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Garabet R, Dampier W, Tillman S, Malone K, Szep Z, Althoff A, Pirrone V, Nonnemacher MR, Wigdahl B, Schultheis M, Devlin KN. CD4 nadir and neurocognitive trajectories in people living with HIV. J Neurovirol 2024:10.1007/s13365-024-01217-8. [PMID: 38856821 DOI: 10.1007/s13365-024-01217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
Human immunodeficiency virus-associated neurocognitive disorders persist in the combination antiretroviral therapy era. CD4 nadir is a well-established predictor of cognition cross-sectionally, but its impact on longitudinal neurocognitive (NC) trajectories is unclear. The few studies on this topic examined trajectories of global cognition, rather than specific NC domains. The current study examined CD4 nadir in relation to domain-specific NC decline. 132 HIV + adults from the Temple/Drexel Comprehensive NeuroHIV Center, Clinical and Translational Research Support Core Cohort were administered comprehensive NC assessments longitudinally, with last visit occurring an average of 12 years after CD4 nadir. Linear mixed models were used to examine CD4 nadir in relation to longitudinal NC trajectories in three empirically identified NC domains: speed/executive function (S/EF), visuospatial memory (VM), and verbal fluency (VF). CD4 nadir was associated with change in VF (p = 0.020), but not with S/EF or VM. Specifically, those with CD4 nadir < 200 demonstrated increasing VF over time (p = .002), whereas those with CD4 nadir > 200 demonstrated stable VF (p = .568), though these differing trajectories may partly reflect regression to the mean or differential practice effect. CD4 dynamics over time were analyzed as potential mechanisms for the identified associations, with mixed findings. While low CD4 nadir has been associated with weaker neurocognition among people living with HIV, the results of this study suggest that low CD4 nadir is not associated with ongoing decline a decade later. Nadir-related deficits in VF may be stable or even improve over time, possibly reflecting the beneficial cognitive effects of long-term treatment and immune reconstitution.
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Affiliation(s)
- Razmig Garabet
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Will Dampier
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Shinika Tillman
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, PA, USA
| | - Kim Malone
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, PA, USA
| | - Zsofia Szep
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Althoff
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, PA, USA
| | - Vanessa Pirrone
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael R Nonnemacher
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian Wigdahl
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Schultheis
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Kathryn N Devlin
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA.
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2
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Nightingale S, Ances B, Cinque P, Dravid A, Dreyer AJ, Gisslén M, Joska JA, Kwasa J, Meyer AC, Mpongo N, Nakasujja N, Pebody R, Pozniak A, Price RW, Sandford C, Saylor D, Thomas KGF, Underwood J, Vera JH, Winston A. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat Rev Neurol 2023; 19:424-433. [PMID: 37311873 DOI: 10.1038/s41582-023-00813-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/15/2023]
Abstract
Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury - including active or pretreatment legacy damage - from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and to provide a clearer framework of classification for clinical management and research studies.
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Affiliation(s)
- Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Beau Ances
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Paola Cinque
- Unit of Infectious Diseases, San Raffaele Institute, Milan, Italy
| | - Ameet Dravid
- Department of Medicine, Poona Hospital and Research Centre and Noble Hospital, Pune, India
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Magnus Gisslén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Judith Kwasa
- Department of Clinical Medicine and Therapeutics, Faculty of Health Science, University of Nairobi, Nairobi, Kenya
| | - Ana-Claire Meyer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Anton Pozniak
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Deanna Saylor
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- University Teaching Hospital, Lusaka, Zambia
| | - Kevin G F Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jonathan Underwood
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
- HIV Clinical Trials, Winston Churchill Wing, St Mary's Hospital, London, UK
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Yuan NY, Maung R, Xu Z, Han X, Kaul M. Arachidonic Acid Cascade and Eicosanoid Production Are Elevated While LTC4 Synthase Modulates the Lipidomics Profile in the Brain of the HIVgp120-Transgenic Mouse Model of NeuroHIV. Cells 2022; 11:2123. [PMID: 35805207 PMCID: PMC9265961 DOI: 10.3390/cells11132123] [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: 05/21/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has transformed HIV infection from a terminal disease to a manageable chronic health condition, extending patients' life expectancy to that of the general population. However, the incidence of HIV-associated neurocognitive disorders (HANDs) has persisted despite virological suppression. Patients with HIV display persistent signs of immune activation and inflammation despite cART. The arachidonic acid (AA) cascade is an important immune response system responsible for both pro- and anti-inflammatory processes. METHODS Lipidomics, mRNA and Western blotting analysis provide valuable insights into the molecular mechanisms surrounding arachidonic acid metabolism and the resulting inflammation caused by perturbations thereof. RESULTS Here, we report the presence of inflammatory eicosanoids in the brains of a transgenic mouse model of NeuroHIV that expresses soluble HIV-1 envelope glycoprotein in glial cells (HIVgp120tg mice). Additionally, we report that the effect of LTC4S knockout in HIVgp120tg mice resulted in the sexually dimorphic transcription of COX- and 5-LOX-related genes. Furthermore, the absence of LTC4S suppressed ERK1/2 and p38 MAPK signaling activity in female mice only. The mass spectrometry-based lipidomic profiling of these mice reveals beneficial alterations to lipids in the brain. CONCLUSION Targeting the AA cascade may hold potential in the treatment of neuroinflammation observed in NeuroHIV and HANDs.
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Affiliation(s)
- Nina Y. Yuan
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA 92521, USA; (N.Y.Y.); (R.M.)
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Ricky Maung
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA 92521, USA; (N.Y.Y.); (R.M.)
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Ziying Xu
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.X.); (X.H.)
| | - Xianlin Han
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.X.); (X.H.)
- Department of Medicine-Diabetes, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Marcus Kaul
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA 92521, USA; (N.Y.Y.); (R.M.)
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
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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.
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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
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Abstract
Objective: The aim of this study was to examine neurocognitive course over time among people with well treated HIV. Design: The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is an ongoing, prospective, longitudinal, multicenter and multilingual study within the Swiss HIV Cohort Study (SHCS). Participants undergo neuropsychological assessment at baseline and two-yearly follow-up. Setting: Seven SHCS centres. Participants: Patients aged at least 45 years enrolled in the SHCS with fluency in the local language (French, German or Italian) and agreeing to participate in the NAMACO study: 981 participants at baseline, 720 at 2-year follow-up of whom 644 had complete data sets. Intervention: Standardized neuropsychological assessment at baseline and 2-year follow-up. Main outcome measure: Neurocognitive performance using Frascati criteria and mean z-scores. Results: Four participants (of 644, 0.6%) had plasma HIV-1 RNA more than 50 copies/ml; median CD4+ cell count was 660 cells/μl. According to Frascati criteria, 204 participants (31.7%) had neurocognitive impairment (NCI) at baseline. NCI severity in these participants changed little over 2 years and comprehensive models based on Frascati criteria were not feasible. Examining mean z-scores, however, we observed neurocognitive stability or improvement over two years in five of seven neurocognitive domains assessed. Age at least 65 years (P = 0.02) and cognitive complaints (P = 0.004) were associated with neurocognitive decline, while black race (P = 0.01) and dolutegravir treatment (P = 0.002) were associated with improvement. Conclusion: Frascati criteria were less sensitive in measuring NCI change and therefore unsuitable for following neurocognitive course in our cohort of people with well treated HIV. Examining neurocognitive course by mean z-score change, we observed stability or improvement.
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Sarfo FS, Kyem G, Asibey SO, Tagge R, Ovbiagele B. Contemporary trends in HIV-associated neurocognitive disorders in Ghana. Clin Neurol Neurosurg 2021; 210:107003. [PMID: 34715557 DOI: 10.1016/j.clineuro.2021.107003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Widespread introduction of early combination antiretroviral therapy (cART) for People Living with HIV (PLWH) will influence the burden, profile, and trajectory of HIV-associated neurocognitive disorders (HAND) in the 21st century. OBJECTIVES To assess the prevalence and trajectory of HAND among PLWH in a Ghanaian tertiary medical center. METHODS We analyzed the dataset of a study involving PLWH established on cART (n = 256) and PLWH not initially on cART (n = 244). HIV-negative individuals (n = 246) served as normative controls for neurocognitive assessments. HAND was defined according to the Frascati criteria into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD) at enrollment and at month 12. Multivariate logistic regression models were fitted to identify factors associated with HAND. RESULTS Among PLWH on cART, 21.5%, 3.5% and 0.0% had ANI, MND and HAD respectively compared with 20.1%, 9.8% and 2.0% among PLWH cART naïve, p < 0.0001. Overall, 71.6%, 20.8%, 6.6% and 1.0% had no cognitive impairment, ANI, MND and HAD at baseline. Among participants who completed month 12 follow-up, 55.2% had no cognitive impairment, 43.5%, 1.2%, 0.0% had ANI, MND and HAD respectively, p < 0.0001. Adjusted odds ratio (95% CI) of six independent predictors of HAND at month 12 were no education (3.29;1.81-6.00), stage 4 disease (4.64;1.37-15.69), hypertension (2.28;1.10-4.73), nevirapine use (2.05;1.04-4.05), baseline viral load (0.66;0.56-0.77), and cigarette use (0.10; 0.03-0.42). CONCLUSION Most Ghanaian patients in the post-cART era with HAND had mild neurocognitive impairments. The impact of hypertension on progression of HAND warrants further evaluation in our settings.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Gloria Kyem
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Raelle Tagge
- Northern California Institute of Research and Education, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California San Francisco, USA
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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.
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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
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Fülöp T, Munawara U, Larbi A, Desroches M, Rodrigues S, Catanzaro M, Guidolin A, Khalil A, Bernier F, Barron AE, Hirokawa K, Beauregard PB, Dumoulin D, Bellenger JP, Witkowski JM, Frost E. Targeting Infectious Agents as a Therapeutic Strategy in Alzheimer's Disease. CNS Drugs 2020; 34:673-695. [PMID: 32458360 PMCID: PMC9020372 DOI: 10.1007/s40263-020-00737-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is the most prevalent dementia in the world. Its cause(s) are presently largely unknown. The most common explanation for AD, now, is the amyloid cascade hypothesis, which states that the cause of AD is senile plaque formation by the amyloid β peptide, and the formation of neurofibrillary tangles by hyperphosphorylated tau. A second, burgeoning theory by which to explain AD is based on the infection hypothesis. Much experimental and epidemiological data support the involvement of infections in the development of dementia. According to this mechanism, the infection either directly or via microbial virulence factors precedes the formation of amyloid β plaques. The amyloid β peptide, possessing antimicrobial properties, may be beneficial at an early stage of AD, but becomes detrimental with the progression of the disease, concomitantly with alterations to the innate immune system at both the peripheral and central levels. Infection results in neuroinflammation, leading to, and sustained by, systemic inflammation, causing eventual neurodegeneration, and the senescence of the immune cells. The sources of AD-involved microbes are various body microbiome communities from the gut, mouth, nose, and skin. The infection hypothesis of AD opens a vista to new therapeutic approaches, either by treating the infection itself or modulating the immune system, its senescence, or the body's metabolism, either separately, in parallel, or in a multi-step way.
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Affiliation(s)
- Tamàs Fülöp
- Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, Research Center on Aging, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada.
| | - Usma Munawara
- Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, Research Center on Aging, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Immunos Building, Biopolis, Singapore, Singapore
- Department of Biology, Faculty of Science, University Tunis El Manar, Tunis, Tunisia
| | - Mathieu Desroches
- MathNeuro Team, Inria Sophia Antipolis Méditerranée, Valbonne, France
- Université Côte d'Azur, Nice, France
| | - Serafim Rodrigues
- Ikerbasque, The Basque Foundation for Science, Bilbao, Spain
- BCAM, The Basque Center for Applied Mathematics, Bilbao, Spain
| | - Michele Catanzaro
- Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, Research Center on Aging, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Andrea Guidolin
- BCAM, The Basque Center for Applied Mathematics, Bilbao, Spain
| | - Abdelouahed Khalil
- Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, Research Center on Aging, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - François Bernier
- Next Generation Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Annelise E Barron
- Department of Bioengineering, Stanford School of Medicine, Stanford, CA, USA
| | - Katsuiku Hirokawa
- Department of Pathology, Institute of Health and Life Science, Tokyo and Nito-memory Nakanosogo Hospital, Tokyo Med. Dent. University, Tokyo, Japan
| | - Pascale B Beauregard
- Department of Biology, Faculty of Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - David Dumoulin
- Department of Biology, Faculty of Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Philippe Bellenger
- Department of Chemistry, Faculty of Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jacek M Witkowski
- Department of Pathophysiology, Medical University of Gdansk, Gdansk, Poland
| | - Eric Frost
- Department of Microbiology and Infectious diseases, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
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9
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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.
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10
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Ripamonti E, Clerici M. The association of memory disorders and chronic HIV disease in the antiretroviral therapy era: a systematic literature review. HIV Med 2019; 21:9-20. [PMID: 31603624 DOI: 10.1111/hiv.12793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Despite recent pharmacological progress, memory impairment is still frequently reported in people living with HIV. We aimed to conduct a systematic literature review investigating the presence of impairment of (sub)components of memory function in patients prescribed highly active antiretroviral therapy (ART). METHODS We adopted a cognitive neuropsychological model of memory function as the theoretical framework, distinguishing between a short-term working memory component and a long-term component of memory, along with their specific (sub)components. We systematically searched for the presence of impairment of each (sub)component in the selected papers. Careful consideration was given to study design and methods and control of covariates. RESULTS Only the central executive component of working memory has been consistently reported to be impaired in HIV infection. The other two (sub)components, namely the phonological loop and the visuospatial sketchpad, were unimpaired. Discordant results have been obtained as to verbal and visual episodic memory, as some authors reported an association with HIV infection, whereas others did not. There is little evidence for semantic memory deficit in HIV infection, while there are suggestions that the neural substrate of implicit memory may be damaged by the effects of HIV infection and inflammation. Most studies in this area have been conducted in small samples and with poor control for covariates. Thus, conclusions regarding the association of memory dysfunction with HIV infection are hampered by methodological issues such as selection bias and unmeasured confounding. CONCLUSIONS The task remains for future research to ascertain the impact of HIV infection on memory function.
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Affiliation(s)
- E Ripamonti
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Clerici
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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11
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Fulop T, Witkowski JM, Larbi A, Khalil A, Herbein G, Frost EH. Does HIV infection contribute to increased beta-amyloid synthesis and plaque formation leading to neurodegeneration and Alzheimer's disease? J Neurovirol 2019; 25:634-647. [PMID: 30868421 DOI: 10.1007/s13365-019-00732-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
HIV infection in the combination antiretroviral therapy (cART) era has become a chronic disease with a life expectancy almost identical to those free from this infection. Concomitantly, chronic diseases such as neurodegenerative diseases have emerged as serious clinical problems. HIV-induced cognitive changes, although clinically very diverse are collectively called HIV-associated neurocognitive disorder (HAND). HAND, which until the introduction of cART manifested clinically as a subcortical disorder, is now considered primarily cognitive disorder, which makes it similar to diseases like Alzheimer's (AD) and Parkinson's disease (PD). The pathogenesis involves either the direct effects of the virus or the effect of viral proteins such as Tat, Ggp120, and Nef. These proteins are either capable of destroying neurons directly by inducing neurotoxic mediators or by initiating neuroinflammation by microglia and astrocytes. Recently, it has become recognized that HIV infection is associated with increased production of the beta-amyloid peptide (Aβ) which is a characteristic of AD. Moreover, amyloid plaques have also been demonstrated in the brains of patients suffering from HAND. Thus, the question arises whether this production of Aβ indicates that HAND may lead to AD or it is a form of AD or this increase in Aβ production is only a bystander effect. It has also been discovered that APP in HIV and its metabolic product Aβ in AD manifest antiviral innate immune peptide characteristics. This review attempts to bring together studies linking amyloid precursor protein (APP) and Aβ production in HIV infection and their possible impact on the course of HAND and AD. These data indicate that human defense mechanisms in HAND and AD are trying to contain microorganisms by antimicrobial peptides, however by employing different means. Future studies will, no doubt, uncover the relationship between HAND and AD and, hopefully, reveal novel treatment possibilities.
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Affiliation(s)
- Tamas Fulop
- Research Center on Aging, Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Jacek M Witkowski
- Department of Pathophysiology, Medical University of Gdansk, Gdansk, Poland
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Immunos Building, Biopolis, Singapore, Singapore.,Department of Biology, Faculty of Science, University Tunis El Manar, Tunis, Tunisia
| | - Abdelouahed Khalil
- Research Center on Aging, Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Georges Herbein
- Department Pathogens & Inflammation-EPILAB, UPRES EA4266, Université of Franche-Comté (UFC), University of Bourgogne France-Comté (UBFC), F-25030, Besançon, France.,Department of Virology, CHRU Besancon, F-25030, Besancon, France
| | - Eric H Frost
- Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
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12
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Cysique LA, Casaletto KB, Heaton RK. Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2019; 50:271-298. [PMID: 31559600 DOI: 10.1007/7854_2019_116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
HIV infection has become a chronic disease managed across the life span. In this context, the cognitive health of HIV infection needs to have methods for monitoring over time, in order to better anticipate HIV-associated neurocognitive disorder (HAND) trajectories in relation to biomarkers, and predict prognosis and especially the risk of dementia as People Living with HIV (PLHIV) age. In this chapter, we critically review several statistical frameworks to quantify cognitive change. We then provide a critical review of naturalistic longitudinal studies and selected randomized clinical trials assessing neurocognitive change as a primary outcome in PLHIV, conducted since the advent of the combined antiretroviral therapy era (censored January 2019). Doing so, we distinguish between PLHIV who were treated early and did not experience AIDS (CDC 1993), versus treated late, after experiencing AIDS and more severe immune compromise. Highlighting strengths and limitations of these studies, we emphasize that issues of reliability pertaining to the use of neuropsychological tests need careful consideration for the robust quantification of cognitive change, including measurement error, practice effect, inter-individual variability, baseline level of functioning, demographic effects, timeframe between testing intervals, normative longitudinal data, and operationalization of clinically meaningful neurocognitive change. In addition, issues pertaining to longitudinal analyses including type, amount and pattern of missing data and/or participant attrition, regression toward the mean, and survivor bias need to be properly addressed. We conclude by proposing future research directions with emphasis on research translation to clinical participants.
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Affiliation(s)
- Lucette A Cysique
- Faculty of Medicine, Neuroscience Research Australia, School of Medical Sciences, The University of New South Wales, Sydney, Sydney, NSW, Australia.
| | - Kaitlin B Casaletto
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, UCSD School of Medicine, La Jolla, CA, USA
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Impact of glycemic status on longitudinal cognitive performance in men with and without HIV infection. AIDS 2018; 32:1849-1860. [PMID: 29746300 DOI: 10.1097/qad.0000000000001842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine the relationship between glycemic status and cognitive performance in men living with HIV (MLWH) and without HIV infection. DESIGN A prospective HIV/AIDS cohort study in four US cities between 1999 and 2016. METHODS Glycemic status was categorized as normal glucose, impaired fasting glucose, controlled diabetes mellitus and uncontrolled diabetes mellitus at each semiannual visit. Cognitive performance was evaluated using nine neuropsychological tests which measure attention, constructional ability, verbal learning, executive functioning, memory and psychomotor speed. Linear mixed models were used to assess the association between glycemic status and cognition. RESULTS Overall, 900 MLWH and 1149 men without HIV were included. MLWH had significantly more person-visits with impaired fasting glucose (52.1 vs. 47.9%) and controlled diabetes mellitus (58.2 vs. 41.8%) than men without HIV (P < 0.05). Compared with men with normal glucose, men with diabetes mellitus had significantly poorer performance on psychomotor speed, executive function and verbal learning (all P < 0.05). There was no difference in cognition by HIV serostatus. The largest effect was observed in individuals with uncontrolled diabetes mellitus throughout the study period, equivalent to 16.5 and 13.4 years of aging on psychomotor speed and executive function, respectively, the effect of which remained significant after adjusting for HIV-related risk factors. Lower CD4+ nadir was also associated with worse cognitive performance. CONCLUSION Abnormalities in glucose metabolism were more common among MLWH than men without HIV and were related to impaired cognitive performance. Metabolic status, along with advanced age and previous immunosuppression, may be important predictors of cognition in the modern antiretroviral therapy era.
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14
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Haddow LJ, Laverick R, Daskalopoulou M, McDonnell J, Lampe FC, Gilson R, Speakman A, Antinori A, Balestra P, Bruun T, Gerstoft J, Nielsen L, Vassilenko A, Collins S, Rodger AJ. Multicenter European Prevalence Study of Neurocognitive Impairment and Associated Factors in HIV Positive Patients. AIDS Behav 2018; 22:1573-1583. [PMID: 28144792 PMCID: PMC5902513 DOI: 10.1007/s10461-017-1683-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We conducted a cross-sectional study in 448 HIV positive patients attending five European outpatient clinics to determine prevalence of and factors associated with neurocognitive impairment (NCI) using computerized and pen-and-paper neuropsychological tests. NCI was defined as a normalized Z score ≤-1 in at least 2 out of 5 cognitive domains. Participants' mean age was 45.8 years; 84% male; 87% white; 56% university educated; median CD4 count 550 cells/mm3; 89% on antiretroviral therapy. 156 (35%) participants had NCI, among whom 26 (17%; 5.8% overall) reported a decline in activities of daily living. Prevalence of NCI was lower in those always able to afford basic needs (adjusted prevalence ratio [aPR] 0.71, 95% confidence interval [CI] 0.54-0.94) or with a university education (aPR 0.72, 95% CI 0.54-0.97) and higher in those with severe depressive symptoms (aPR 1.53, 95% CI 1.09-2.14) or a significant comorbid condition (aPR 1.40, 95% CI 1.03-1.90).
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Affiliation(s)
- Lewis J Haddow
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK.
| | - Rosanna Laverick
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Marina Daskalopoulou
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - Pietro Balestra
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - Tina Bruun
- Department of Infectious Diseases, Rigshospitalet, Centre for Health & Infectious Disease Research (CHIP), University of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Centre for Health & Infectious Disease Research (CHIP), University of Copenhagen, Copenhagen, Denmark
| | - Lars Nielsen
- Infektionsmedicinsk Afdeling, Nordsjællands Hospital, Hillerød, Denmark
| | | | | | - Alison J Rodger
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
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15
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Underwood J, De Francesco D, Leech R, Sabin CA, Winston A. Medicalising normality? Using a simulated dataset to assess the performance of different diagnostic criteria of HIV-associated cognitive impairment. PLoS One 2018; 13:e0194760. [PMID: 29641619 PMCID: PMC5894993 DOI: 10.1371/journal.pone.0194760] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/09/2018] [Indexed: 11/20/2022] Open
Abstract
Objective The reported prevalence of cognitive impairment remains similar to that reported in the pre-antiretroviral therapy era. This may be partially artefactual due to the methods used to diagnose impairment. In this study, we evaluated the diagnostic performance of the HIV-associated neurocognitive disorder (Frascati criteria) and global deficit score (GDS) methods in comparison to a new, multivariate method of diagnosis. Methods Using a simulated ‘normative’ dataset informed by real-world cognitive data from the observational Pharmacokinetic and Clinical Observations in PeoPle Over fiftY (POPPY) cohort study, we evaluated the apparent prevalence of cognitive impairment using the Frascati and GDS definitions, as well as a novel multivariate method based on the Mahalanobis distance. We then quantified the diagnostic properties (including positive and negative predictive values and accuracy) of each method, using bootstrapping with 10,000 replicates, with a separate ‘test’ dataset to which a pre-defined proportion of ‘impaired’ individuals had been added. Results The simulated normative dataset demonstrated that up to ~26% of a normative control population would be diagnosed with cognitive impairment with the Frascati criteria and ~20% with the GDS. In contrast, the multivariate Mahalanobis distance method identified impairment in ~5%. Using the test dataset, diagnostic accuracy [95% confidence intervals] and positive predictive value (PPV) was best for the multivariate method vs. Frascati and GDS (accuracy: 92.8% [90.3–95.2%] vs. 76.1% [72.1–80.0%] and 80.6% [76.6–84.5%] respectively; PPV: 61.2% [48.3–72.2%] vs. 29.4% [22.2–36.8%] and 33.9% [25.6–42.3%] respectively). Increasing the a priori false positive rate for the multivariate Mahalanobis distance method from 5% to 15% resulted in an increase in sensitivity from 77.4% (64.5–89.4%) to 92.2% (83.3–100%) at a cost of specificity from 94.5% (92.8–95.2%) to 85.0% (81.2–88.5%). Conclusion Our simulations suggest that the commonly used diagnostic criteria of HIV-associated cognitive impairment label a significant proportion of a normative reference population as cognitively impaired, which will likely lead to a substantial over-estimate of the true proportion in a study population, due to their lower than expected specificity. These findings have important implications for clinical research regarding cognitive health in people living with HIV. More accurate methods of diagnosis should be implemented, with multivariate techniques offering a promising solution.
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Affiliation(s)
- Jonathan Underwood
- Division of Infectious Diseases, Imperial College London, London, United Kingdom
- * E-mail:
| | - Davide De Francesco
- Department of Infection & Population Health, University College London, London, United Kingdom
| | - Robert Leech
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Caroline A. Sabin
- Department of Infection & Population Health, University College London, London, United Kingdom
| | - Alan Winston
- Division of Infectious Diseases, Imperial College London, London, United Kingdom
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16
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Abstract
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) affects roughly half the HIV-positive population. The symptoms of cognitive slowing, poor concentration, and memory problems can impact on everyday life. Its diagnosis is validated where possible by identifying deficits in two cognitive domains on neuropsychologic testing in patients either with or without symptoms. Corroborating evidence may be found on imaging, blood tests, and cerebrospinal fluid analysis, though sensitive and specific biomarkers are currently lacking. The introduction of combined antiretroviral therapy in the 1990s has generated a therapeutic paradox whereby the number of severe cases of HAND has fallen, yet milder forms continue to rise in prevalence. New emphasis has been placed on identifying the cause of apparent ongoing HIV infection and inflammation of the central nervous system (CNS) in the face of durable systemic viral suppression, and how this equates to the neuronal dysfunction underlying HAND. The interaction with aging and comorbidities is becoming increasingly common as the HIV-positive population enters older adulthood, with neurodegenerative, metabolic, and vascular causes of cognitive impairment combining and probably accelerating in the context of chronic HIV infection. Therapies targeted to the CNS, but without neurotoxic side-effects, are being investigated to attempt to reduce the likelihood of developing, and improving, HAND.
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Affiliation(s)
| | - Bruce James Brew
- Departments of Neurology and HIV Medicine, St. Vincent's Hospital and Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, NSW, Australia.
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17
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Saloner R, Cysique LA. HIV-Associated Neurocognitive Disorders: A Global Perspective. J Int Neuropsychol Soc 2017; 23:860-869. [PMID: 29198283 PMCID: PMC5939823 DOI: 10.1017/s1355617717001102] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 01/17/2023]
Abstract
The present review on HIV-associated neurocognitive disorders (HAND) provides a worldwide overview of studies that have investigated the rate and neuropsychological (NP) profile of HAND research since the inception of the 2007 HAND diagnostic nomenclature. In the first part, the review highlights some of the current controversies around HAND prevalence rates. In the second part, the review critically assesses some solutions to move the field forward. In the third part, we present the cross-sectional NP profile in non-Western HIV+ cohorts and in relation to Western cohorts' findings. The adopted global perspective highlights the successful expansion of NP studies in HIV infection to culturally diverse low- to medium-income countries with high HIV burden. These studies have produced interestingly similar rates of HAND whether patients were naïve or treated and/or virally suppressed compared to the rich income countries where the NP research in NeuroHIV has originated. The perspective also demonstrates that globally, the group which is the most representative of the HIV epidemic, and thus at risk for HAND are persons with chronic HIV infection and survivors of past immunosuppression, while in relative terms, those who have been treated early with long-term viral suppression represent a minority. In the last part, we present a review of the naturalistic longitudinal NP global studies in HIV+cohorts, discuss the role of longitudinal design in solving issues around the question of asymptomatic neurocognitive impairment, and the question of biomarker discovery. Finally, we conclude by calling for greater methods and data harmonization at a global level. (JINS, 2017, 23, 860-869).
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Affiliation(s)
- Rowan Saloner
- The HIV Neurobehavioral Research Program (HNRP), Department of Psychiatry, University of California, San Diego, San Diego, California
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, California
| | - Lucette A. Cysique
- School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW
- Neuroscience Research Australia, Barker Street, Randwick, NSW
- Neuroscience Program and Peter Duncan Neurosciences Unit St. Vincent’s Hospital Centre for Applied Medical Research Centre, and departments of Neurology and HIV St. Vincent’s Hospital Sydney, NSW
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18
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Rubin LH, Maki PM, Springer G, Benning L, Anastos K, Gustafson D, Villacres MC, Jiang X, Adimora AA, Waldrop-Valverde D, Vance DE, Bolivar H, Alden C, Martin EM, Valcour VG. Cognitive trajectories over 4 years among HIV-infected women with optimal viral suppression. Neurology 2017; 89:1594-1603. [PMID: 28904086 DOI: 10.1212/wnl.0000000000004491] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/03/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether persistent viral suppression alters cognitive trajectories among HIV-infected (HIV+) women on combination antiretroviral therapy (cART) by investigating performance longitudinally in uninfected (HIV-) and 3 groups of HIV+ women: those with consistent viral suppression after continuous cART use (VS), those without consistent virologic suppression despite continuous cART use (NVS), and those without consistent virologic suppression after intermittent cART use (Int NVS). METHODS Two hundred thirty-nine VS, 220 NVS, 172 Int NVS, and 301 HIV- women from the Women's Interagency HIV Study (WIHS) completed neuropsychological testing every 2 years for 3 visits between 2009 and 2013. Mixed-effects regressions were used to examine group differences on continuous T scores and categorical measures of impairment (T score <40). RESULTS On global function, VS women demonstrated lower scores and were more likely to score in the impaired range than HIV- women (p = 0.01). These differences persisted over time (group × time, p > 0.39). VS women demonstrated lower learning and memory scores than HIV- women (p < 0.05) and lower attention/working memory and fluency scores than HIV- and NVS women (p < 0.05). Group differences in scores persisted over time. Categorically, VS women were more likely to be impaired on attention/working memory and executive function than HIV- women (p < 0.05). On motor skills, VS and NVS women showed a greater decline and were more likely to be impaired than HIV- women (p < 0.05). CONCLUSIONS Cognitive difficulties remain among HIV+ women despite persistent viral suppression. In some instances, VS women are worse than NVS women, reinforcing the need for novel adjunctive therapies to attenuate cognitive problems.
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Affiliation(s)
- Leah H Rubin
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco.
| | - Pauline M Maki
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Gayle Springer
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Lorie Benning
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Kathryn Anastos
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Deborah Gustafson
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Maria C Villacres
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Xiong Jiang
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Adaora A Adimora
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Drenna Waldrop-Valverde
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - David E Vance
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Hector Bolivar
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Christine Alden
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Eileen M Martin
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
| | - Victor G Valcour
- From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco
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Eggers C, Arendt G, Hahn K, Husstedt IW, Maschke M, Neuen-Jacob E, Obermann M, Rosenkranz T, Schielke E, Straube E. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol 2017; 264:1715-1727. [PMID: 28567537 PMCID: PMC5533849 DOI: 10.1007/s00415-017-8503-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023]
Abstract
The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus-brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
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Affiliation(s)
- Christian Eggers
- Department of Neurology, Krankenhaus Barmherzige Brüder, Seilerstätte 2, 4021, Linz, Austria.
| | - Gabriele Arendt
- Neurologische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Katrin Hahn
- Neurologische Klinik, Charité, Berlin, Germany
| | - Ingo W Husstedt
- Klinik für Neurologie, Universitätsklinikum Münster, Münster, Germany
| | - Matthias Maschke
- Neurologische Abteilung, Brüderkrankenhaus Trier, Trier, Germany
| | - Eva Neuen-Jacob
- Institut für Neuropathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Mark Obermann
- Direktor des Zentrums für Neurologie, Asklepios Kliniken Schildautal, Seesen, Germany
| | - Thorsten Rosenkranz
- Neurologische Abteilung, Asklepios-Klinik Hamburg-St. Georg, Hamburg, Germany
| | - Eva Schielke
- Praxis für Neurologie Berlin-Mitte, 10117, Berlin, Germany
| | - Elmar Straube
- HIV-Schwerpunktpraxis, 30890, Barsinghausen, Germany
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20
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Topographies of Cortical and Subcortical Volume Loss in HIV and Aging in the cART Era. J Acquir Immune Defic Syndr 2017; 73:374-383. [PMID: 27454251 DOI: 10.1097/qai.0000000000001111] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Studies of HIV-associated brain atrophy often focus on a priori brain regions of interest, which can introduce bias. A data-driven, minimally biased approach was used to analyze changes in brain volumetrics associated with HIV and their relationship to aging, viral factors, combination antiretroviral therapy (cART), and gender, and smoking. DESIGN A cross-sectional study of 51 HIV-uninfected (HIV-) and 146 HIV-infected (HIV+) participants. METHODS Structural MRI of participants was analyzed using principal component analysis (PCA) to reduce dimensionality and determine topographies of volumetric changes. Neuropsychological (NP) assessment was examined using global and domain-specific scores. The effects of HIV disease factors (eg, viral load, CD4, etc.) on brain volumes and neuropsychological were investigated using penalized regression (LASSO). RESULTS Two components of interest were visualized using principal component analysis. An aging effect predominated for both components. The first component, a cortically weighted topography, accounted for a majority of variance across participants (43.5% of variance) and showed independent effects of HIV and smoking. A secondary, subcortically weighted topography (4.6%) showed HIV-status accentuated age-related volume loss. In HIV+ patients, the cortical topography correlated with global neuropsychological scores and nadir CD4, whereas subcortical volume loss was associated with recent viral load. CONCLUSIONS Cortical regions showed the most prominent volumetric changes because of aging and HIV. Within HIV+ participants, cortical volumes were associated with immune history, whereas subcortical changes correlated with current immune function. Cognitive function was primarily associated with cortical volume changes. Observed volumetric changes in chronic HIV+ patients may reflect both past infection history and current viral status.
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Cognitive Decline in Relation to Psychological Wellbeing and HIV Disease- and Treatment Characteristics in HIV-Infected Patients on cART: A One-Year Follow-Up Study. AIDS Behav 2017; 21:1728-1734. [PMID: 27752871 PMCID: PMC5422495 DOI: 10.1007/s10461-016-1583-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objectives of the current study were to examine cognitive decline in relation to psychological wellbeing, HIV disease and treatment characteristics and baseline variables over a one-year period of time in a group of HIV-infected patients on long term cART with undetectable viral load in comparison to a HIV-negative control group. Eighty-two of 95 patients and 43 of 55 controls who completed a baseline assessment for the Art-NeCo study underwent a follow-up neuropsychological assessment. A repeated-measure general linear model analysis was performed to compare the performance at follow-up in comparison to baseline between the patients and controls. Reliable change indices were computed as a measure of significant change in cognitive function. Compared to controls, patients overall performed worse on the domain speed of information processing. In the patient group a worse performance at follow-up was present for the verbal fluency domain compared to the controls, in the absence of a baseline group difference. For the executive function domain, no group differences were found at follow-up, but the patients performed worse than the controls at baseline. We found that cognitive decline was related to more frequent use of recreational drugs and a somewhat heightened level of irritability and more somatic complaints at baseline. However, the decliners did not differ from the non-decliners on any of the HIV-related variables.
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22
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Gougeon ML. Alarmins and central nervous system inflammation in HIV-associated neurological disorders. J Intern Med 2017; 281:433-447. [PMID: 27862491 DOI: 10.1111/joim.12570] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the era of highly active antiretroviral therapy (HAART), HIV-1-associated neurocognitive disorders (HAND) persist in infected individuals with adequate immunological and virological status. Risk factors for cognitive impairment include hepatitis C virus co-infection, host genetic factors predisposing to HAND, the early establishment of the virus in the CNS and its persistence under HAART; thus, the CNS is an important reservoir for HIV. Microglial cells are permissive to HIV-1, and NLRP3 inflammasome-associated genes were found expressed in brains of HIV-1-infected persons, contributing to brain disease. Inflammasomes can be triggered by alarmins or danger-associated molecular patterns (DAMPs), which directly stimulate the production of proinflammatory mediators by glial cells, contribute to blood-brain barrier injury through induction of release of various proteases and allow the passage of infected macrophages, and trigger IL-1β release from primed cells. Amongst alarmins involved in HIV-1-induced neuropathogenesis, IL-33 and high-mobility group box 1 (HMGB1) are of particular interest. Neurocognitive alterations were recently associated with dysregulation of the IL-33/ST2 axis in the CNS, leading to the induction of neuronal apoptosis, decrease in synaptic function and neuroinflammation. Specific biomarkers, including HMGB1 and anti-HMGB1 antibodies, have been identified in cerebrospinal fluid from patients with HAND, correlated with immune activation and identifying a very early stage of neurocognitive impairment that precedes changes in metabolites detected by magnetic resonance spectroscopy. Moreover, HMGB1 plays a crucial role in HIV-1 persistence in dendritic cells and in the constitution of viral reservoirs. In this review, the mechanisms whereby alarmins contribute to HIV-1-induced CNS inflammation and neuropathogenesis will be discussed.
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Affiliation(s)
- M-L Gougeon
- Institut Pasteur, Antiviral Immunity, Biotherapy and Vaccine Unit, Infection and Epidemiology Department, Paris, France
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23
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Armstrong NM, Surkan PJ, Treisman GJ, Sacktor NC, Irwin MR, Teplin LA, Stall R, Martin EM, Becker JT, Munro C, Levine AJ, Jacobson LP, Abraham AG. Association of long-term patterns of depressive symptoms and attention/executive function among older men with and without human immunodeficiency virus. J Neurovirol 2017; 23:558-567. [PMID: 28429290 DOI: 10.1007/s13365-017-0527-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 01/19/2023]
Abstract
Older HIV-infected men are at higher risk for both depression and cognitive impairments, compared to HIV-uninfected men. We evaluated the association between longitudinal patterns of depressive symptoms and attention/executive function in HIV-infected and HIV-uninfected men aged 50+ years to understand whether HIV infection influenced the long-term effect of depression on attention/executive function. Responses to the Center for Epidemiologic Studies-Depression scale and attention/executive function tests (Trail Making Test Part B and Symbol Digit Modalities Test) were collected semiannually from May 1986 to April 2015 in 1611 men. Group-based trajectory models, stratified by HIV status, were used to identify latent patterns of depressive symptoms and attention/executive function across 12 years of follow-up. We identified three depression patterns for HIV-infected and HIV-uninfected men (rare/never 50.0 vs. 60.6%, periodically depressed 29.6 vs. 24.5%, chronic high 20.5 vs.15.0%, respectively) and three patterns of attention/executive function for HIV-infected and HIV-uninfected men (worst-performing 47.4 vs. 45.1%; average 41.9 vs. 47.0%; best-performing 10.7 vs. 8.0%, respectively). Multivariable logistic regression models were used to assess associations between depression patterns and worst-performing attention/executive function. Among HIV-uninfected men, those in the periodically depressed and chronic high depressed groups had higher odds of membership in the worst-performing attention/executive function group (adjusted odds ratio [AOR] = 1.45, 95% CI 1.04, 2.03; AOR = 2.25, 95% CI 1.49, 3.39, respectively). Among HIV-infected men, patterns of depression symptoms were not associated with patterns of attention/executive function. Results suggest that HIV-uninfected, but not HIV-infected, men with chronic high depression are more likely to experience a long-term pattern of attention/executive dysfunction.
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Affiliation(s)
- Nicole M Armstrong
- Departments of Epidemiology, Johns Hopkins University Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.
| | - Pamela J Surkan
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Glenn J Treisman
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ned C Sacktor
- Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Departments of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Linda A Teplin
- Departments of Psychiatry and Behavioral Sciences and Medicine: Infectious Diseases, Feinberg School of Medicine, Chicago, IL, USA
| | - Ron Stall
- Departments of Behavioral and Community Health, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eileen M Martin
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | - James T Becker
- Psychiatry, Psychology, and Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Cynthia Munro
- Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew J Levine
- Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Lisa P Jacobson
- Departments of Epidemiology, Johns Hopkins University Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA
| | - Alison G Abraham
- Departments of Epidemiology, Johns Hopkins University Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.,Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Gott C, Gates T, Dermody N, Brew BJ, Cysique LA. Cognitive change trajectories in virally suppressed HIV-infected individuals indicate high prevalence of disease activity. PLoS One 2017; 12:e0171887. [PMID: 28264037 PMCID: PMC5338778 DOI: 10.1371/journal.pone.0171887] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/29/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The longitudinal rate and profile of cognitive decline in persons with stable, treated, and virally suppressed HIV infection is not established. To address this question, the current study quantifies the rate of cognitive decline in a cohort of virally suppressed HIV+ persons using clinically relevant definitions of decline, and determine cognitive trajectories taking into account historical and baseline HAND status. METHODS Ninety-six HIV+ (clinically stable and virally undetectable) and 44 demographically comparable HIV- participants underwent standard neuropsychological testing at baseline and 18-months follow-up. We described clinically relevant cognitive trajectories based on standard definitions of historical and baseline HAND status and cognitive decline. Historical, moderate to severe HAND was formally diagnosed at the start of the cART era in 15/96 participants based on clinical neurological and neuropsychological assessment. The same standard of care has been applied to all participants at St. Vincent's Hospital Infectious Disease Department for the duration of their HIV infection (median of 20 years). RESULTS Relative to HIV- controls (4.5%), 14% of HIV+ participants declined (p = .11), they also scored significantly lower on the global change score (p = .03), processing speed (p = .02), and mental flexibility/inhibition (p = .02) domains. Having HAND at baseline significantly predicted cognitive decline at follow up (p = .005). We determined seven clinically relevant cognitive trajectories taking into account whether participant has a history of HAND prior to study entry (yes/no); their results on the baseline assessment (baseline impairment: yes/no) and their results on the 18-month follow up (decline or stable) which in order of prevalence were: 1) No HAND history, no baseline impairment, 18-month follow-up stable (39%), 2) No HAND history, baseline impairment, 18-month follow-up stable (35%), 3) History of HAND; baseline impairment, 18-month follow-up stable (9%) 4) No history of HAND, baseline impairment, 18-month follow-up decline (7%), 5) History of HAND, no baseline impairment, 18-month follow-up stable (3%), 6) No HAND history, no baseline impairment, 18-month follow-up decline (3%) 7) History of HAND, baseline impairment, 18-month follow-up decline (3%). There was no relationship between cognitive decline (taking into account historical and baseline HAND) and traditional HIV disease biomarkers. CONCLUSIONS Despite long-term viral suppression, we found mostly subclinical levels of decline in psychomotor speed and executive functioning (mental flexibility and cognitive inhibition); well-established markers of HAND progression. Moreover, 57% of our cohort is undergoing slow evolution of their disease, challenging the notion of prevalent neurocognitive stability in virally suppressed HIV infection.
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Affiliation(s)
- Chloe Gott
- Psychology Department, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Thomas Gates
- Departments of HIV and Neurology St Vincent’s Hospital and Peter Duncan Neurosciences Unit St Vincent’s Centre for Applied Medical Research Centre, Darlinghurst, NSW, Australia
| | - Nadene Dermody
- Psychology Department, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bruce J. Brew
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Departments of HIV and Neurology St Vincent’s Hospital and Peter Duncan Neurosciences Unit St Vincent’s Centre for Applied Medical Research Centre, Darlinghurst, NSW, Australia
| | - Lucette A. Cysique
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Departments of HIV and Neurology St Vincent’s Hospital and Peter Duncan Neurosciences Unit St Vincent’s Centre for Applied Medical Research Centre, Darlinghurst, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- * E-mail:
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Haubenberger D, Clifford DB. Clinical Trials in Neurovirology: Successes, Challenges, and Pitfalls. Neurotherapeutics 2016; 13:571-81. [PMID: 27194073 PMCID: PMC4965408 DOI: 10.1007/s13311-016-0440-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Clinical trials in neurovirology illustrate the special challenges confronting investigators planning to study these conditions, as well as the contributions of successful trials in establishing appropriate management for these devastating diseases. This article reviews key examples of progress in neurovirology that have been spurred by clinical trials, emphasizing human herpes virus encephalitis, HIV, and JC virus. Clinical trials in the setting of neurovirological diseases are characterized by specific challenges, which may include small sample sizes, clinical presentations from life-threatening conditions to chronic courses of disease, regional and temporally restricted outbreaks scenarios, and the unavailability of validated diagnostic tests that can be rapidly deployed at the bedside. This review aims to highlight these methodological challenges and pitfalls in designing and executing clinical neurovirology trials, as well as to outline innovative trial designs, which could be useful in addressing common challenges.
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Affiliation(s)
- Dietrich Haubenberger
- Clinical Trials Unit, Office of the Clinical Director, NINDS Intramural Research Program, National Institutes of Health, 9000 Rockville Pike, Rm 6-5700, Bethesda, MD, 20892, USA.
| | - David B Clifford
- Departments of Neurology and Medicine, Washington University in St Louis, Box 8111, 660 S Euclid Ave, Saint Louis, MO, 63110, USA
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Norman LR, Basso M. An Update of the Review of Neuropsychological Consequences of HIV and Substance Abuse: A Literature Review and Implications for Treatment and Future Research. ACTA ACUST UNITED AC 2016; 8:50-71. [PMID: 25751583 DOI: 10.2174/1874473708666150309124820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 12/14/2022]
Abstract
Neuropyschological dysfunction, ranging from mild cerebral indicators to dementia has been a consistent part of the medical picture of HIV/AIDS. However, advances in medical supervision, particularly as a result of antiretroviral (ARV) treatment, have resulted in some mitigation of the neuropsychological effects of HIV and necessitate re-evaluation of the pattern and nature of HIV-related cognitive or mental deficits. The associated enhancements in morbidity and mortality that have occurred as a result of ARV medication have led to a need for interventions and programs that maintain behaviors that are healthy and stop the resurgence of the risk of HIV transmission. Risk factors such as mental illness and substance use that may have contributed to the initial infection with HIV still need consideration. These risk factors may also increase neuropsychological dysfunction and impact observance of prevention for treatment and recommendations. Explicitly, a better comprehension of the role of substance use on the progression of HIV-related mental decline can enlighten management and evaluation of persons living with HIV with concurrent disorders of substance use. This review provides a summary of the neurophyschology of substance use and HIV and the existing research that has looked at the effects of both substance use and HIV disease on neurophyscological function and suggestions for future research and treatment.
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Affiliation(s)
- Lisa R Norman
- Public Health Program, Ponce School of Medicine, Ponce, PR 00732, USA.
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Sacktor N, Skolasky RL, Seaberg E, Munro C, Becker JT, Martin E, Ragin A, Levine A, Miller E. Prevalence of HIV-associated neurocognitive disorders in the Multicenter AIDS Cohort Study. Neurology 2015; 86:334-40. [PMID: 26718568 DOI: 10.1212/wnl.0000000000002277] [Citation(s) in RCA: 281] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/17/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the frequency of HIV-associated neurocognitive disorder (HAND) in HIV+ individuals and determine whether the frequency of HAND changed over 4 years of follow-up. METHODS The Multicenter AIDS Cohort Study (MACS) is a prospective study of gay/bisexual men. Beginning in 2007, all MACS participants received a full neuropsychological test battery and functional assessments every 2 years to allow for HAND classification. RESULTS The frequency of HAND for the 364 HIV+ individuals seen in 2007-2008 was 33% and for the 197 HIV+ individuals seen at all time periods during the 2007-2008, 2009-2010, and 2011-2012 periods were 25%, 25%, and 31%, respectively. The overall frequency of HAND increased from 2009-2010 to 2011-2012 (p = 0.048). Over the 4-year study, 77% of the 197 HIV+ individuals remained at their same stage, with 13% showing deterioration and 10% showing improvement in HAND stage. Hypercholesterolemia was associated with HAND progression. A diagnosis of asymptomatic neurocognitive impairment was associated with a 2-fold increased risk of symptomatic HAND compared to a diagnosis of normal cognition. CONCLUSION HAND remains common in HIV+ individuals. However, for the majority of HIV+ individuals on combination antiretroviral therapy with systemic virologic suppression, the diagnosis of HAND is not a progressive condition over 4 years of follow-up. Future studies should evaluate longitudinal changes in HAND and specific neurocognitive domains over a longer time period.
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Affiliation(s)
- Ned Sacktor
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles.
| | - Richard L Skolasky
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
| | - Eric Seaberg
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
| | - Cynthia Munro
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
| | - James T Becker
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
| | - Eileen Martin
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
| | - Ann Ragin
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
| | - Andrew Levine
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
| | - Eric Miller
- From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles
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[HIV 1-associated neurocognitive disorder: current epidemiology, pathogenesis, diagnosis and management]. DER NERVENARZT 2015; 85:1280-90. [PMID: 25292163 DOI: 10.1007/s00115-014-4082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
By restoring the immunological function the modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. As opposed to the classical manifestations of HIV-induced immunosuppression the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) has not noticeably decreased and HAND continues to be relevant in daily clinical practice. At present, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the introduction of combination antiretroviral treatment (cART). The predominant clinical manifestation is a subcortical dementia with deficits in the domains attention, concentration and memory. Signs of central motor pathway lesions have become less frequent and less prominent. Prior to the advent of cART the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In patients with at least partially successfully treated infections, this relationship no longer exists, but a plethora of poorly understood immunological and probably toxic phenomena are under discussion.This consensus paper summarizes the progress made in the last 12 years in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
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Nightingale S, Winston A, Letendre S, Michael BD, McArthur JC, Khoo S, Solomon T. Controversies in HIV-associated neurocognitive disorders. Lancet Neurol 2014; 13:1139-1151. [PMID: 25316020 PMCID: PMC4313542 DOI: 10.1016/s1474-4422(14)70137-1] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cross-sectional studies show that around half of individuals infected with HIV-1 have some degree of cognitive impairment despite the use of antiretroviral drugs. However, prevalence estimates vary depending on the population and methods used to assess cognitive impairment. Whether asymptomatic patients would benefit from routine screening for cognitive difficulties is unclear and the appropriate screening method and subsequent management is the subject of debate. In some patients, HIV-1 RNA can be found at higher concentrations in CSF than in blood, which potentially results from the poor distribution of antiretroviral drugs into the CNS. However, the clinical relevance of so-called CSF viral escape is not well understood. The extent to which antiretroviral drug distribution and toxicity in the CNS affect clinical decision making is also debated.
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Affiliation(s)
- Sam Nightingale
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
| | - Alan Winston
- Division of Medicine, Imperial College London, St Mary's Campus, London, UK
| | - Scott Letendre
- University of California and HIV Neurobehavioral Research Center and Antiviral Research Center, San Diego, CA, USA
| | - Benedict D Michael
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; The Walton Centre Neurology and Neurosurgery NHS Foundation Trust, Liverpool, UK
| | - Justin C McArthur
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saye Khoo
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; The Walton Centre Neurology and Neurosurgery NHS Foundation Trust, Liverpool, UK
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Cysique LA. Should longitudinal multisite studies become the new standard for investigating neurocognitive functions in HIV infection? Clin Infect Dis 2014; 60:481-2. [PMID: 25362203 DOI: 10.1093/cid/ciu863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucette A Cysique
- University of New South Wales Neuroscience Research Australia St Vincent's Centre for Applied Medical Research, Sydney, Australia
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Becker JT, Kingsley LA, Molsberry S, Reynolds S, Aronow A, Levine AJ, Martin E, Miller EN, Munro CA, Ragin A, Sacktor N, Selnes OA. Cohort Profile: Recruitment cohorts in the neuropsychological substudy of the Multicenter AIDS Cohort Study. Int J Epidemiol 2014; 44:1506-16. [PMID: 24771276 DOI: 10.1093/ije/dyu092] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 11/14/2022] Open
Abstract
The Multicenter AIDS Cohort Study (MACS) is one of the largest and longest running studies of the natural and treated history of HIV disease. The Neuropsychological (NP) substudy was begun in 1988 following reports of significant adverse neurological consequences of HIV disease, including dementia. The goal was to characterize the neuropsychological deficits among individuals with HIV disease, and track the natural history of the neurological complications over time. There were three distinct MACS recruitment stages that focused on different groups of HIV-infected men, or men at risk for infection. Initially, a subcohort was evaluated semi-annually with NP tests but, beginning in 2005, the entire group of MACS participants have had NP examinations biannually, unless closer follow-up was warranted. The participants complete a battery of NP tests, and are classified as either normal, mildly or severely impaired using the Antinori criteria for HIV-Associated Neurocognitive Disorder (HAND). Additional behavioural data, including mood state and psychoactive substance use, are recorded as part of the main MACS data collection. The MACS public data set (PDS) has been available since 1994 and includes baseline and 6-monthly follow-up data. Beginning in October 1995, the PDS has been released annually with new releases superseding previous versions.
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Affiliation(s)
- James T Becker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA, Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA, Department of Psychology, Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA,
| | - Lawrence A Kingsley
- Department of Psychology, Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samantha Molsberry
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sandra Reynolds
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aaron Aronow
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew J Levine
- Department of Neurology, University of California, Los Angeles, CA, USA,
| | - Eileen Martin
- Department of Psychiatry, Rush University School of Medicine, Chicago, IL, USA
| | - Eric N Miller
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Cynthia A Munro
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA and
| | - Ann Ragin
- Department of Radiology, Northwestern University, Evanston, IL, USA
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA and
| | - Ola A Selnes
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA and
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Cysique LA, Heaton RK, Kamminga J, Lane T, Gates TM, Moore DM, Hubner E, Carr A, Brew BJ. HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research. J Neurovirol 2014; 20:258-68. [PMID: 24696363 DOI: 10.1007/s13365-014-0242-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/28/2014] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
The Australian HIV-infected (HIV+) population is largely comprised of high-functioning men who have sex with men (MSM). Like other English-speaking countries, Australia mostly relies on US neuropsychological normative standards to detect and determine the prevalence of neurological disorders. Whether the US neuropsychological (NP) normative standards are appropriate in Australian HIV+ MSM has not been established. Ninety virally suppressed HIV+ and 49 HIV-uninfected (HIV-) men (respectively 86 and 85 % self-reported MSM; mean age 54 and 56 years, mean premorbid verbal IQ estimate 110 and 111) undertook standard NP testing. The raw neuropsychological data were transformed using the following: (1) US standards as uncorrected scaled scores and demographically corrected T scores (US norms); and (2) z scores (without demographic corrections) derived from Australian comparison group scaled scores (local norms). To determine HIV-associated neurocognitive disorder prevalence, we used a standard definition of impairment based upon a battery-wide summary score: the global deficit score (GDS). Impairment classification (GDS ≥ 0.5) based on the local norms was best at discriminating between the two groups (HIV- = 14.3 % vs. HIV+ = 53.3 %; p < 0.0001). This definition was significantly associated with age. Impairment classification based on the US norms yielded much lower impairment rate regardless of the HIV status (HIV- = 4.1 % vs. HIV+ = 14.7 %; p = 0.05), but was associated with historical AIDS, and not age. Both types of summary scores were associated with reduced independence in activities of daily living (p ≤ 0.03). Accurate neuropsychological classifications of high (or low) functioning individuals may need country-specific norms that correct for performance-based (e.g., reading) estimates of premorbid cognition in addition to the traditional demographic factors.
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Affiliation(s)
- Lucette A Cysique
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia,
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Clifford DB, Ances BM. HIV-associated neurocognitive disorder. THE LANCET. INFECTIOUS DISEASES 2014; 13:976-86. [PMID: 24156898 DOI: 10.1016/s1473-3099(13)70269-x] [Citation(s) in RCA: 436] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neurological involvement in HIV is often associated with cognitive impairment. Although severe and progressive neurocognitive impairment has become rare in HIV clinics in the era of potent antiretroviral therapy, most patients with HIV worldwide have poor outcomes on formal neurocognitive tests. In this Review, we describe the manifestations of HIV-associated neurocognitive disorder in the era of effective HIV therapy, outline diagnosis and treatment recommendations, and explore the research questions that remain. Although comorbid disorders, such as hepatitis C infection or epilepsy, might cause some impairment, their prevalence is insufficient to explain the frequency with which it is encountered. HIV disease markers, such as viral load and CD4 cell counts, are not strongly associated with ongoing impairment on treatment, whereas cardiovascular disease markers and inflammatory markers are. New cerebrospinal fluid and neuroimaging biomarkers are needed to detect and follow impairment. Ongoing research efforts to optimise HIV therapy within the CNS, and potentially to intervene in downstream mechanisms of neurotoxicity, remain important avenues for future investigation. Ultimately, the full control of virus in the brain is a necessary step in the goal of HIV eradication.
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Affiliation(s)
- David B Clifford
- Department of Neurology and Medicine, Washington University in St Louis, St Louis, MO, USA.
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Vo QT, Cox C, Li X, Jacobson LP, McKaig R, Sacktor N, Selnes OA, Martin E, Becker JT, Miller EN. Neuropsychological test performance before and after HIV-1 seroconversion: the Multicenter AIDS Cohort Study. J Neurovirol 2013; 19:24-31. [PMID: 23229349 PMCID: PMC3568242 DOI: 10.1007/s13365-012-0136-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/14/2012] [Accepted: 10/29/2012] [Indexed: 12/12/2022]
Abstract
The objective of this study is to compare neuropsychological test performance before and after HIV-1 seroconversion in order to identify possible acute changes in psychomotor speed, memory, attention, and concentration secondary to seroconversion. The study utilized mixed effects models to examine longitudinal neuropsychological test data. We conducted a nested cohort study of 362 male HIV-1 seroconverters enrolled in the Multicenter AIDS Cohort Study. We used linear mixed models with random subject effects to compare repeated neuropsychological test outcomes from 5 years before seroconversion to 2 years after seroconversion on the Trail Making Test (parts A and B), Symbol-Digit Test, Grooved Pegboard (dominant and non-dominant hands), Stroop Color-Interference Test, Rey Auditory Verbal Learning Test, and the CalCAP Reaction Time Test. We found no significant changes in the time-dependent score after seroconversion for the majority of neuropsychological tests used in the Multicenter AIDS Cohort Study. There was a significant change in time trend after seroconversion on part B of the Trail Making Test (p=0.042), but the difference only represented a 2 % decrease in performance. We found the following characteristics to be associated with worse neuropsychological test performance: lower education levels, history of depression, older age, and no previous neurocognitive testing (p< .05). Our results suggest that despite a 50 % decrease in CD4 cell count immediately following infection, HIV-1 does not appear to have a measurable effect on psychomotor or complex cognitive processing for up to 2 years following infection, using this set of neurocognitive measures.
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Affiliation(s)
- Quynh T Vo
- Division of AIDS, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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McArthur J, Smith B. Neurologic Complications and Considerations in HIV-Infected Persons. Curr Infect Dis Rep 2013; 15:61-6. [PMID: 23307491 DOI: 10.1007/s11908-012-0312-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neurologic complications for HIV-infected persons retain significant prevalence despite an increasingly global use of antiretroviral therapies. Such complications are often ascribed to advanced immunosuppression; however, the most common neurologic problems for HIV-infected persons, distal sensory polyneuropathy and HIV-associated neurocognitive disorders, affect a significant proportion of patients who have successfully achieved immunologic restoration with normal or near-normal CD4 count levels and undetectable HIV RNA in the periphery. Understanding specific considerations for HIV-associated complications, including the epidemiology, risk factors, medication-adverse effects, and benefits of appropriate management, is vital for all providers caring for those with HIV. This review will describe such considerations, as well as providing a more detailed review of the most common neurologic complications of HIV infection, and will highlight some of the challenges involved with diagnosis, management, and long-term effects.
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Affiliation(s)
- Justin McArthur
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 6113, Baltimore, MD, 21287, USA,
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Watkins CC, Treisman GJ. Neuropsychiatric complications of aging with HIV. J Neurovirol 2012; 18:277-90. [PMID: 22644745 DOI: 10.1007/s13365-012-0108-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/23/2012] [Accepted: 04/26/2012] [Indexed: 01/28/2023]
Abstract
Persons over age 50 are not only aging with human immunodeficiency virus (HIV) infection but also represent a high proportion of new HIV infections. Neuropsychiatric symptoms, including depression, cognitive impairment, and substance abuse, are very common in individuals infected with HIV. However, there is little understanding of the relationship between these HIV-related comorbid conditions in newly infected elderly patients compared to uninfected elderly and those who have survived after 20 years of HIV/AIDS. We summarize the current theories and research that link aging and HIV with psychiatric illnesses and identify emerging areas for improved research, treatment, and patient care.
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Affiliation(s)
- Crystal C Watkins
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Towgood KJ, Pitkanen M, Kulasegaram R, Fradera A, Kumar A, Soni S, Sibtain NA, Reed L, Bradbeer C, Barker GJ, Kopelman MD. Mapping the brain in younger and older asymptomatic HIV-1 men: Frontal volume changes in the absence of other cortical or diffusion tensor abnormalities. Cortex 2012; 48:230-41. [DOI: 10.1016/j.cortex.2011.03.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/08/2011] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
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Abstract
Combination antiretroviral therapy has significantly reduced morbidity and mortality with HIV infection. However, HIV-associated neurocognitive disorders persist at a relatively high prevalence rate despite successful systemic treatment. This paper reviews the current issues related to the neurocognitive impact of antiretroviral treatment.
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Holguin A, Banda M, Willen EJ, Malama C, Chiyenu KO, Mudenda VC, Wood C. HIV-1 effects on neuropsychological performance in a resource-limited country, Zambia. AIDS Behav 2011; 15:1895-901. [PMID: 21744118 PMCID: PMC3314062 DOI: 10.1007/s10461-011-9988-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Zambia has substantially been affected by the HIV/AIDS epidemic with prevalence rates at 14% in a population estimated at 12 million. Yet, the extent of HIV-associated neurocognitive disorders (HAND) in this population remains to be clearly understood. A series of culturally appropriate neuropsychological (NP) assessments [International HIV Dementia Scale (IHDS), Color Trails Test 1 and 2, Grooved pegboard Test, and Time Gait Test] were used to test the effects of HIV on NP performance of HIV seropositive and seronegative individuals. Twenty-two percent HIV positive individuals ARV naïve met the criteria for IHDS-defined NP impairment. Gender significantly influenced the performance on NP tests with females performing more poorly compared to males. Larger studies that will accommodate gender differences and age are necessary to generate appropriate norms in Zambia in order to better assess the prevalence of HAND in the developing country setting.
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Affiliation(s)
- Adelina Holguin
- Nebraska Center for Virology, School of Biological Sciences, University of Nebraska, Lincoln, 68583-0900, USA.
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Crystal HA, Weedon J, Holman S, Manly J, Valcour V, Cohen M, Anastos K, Liu C, Mack WJ, Golub E, Lazar J, Ho A, Kreek MJ, Kaplan RC. Associations of cardiovascular variables and HAART with cognition in middle-aged HIV-infected and uninfected women. J Neurovirol 2011; 17:469-76. [PMID: 22006469 PMCID: PMC3509940 DOI: 10.1007/s13365-011-0052-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/18/2011] [Accepted: 08/03/2011] [Indexed: 11/26/2022]
Abstract
Despite the use of highly active anti-retroviral treatment (HAART), cognitive impairment remains prevalent in HIV. Indeed a recent study suggested that in certain instances, stopping HAART was associated with improved cognitive function (Robertson et al. Neurology 74(16):1260-1266 2010). HAART is occasionally associated with cardiovascular pathology and such pathology may be associated with cognitive impairment. To explore these associations, we assessed the relative contributions of cardiovascular variables such as hypertension and atherosclerosis, of HIV and HAART to cognition. The participants were members of the Women's Interagency HIV Study. In the analysis of cross-sectional data using general linear models, we assessed the relationship between each cardiovascular variable and Stroop interference time and symbol digit modalities test while adjusting for age, HIV, education, depression, and race/ethnicity. We also analyzed the association of summary measures of HAART use with cognition. In multivariate models, significance was limited to carotid lesions and carotid intima-medial thickness quintile (CIMT) with Stroop interference time (for carotid lesions, coefficient = 10.5, CI 3.5 to 17.5, p = 0.003, N = 1,130; for CIMT quintile, coefficient = 8.6, CI = 1.7 to 15.4, p = 0.025, N = 1,130). The summary measures of protease inhibitor use and other HAART measures were in most cases not associated with cognitive score in multivariate models. We conclude that in the HAART era among middle-aged women with HIV, carotid disease may be significantly associated with some measures of cognitive impairment. In this cross-sectional study, we could detect neither positive nor negative effects of HAART on cognition.
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Affiliation(s)
- Howard A Crystal
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
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Becker JT, Maruca V, Kingsley LA, Sanders JM, Alger JR, Barker PB, Goodkin K, Martin E, Miller EN, Ragin A, Sacktor N, Selnes O. Factors affecting brain structure in men with HIV disease in the post-HAART era. Neuroradiology 2011; 54:113-21. [PMID: 21424708 DOI: 10.1007/s00234-011-0854-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The purpose of this study was to characterize brain volumetric differences in HIV seropositive and seronegative men and to determine effects of age, cardiovascular risk, and HIV infection on structural integrity. METHODS Magnetic resonance imaging was used to acquire high-resolution neuroanatomic data in 160 men aged 50 years and over, including 84 HIV seropositive and 76 seronegative controls. Voxel-based morphometry was used to derive volumetric measurements at the level of the individual voxel. Data from a detailed neuropsychological test battery were recombined into four summary scores representing psychomotor speed, visual memory, verbal memory, and verbal fluency. RESULTS Both age and HIV status had a significant effect on both gray matter (GM) and white matter (WM) volume. The age-related GM atrophy was primarily in the superior temporal and inferior frontal regions; the HIV-related GM loss included the posterior and inferior temporal lobes, the parietal lobes, and the cerebellum. Among all subjects, the performance on neuropsychological tests, as indexed by a summary variable, was related to the volume of both the GM and WM. Contrary to our predictions, the CVD variables were not linked to brain volume in statistically adjusted models. CONCLUSION In the post-HAART era, having HIV infection is still linked to atrophy in both GM and WM. Secondly, advancing age, even in this relatively young cohort, is also linked to changes in GM and WM volume. Thirdly, CNS structural integrity is associated with overall cognitive functions, regardless of the HIV infection status of the study volunteers.
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Affiliation(s)
- James T Becker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Prevalence of non-confounded HIV-associated neurocognitive impairment in the context of plasma HIV RNA suppression. J Neurovirol 2011; 17:176-83. [PMID: 21416169 DOI: 10.1007/s13365-011-0021-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/16/2011] [Accepted: 02/18/2011] [Indexed: 01/19/2023]
Abstract
HIV-associated neurocognitive disorder is known to occur in the context of successful combination antiretroviral therapy (cART; plasma HIV RNA <50 copies/ml). Here, we newly provide an analysis of its prevalence and nature in the absence of medical or psychiatric confounds that may otherwise inflate the prevalence rate. We enrolled a cohort of 116 advanced HIV + individuals on cART (51% virally suppressed (VS)). They were screened for active Hepatitis C, current substance use disorder and were assessed with standard neuropsychological (NP) testing. Our results showed that out of the entire sample, NP impairment occurred in 18.1% (21/116) in VS individuals which was not statistically different from the 24.1% (28/116) that were found to be NP-impaired and not VS. In comparison with NP-normal-VS persons, NP impairment in VS individuals was associated with shorter duration of current cART and lower pre-morbid ability. Higher cART CNS penetration effectiveness tended to be associated with lesser cognitive severity in NP-impaired VS individuals. Current CD4 cell count, depression symptoms and past CNS HIV-related diseases did not specifically account for persistent NP impairment in VS individuals. In conclusion, despite suppression of systemic viral load, non-confounded HIV-related NP-impairment prevalence reached 18.1%. Of the potential explanations for this persistent deficit, a "burnt-out" form of the disease and immune reconstitution inflammatory syndrome were the less likely explanations, while a shorter current cART duration and lower pre-morbid intellectual capacity were significant. Nonetheless, predictive modelling with these last two factors misclassified 27% and had low sensitivity (43%) emphasising that other yet-to-be-defined factors were operative.
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Cysique LA, Franklin D, Abramson I, Ellis RJ, Letendre S, Collier A, Clifford D, Gelman B, McArthur J, Morgello S, Simpson D, McCutchan JA, Grant I, Heaton RK. Normative data and validation of a regression based summary score for assessing meaningful neuropsychological change. J Clin Exp Neuropsychol 2011; 33:505-22. [PMID: 21391011 DOI: 10.1080/13803395.2010.535504] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reliable detection and quantification of longitudinal cognitive change are of considerable importance in many neurological disorders, particularly to monitor central nervous system effects of disease progression and treatment. In the current study, we developed normative data for repeated neuropsychological (NP) assessments (6 testings) using a modified standard regression-based (SRB) approach in a sample that includes both HIV-uninfected (HIV-, N = 172) and neuromedically stable HIV-infected (HIV+, N = 124) individuals. Prior analyses indicated no differences in NP change between the infected and uninfected participants. The norms for change included correction for factors found to significantly affect follow-up performance, using hierarchical regression. The most robust and consistent predictors of follow-up performance were the prior performance on the same test (which contributed in all models) and a measure of prior overall NP competence (predictor in 97% of all models). Demographic variables were predictors in 10-46% of all models and in small amounts; while test-retest interval contributed in only 6% of all models. Based on the regression equations, standardized change scores (z scores) were computed for each test measure at each interval; these z scores were then averaged to create a total battery change score. An independent sample of HIV- participants who had completed 8 of the 15 tests was used to validate an abridged summary change score. The normative data are available in an electronic format by e-mail request to the first author. Correction for practice effects based on normative data improved the consistency of NP impairment classification in a clinically stable longitudinal cohort after baseline.
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Affiliation(s)
- Lucette A Cysique
- Department of Psychiatry, HIV Neurobehavioral Research Center, University of California at San Diego, San Diego, CA, USA
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Sacktor N, Skolasky RL, Cox C, Selnes O, Becker JT, Cohen B, Martin E, Miller EN. Longitudinal psychomotor speed performance in human immunodeficiency virus-seropositive individuals: impact of age and serostatus. J Neurovirol 2011; 16:335-41. [PMID: 20726699 DOI: 10.3109/13550284.2010.504249] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Older human immunodeficiency virus-seropositive (HIV+) individuals (greater than age 50 years) are twice as likely to develop HIV dementia compared to younger HIV+ individuals. The objective of this study was to examine the impact of both age and serostatus on longitudinal changes in psychomotor speed/executive functioning performance among HIV+ and HIV− individuals. Four hundred and seventy-seven HIV+ and 799 HIV− individuals from the Multicenter AIDS Cohort Study (MACS) were subdivided into three age groups: (1) <40 years, (2) 40-50 years, and (3) >50 years. Psychomotor speed/executive functioning test performance was measured by the Symbol Digit Modalities Test (SDMT) and the Trail Making (TM) Test Parts A and B. Changes in performance were compared among the three age groups for both HIV+ and HIV− individuals. Among HIV+ individuals, on the TM Test Part B the younger group demonstrated improvement in performance over time (P = .007). The older and middle age groups demonstrated decline in performance over time (P = .041 and .030). The older group had a significantly different trajectory relative to the younger group (P = .046). Among the HIV− individuals, there was no effect of age on longitudinal performance. In conclusion, older HIV+ individuals show greater decline over time than younger HIV+ individuals on the TM Test Part B. Our results suggest that both HIV serostatus and age together may impact longitudinal performance on this test. Mild neurocognitive changes over time among older HIV+ individuals are likely to reflect age associated pathophysiological mechanisms including cerebrovascular risk factors.
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Affiliation(s)
- Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Simioni S, Cavassini M, Annoni JM, Hirschel B, Du Pasquier RA. HIV-associated neurocognitive disorders: a changing pattern. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.10.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Combination antiretroviral therapy has dramatically decreased the incidence of HIV-related mortality and serious opportunistic diseases, among which is HIV-associated dementia. However, minor forms of cognitive dysfunction have not disappeared and may even have increased in frequency. Aging of HIV+ patients, insufficient penetration of antiretroviral drugs into the brain with continuous low-grade viral production and inflammation may play a role. A putative neurotoxicity of combination antiretroviral therapy is controversial. In this article, we will discuss these aspects, as well as clinical and pathophysiological features shared by HIV-associated neurocognitive disorders and other neurodegenerative diseases, especially Alzheimer’s disease. This article will briefly summarize the current clinical trials on neuroprotective agents, and the management of patients with neurocognitive disorders will be discussed.
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Affiliation(s)
- Samanta Simioni
- Division of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jean-Marie Annoni
- Division of Neurology, Geneva University Hospital, Rue Gabrielle–Perret–Gentil 4, 1211 Geneva 14, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospital, Rue Gabrielle–Perret–Gentil 4, 1211 Geneva 14, Switzerland
| | - Renaud A Du Pasquier
- Department of Immunology, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011 Lausanne, Switzerland
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Tan IL, McArthur JC. HIV-associated central nervous system diseases in the era of combination antiretroviral therapy. Eur J Neurol 2010; 18:371-2. [PMID: 21159069 DOI: 10.1111/j.1468-1331.2010.03287.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Malaspina L, Woods SP, Moore DJ, Depp C, Letendre SL, Jeste D, Grant I. Successful cognitive aging in persons living with HIV infection. J Neurovirol 2010; 17:110-9. [PMID: 21165783 PMCID: PMC3032198 DOI: 10.1007/s13365-010-0008-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 10/27/2010] [Accepted: 11/08/2010] [Indexed: 11/01/2022]
Abstract
The number of older adults living with human immunodeficiency virus (HIV) infection is growing and this subpopulation of the epidemic is at heightened risk for a variety of poor health outcomes including HIV-associated neurocognitive disorders. The current study sought to examine the factors associated with freedom from neurocognitive impairment in older HIV-infected adults. Participants included 74 middle-aged and older (mean age 51 years), HIV-infected individuals with a mean estimated duration of infection of 17 years who underwent comprehensive neuropsychological, psychiatric, and medical evaluations. Successful cognitive aging (SCA) was operationally defined as the absence of neurocognitive deficits as determined by a battery of well-validated cognitive tests and self-endorsed cognitive complaints. Thirty-two percent of the cohort met these criteria. Compared to the group that did not meet these criteria, successful cognitive agers had significantly lower lifetime rates of major depressive disorder and current affective distress (e.g., depression, anxiety). Moreover, the SCA group evidenced better everyday functioning outcomes, including medication adherence, lower self-reported rates of declines in activities of daily living, and superior abilities related to medication management and dealing with healthcare providers. SCA was not related to demographic composition, HIV disease or treatment factors, medical comorbidities, or histories of substance use disorders. Findings from this preliminary study suggest that approximately one-third of older persons with HIV were free of cognitive impairments, which is associated with more favorable emotional, psychosocial, and everyday functioning.
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Cysique LA, Murray JM, Dunbar M, Jeyakumar V, Brew BJ. A screening algorithm for HIV-associated neurocognitive disorders. HIV Med 2010; 11:642-9. [DOI: 10.1111/j.1468-1293.2010.00834.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Incidence and nature of cognitive decline over 1 year among HIV-infected former plasma donors in China. AIDS 2010; 24:983-90. [PMID: 20299964 DOI: 10.1097/qad.0b013e32833336c8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To quantify and characterize the nature of cognitive change over 1 year in a cohort of HIV-positive former plasma donors in rural China. DESIGN The present study is an observational cohort study. METHODS One hundred and ninety-two HIV-positive and 101 demographically comparable HIV-negative individuals, all former plasma donors, who lived in a rural part of China, received comprehensive medical and neuropsychological examinations. At study entry, 56% of HIV-positive group was on combination antiretroviral treatment and 60.9% at follow-up. Multiple regression change score approach was used with the HIV-negative sample to develop norms for change that would be then applied to the HIV-positive participants. Follow-up test scores adjusted for the control group practice effect. RESULTS Fifty-three HIV-positive individuals (27%) developed significant cognitive decline as compared with five (5%) HIV-negative individuals. Cognitive decline was predicted at baseline by AIDS status, lower nadir CD4, and worse processing speed; at follow-up, it was associated with lower current CD4 cell count and failure of viral suppression on combination antiretroviral treatment. Neuropsychological decline also was associated with decreased independence in activities of daily living. Using neuropsychological impairment scores that were corrected for 'practice' on repeated testing, we found that among the decliners, 41.5% (N = 22) had incident impairment, whereas 38% (N = 20) declined within the impaired range and another 20.7% (N = 11) declined within the normal range. CONCLUSION The present study demonstrates that despite ongoing combination antiretroviral treatment, cognitive decline in HIV-positive people is common over a 1-year follow-up. Regression-based norms for change on western neuropsychological tests can be used to detect disease-related cognitive decline in a developing country.
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