Tat(-)]. We further tested whether aged mice that maintained their endocrine status (pre-estropausal) were more resilient to Tat/age-related comorbidities than peri- or post-estropausal mice. Tat and endocrine aging status exerted separate and interacting effects that influenced anxiety-like and cognitive behaviors. Peri- and post-estropausal mice exhibited greater anxiety-like behavior in the elevated plus-maze and impaired learning in the radial arm water maze compared to pre-estropausal mice. Irrespective of estropause status, Tat(+) mice demonstrated impaired learning, reduced grip strength, and mechanical allodynia compared to Tat(-) mice. Tat exposure reduced circulating estradiol in post-estropausal mice and increased the estradiol-to-testosterone ratio in pre-estropausal mice. Changes in circulating estradiol, testosterone, and progesterone correlated with grip strength. Thus, endocrine status is an important factor in age-related anxiety, cognition, neuromuscular function, and allodynia that can be accelerated by HIV-1 Tat protein.
Collapse
Affiliation(s)
- Alaa N Qrareya
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA
| | - Fakhri Mahdi
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA
| | - Marc J Kaufman
- Department of Psychiatry, McLean Imaging Center, McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA
| | - Nicole M Ashpole
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS, 38677, USA
| | - Jason J Paris
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA.
- Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS, 38677, USA.
| |
Collapse
|
43
|
Dybul M, Attoye T, Baptiste S, Cherutich P, Dabis F, Deeks SG, Dieffenbach C, Doehle B, Goodenow MM, Jiang A, Kemps D, Lewin SR, Lumpkin MM, Mathae L, McCune JM, Ndung'u T, Nsubuga M, Peay HL, Pottage J, Warren M, Sikazwe I. The case for an HIV cure and how to get there. Lancet HIV 2021; 8:e51-e58. [PMID: 33271124 PMCID: PMC7773626 DOI: 10.1016/s2352-3018(20)30232-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
In light of the increasing global burden of new HIV infections, growing financial requirements, and shifting funding landscape, the global health community must accelerate the development and delivery of an HIV cure to complement existing prevention modalities. An effective curative intervention could prevent new infections, overcome the limitations of antiretroviral treatment, combat stigma and discrimination, and provide a sustainable financial solution for pandemic control. We propose steps to plan for an HIV cure now, including defining a target product profile and establishing the HIV Cure Africa Acceleration Partnership (HCAAP), a multidisciplinary public-private partnership that will catalyse and promote HIV cure research through diverse stakeholder engagement. HCAAP will convene stakeholders, including people living with HIV, at an early stage to accelerate the design, social acceptability, and rapid adoption of HIV-cure products.
Collapse
Affiliation(s)
- Mark Dybul
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA.
| | - Timothy Attoye
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | | | - François Dabis
- Agence Nationale de Recherches sur le SIDA et les Hepatites Virales, Paris, France
| | - Steven G Deeks
- University of California, San Francisco, California, USA
| | - Carl Dieffenbach
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Brian Doehle
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Maureen M Goodenow
- Office of AIDS Research, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Adam Jiang
- McKinsey & Company Secondee at The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Sharon R Lewin
- Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Murray M Lumpkin
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Lauren Mathae
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA
| | - Joseph M McCune
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Thumbi Ndung'u
- Africa Health Research Institute, Durban, South Africa; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban South Africa; Max Planck Institute for Infection Biology, Berlin, Germany; University College London, London, UK
| | - Moses Nsubuga
- Joint Adherent Brothers & Sisters Against AIDS, Kampala, Uganda
| | - Holly L Peay
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| |
Collapse
|
44
|
Neuroimaging Advances in Diagnosis and Differentiation of HIV, Comorbidities, and Aging in the cART Era. Curr Top Behav Neurosci 2021; 50:105-143. [PMID: 33782916 DOI: 10.1007/7854_2021_221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the "cART era" of more widely available and accessible treatment, aging and HIV-related comorbidities, including symptoms of brain dysfunction, remain common among HIV-infected individuals on suppressive treatment. A better understanding of the neurobiological consequences of HIV infection is essential for developing thorough treatment guidelines and for optimizing long-term neuropsychological outcomes and overall brain health. In this chapter, we first summarize magnetic resonance imaging (MRI) methods used in over two decades of neuroHIV research. These methods evaluate brain volumetric differences and circuitry disruptions in adults living with HIV, and help map clinical correlations with brain function and tissue microstructure. We then introduce and discuss aging and associated neurological complications in people living with HIV, and processes by which infection may contribute to the risk for late-onset dementias. We describe how new technologies and large-scale international collaborations are helping to disentangle the effect of genetic and environmental risk factors on brain aging and neurodegenerative diseases. We provide insights into how these advances, which are now at the forefront of Alzheimer's disease research, may advance the field of neuroHIV. We conclude with a summary of how we see the field of neuroHIV research advancing in the decades to come and highlight potential clinical implications.
Collapse
|
45
|
Yang S, Deng X, Zhang T, Xiao Y, Peng L, Li L, He X, Wei Y, Liu L, Cao H, Long B, Huang S. [SBi4211 alleviates gp120-induced central nervous system injury via inhibiting S100B/ RAGE]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1693-1702. [PMID: 33380406 DOI: 10.12122/j.issn.1673-4254.2020.12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the protective effect of SBi4211 (heptamidine), an inhibitor of S100B, against central nervous system injury induced by HIV-1 envelope protein gp120. METHODS In an in vitro model, U251 glioma cells were co-cultured with SH-SY5Y cells to explore the protective effect of SBi4211 against gp120-induced central nervous system injury. In a gp120 transgenic (Tg) mouse model (8 months old) mimicking HIV-associated neurocognitive disorder (HAND), the effect of treatment with gp120 or both gp120 and SBi4211 on neuronal activity and apoptosis were assessed using Cell Counting kit-8 (CCK-8) and flow cytometry. ELISA, Western blotting and immunohistochemistry were used to determine the expression levels of S100B, RAGE, GFAP, NeuN, Syn, MAP-2 and the inflammatory factors IL-6 and TNF-α. RESULTS In the cell co-culture system, SBi4211 treatment significantly inhibited gp120-induced expression of S100B, RAGE and GFAP in U251 cells (P < 0.001), reduced the levels of inflammatory factors iNOS, IL-6 and TNF-α (P < 0.001) and enhanced the expressions of neuron-related proteins NeuN, Syn and MAP-2 (P < 0.001). In the transgenic mouse model, SBi4211 treatment significantly reduced the expressions of S100B, RAGE and inflammation levels (P < 0.05), inhibited the activation of astrocytes in the brain, and maintained the integrity of the neurons (P < 0.05). CONCLUSIONS SBi4211 can protect neurons from gp120-induced neurotoxicity possibly by inhibiting the S100B/ RAGE-mediated signaling pathway.
Collapse
Affiliation(s)
- Shaojie Yang
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Diseases Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Xiaoyan Deng
- KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou 511436, China
| | - Tiesong Zhang
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming 650228, China
| | - Yi Xiao
- Department of Clinical Laboratory, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510700, China
| | - Liang Peng
- Department of Clinical Laboratory, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510700, China
| | - Li Li
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming 650228, China
| | - Xiaolong He
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Diseases Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Yi Wei
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Diseases Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Liqun Liu
- Department of Pediatrics, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Hong Cao
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Diseases Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Beiguo Long
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Diseases Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Shenghe Huang
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Diseases Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
46
|
Britton MK, Porges EC, Bryant V, Cohen RA. Neuroimaging and Cognitive Evidence for Combined HIV-Alcohol Effects on the Central Nervous System: A Review. Alcohol Clin Exp Res 2020; 45:290-306. [PMID: 33296091 DOI: 10.1111/acer.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) among people living with HIV (PLWH) is a significant public health concern. Despite the advent of effective antiretroviral therapy, up to 50% of PLWH still experience worsened neurocognition, which comorbid AUD exacerbates. We report converging lines of neuroimaging and neuropsychological evidence linking comorbid HIV/AUD to dysfunction in brain regions linked to executive function, learning and memory, processing speed, and motor control, and consequently to impairment in daily life. The brain shrinkage, functional network alterations, and brain metabolite disruption seen in individuals with HIV/AUD have been attributed to several interacting pathways: viral proteins and EtOH are directly neurotoxic and exacerbate each other's neurotoxic effects; EtOH reduces antiretroviral adherence and increases viral replication; AUD and HIV both increase gut microbial translocation, promoting systemic inflammation and HIV transport into the brain by immune cells; and HIV may compound alcohol's damaging effects on the liver, further increasing inflammation. We additionally review the neurocognitive effects of aging, Hepatitis C coinfection, obesity, and cardiovascular disease, tobacco use, and nutritional deficiencies, all of which have been shown to compound cognitive changes in HIV, AUD, and in their comorbidity. Finally, we examine emerging questions in HIV/AUD research, including genetic and cognitive protective factors, the role of binge drinking in HIV/AUD-linked cognitive decline, and whether neurocognitive and brain functions normalize after drinking cessation.
Collapse
Affiliation(s)
- Mark K Britton
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Vaughn Bryant
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, (VB), University of Florida, Gainesville, Florida, USA
| | - Ronald A Cohen
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
47
|
Yoshino Y, Koga I, Kitazawa T, Oba H, Furui S, Matsuda H, Ota Y. Magnetic resonance imaging changes in Asian people living with HIV. Infect Dis (Lond) 2020; 53:89-93. [PMID: 32988259 DOI: 10.1080/23744235.2020.1825797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Previous studies have reported a significant increase in age-related magnetic resonance imaging (MRI) changes in relatively younger people living with HIV (PLWH). However, there is little data available for brain changes in Asian PLWH. The data to differentiate HIV specific brain change from usual aging change was also sparse. To clarify them, we assessed the presence of leukoaraiosis and brain atrophic changes on MRI in young and middle-aged Japanese PLWH. METHODS We reviewed data from well-controlled PLWH (age: 20-64 years) and coeval controls. We evaluated the presence of leukoaraiosis, as well as the extent of whole-brain grey matter (GM) atrophy and parahippocampal atrophy on brain MRI and determined between-group differences. Moreover, we evaluated the severity of parahippocampal atrophy based on the voxel-based specific regional analysis system for Alzheimer's disease. RESULTS We enrolled 40 PLWH and 33 controls (median age: 40.15 and 48.00 years, respectively, [p = .3585]). Leukoaraiosis was significantly more prevalent among the PLWH (20 cases [50%]) than in the controls (9 cases [27.3%]) (univariate: p = .0483, multivariate: p = .0206). The extent of whole-brain GM atrophy was significantly greater in the PLWH than in the controls (univariate: p < .001, multivariate: p = .0012). Contrastingly, there was no significant between-group difference in the extent and severity of parahippocampal atrophy. CONCLUSIONS Aging changes in the brain were significantly more prevalent in well-controlled Japanese PLWH. However, the process of atrophic brain changes might differ between HIV and one of age-related diseases, Alzheimer's disease.
Collapse
Affiliation(s)
- Yusuke Yoshino
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan
| | - Ichiro Koga
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan
| | - Takatoshi Kitazawa
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, Itabashi, Japan
| | - Shigeru Furui
- Department of Radiology, Teikyo University School of Medicine, Itabashi, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yasuo Ota
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan.,Department of Internal Medicine, National Hospital Organization Higashi Saitama Hospital, Hasuda, Japan
| |
Collapse
|
48
|
Azadian A, Nasab MG, Payghani C, Firouzamandi M. Naturally FIV-infected cats exhibit a higher risk of age-related visuospatial working memory impairment compared with cats without FIV disease. J Vet Behav 2020. [DOI: 10.1016/j.jveb.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
49
|
Derry HM, Johnston CD, Burchett CO, Siegler EL, Glesby MJ. Gait Speed Is Associated with Cognitive Function among Older Adults with HIV. J Aging Health 2020; 32:1510-1515. [PMID: 32697615 DOI: 10.1177/0898264320943330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: To determine links between objectively and subjectively measured physical function and cognitive function among HIV-positive older adults, a growing yet understudied group with elevated risk for multimorbidity. Methods: At a biomedical research visit, 162 participants completed objective tests of gait speed (4-m walk), grip strength (dynamometer), and cognitive function (Montreal Cognitive Assessment, MoCA) and reported their well-being (Medical Outcomes Study-HIV survey). Results: Those with faster gait speed had better overall cognitive function than those with slower gait speed (b = 3.98, SE = 1.30, p = .003) in an adjusted regression model controlling for age, sex, race, height, preferred language, and assistive device use. Grip strength was not significantly associated with overall cognitive function. Self-rated cognitive function was weakly related to MoCA scores (r = .26) and gait speed (r = .14) but was strongly associated with emotional well-being (r = .53). Discussion: These observed, expected connections between physical and cognitive function could inform intervention strategies to mitigate age-related declines for older adults with HIV.
Collapse
Affiliation(s)
- Heather M Derry
- Division of Geriatrics and Palliative Medicine, 12295Weill Cornell Medicine, NY, USA
| | - Carrie D Johnston
- Division of Infectious Diseases, 12295Weill Cornell Medicine, NY, USA
| | - Chelsie O Burchett
- Division of Geriatrics and Palliative Medicine, 12295Weill Cornell Medicine, NY, USA
| | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, 12295Weill Cornell Medicine, NY, USA
| | - Marshall J Glesby
- Division of Infectious Diseases, 12295Weill Cornell Medicine, NY, USA
| |
Collapse
|
50
|
Absence of peripapillary retinal nerve-fiber-layer thinning in combined antiretroviral therapy-treated, well-sustained aviremic persons living with HIV. PLoS One 2020; 15:e0229977. [PMID: 32155200 PMCID: PMC7064175 DOI: 10.1371/journal.pone.0229977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/18/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare peripapillary retinal nerve-fiber–layer (pRNFL) thickness, total retina macular volume, and ganglion-cell-layer (GCL) macular volume and thickness between persons living with HIV (PLHIVs) with well-controlled infections and good immune recovery, and sex- and age-matched HIV-uninfected controls (HUCs). Methods This prospective cross-sectional study (www.clinicaltrials.gov identifier: NCT02003989) included 56 PLHIVs, infected for ≥10 [median 20.2] years and with sustained plasma HIV-load suppression on combined antiretroviral therapy (cART) for ≥5 years, and 56 matched HUCs. Participants underwent spectral-domain optical coherence tomography (SD-OCT) with thorough ophthalmological examinations and brain magnetic resonance imaging (MRI). Their overall and quadrant pRNFL thicknesses, total macular volumes, and GCL macular volumes and thicknesses were compared. Cerebral small-vessel diseases (CSVD) complied with STRIVE criteria. Results Median [interquartile range, IQR] ages of PLHIVs and HUCs, respectively, were 52 [46–60] and 52 [44–60] years. Median [IQR] PLHIVs’ nadir CD4+ T-cell count and current CD4/CD8 T-cell ratio were 249/μL [158–350] and 0.95 [0.67–1.10], respectively; HIV-seropositivity duration was 20.2 [15.9–24.5] years; cART duration was 16.8 [12.6–18.6] years; and aviremia duration was 11.4 [7.8–13.6] years. No significant between-group pRNFL thickness, total macular volume, macular GCL-volume and -thickness differences were found. MRI-detected CSVD in 21 (38%) PLHIVs and 14 (25%) HUCs was associated with overall thinner pRNFLs, and smaller total retina and GCL macular volumes, independently of HIV status. Conclusions SD-OCT could not detect pRNFL thinning or macular GCL-volume reduction in well-sustained, aviremic, cART-treated PLHIVs who achieved good immune recovery. However, CSVD was associated with thinner pRNFLs and GCLs, independently of HIV status.
Collapse
|