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Nakamichi K, Miura Y, Shimokawa T, Takahashi K, Suzuki T, Funata N, Harada M, Mori K, Sanjo N, Yukitake M, Takahashi K, Hamaguchi T, Izaki S, Oji S, Nakahara J, Ae R, Kosami K, Nukuzuma S, Nakamura Y, Nomura K, Kishida S, Mizusawa H, Yamada M, Takao M, Ebihara H, Saijo M. Nationwide Laboratory Surveillance of Progressive Multifocal Leukoencephalopathy in Japan: Fiscal Years 2011-2020. Viruses 2023; 15:v15040968. [PMID: 37112948 PMCID: PMC10144269 DOI: 10.3390/v15040968] [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: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a devastating demyelinating disease caused by JC virus (JCV), predominantly affecting patients with impaired cellular immunity. PML is a non-reportable disease with a few exceptions, making national surveillance difficult. In Japan, polymerase chain reaction (PCR) testing for JCV in the cerebrospinal fluid (CSF) is performed at the National Institute of Infectious Diseases to support PML diagnosis. To clarify the overall profile of PML in Japan, patient data provided at the time of CSF-JCV testing over 10 years (FY2011-2020) were analyzed. PCR testing for 1537 new suspected PML cases was conducted, and 288 (18.7%) patients tested positive for CSF-JCV. An analysis of the clinical information on all individuals tested revealed characteristics of PML cases, including the geographic distribution, age and sex patterns, and CSF-JCV-positivity rates among the study subjects for each type of underlying condition. During the last five years of the study period, a surveillance system utilizing ultrasensitive PCR testing and widespread clinical attention to PML led to the detection of CSF-JCV in the earlier stages of the disease. The results of this study will provide valuable information not only for PML diagnosis, but also for the treatment of PML-predisposing conditions.
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Affiliation(s)
- Kazuo Nakamichi
- Department of Virology 1, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Yoshiharu Miura
- Department of Neurology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Toshio Shimokawa
- Department of Medical Data Science, Graduate School of Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Kenta Takahashi
- Department of Pathology, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Nobuaki Funata
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University School of Medicine, Tokushima 770-8503, Japan
| | - Koichiro Mori
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Motohiro Yukitake
- Department of Neurology, Kouhoukai Takagi Hospital, Okawa-shi 831-0016, Fukuoka, Japan
| | - Kazuya Takahashi
- Department of Neurology, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa-shi 920-0192, Ishikawa, Japan
| | - Tsuyoshi Hamaguchi
- Department of Neurology, Kanazawa Medical University, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Shoko Izaki
- Department of Neurology, National Hospital Organization Saitama Hospital, Wako-shi 351-0102, Saitama, Japan
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe-shi 350-8550, Saitama, Japan
| | - Satoru Oji
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe-shi 350-8550, Saitama, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke-shi 329-0498, Tochigi, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke-shi 329-0498, Tochigi, Japan
| | - Souichi Nukuzuma
- Department of Infectious Diseases, Kobe Institute of Health, Kobe-shi 650-0046, Hyogo, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke-shi 329-0498, Tochigi, Japan
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe-shi 350-8550, Saitama, Japan
- Higashimatsuyama Municipal Hospital, Higashimatsuyama-shi 355-0005, Saitama, Japan
| | - Shuji Kishida
- Department of Neurology, Narita Tomisato Tokushukai Hospital, Tomisato-shi 286-0201, Chiba, Japan
| | - Hidehiro Mizusawa
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo 187-8551, Japan
| | - Masahito Yamada
- Division of Neurology, Department of Internal Medicine, Kudanzaka Hospital, Chiyoda-ku, Tokyo 102-0074, Japan
| | - Masaki Takao
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo 187-8551, Japan
- Department of General Internal Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo 187-8551, Japan
| | - Hideki Ebihara
- Department of Virology 1, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Masayuki Saijo
- Department of Virology 1, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo 162-8640, Japan
- Medical Affairs Department, Health and Welfare Bureau, Sapporo-shi 060-0042, Hokkaido, Japan
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Odlum M, Yoon S. Understanding Comorbidities and Their Contribution to Predictors of Medical Resource Utilization for an Age- and Sex-Matched Patient Population Living With HIV: Cross-Sectional Study. JMIR Aging 2019; 2:e13865. [PMID: 31516123 PMCID: PMC6746060 DOI: 10.2196/13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/19/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than 60% of people aging with HIV are observed to have multiple comorbidities, which are attributed to a variety of factors (eg, biological and environmental), with sex differences observed. However, understanding these differences and their contribution to medical resource utilization remains challenging as studies conducted exclusively and predominantly among males do not translate well to females, resulting in inconsistent findings across study cohorts and limiting our knowledge of sex-specific comorbidities. OBJECTIVE The objective of the study was to provide further insight into aging-related comorbidities, their associated sex-based differences, and their contribution to medical resource utilization, through the analysis of HIV patient data matched by sex. METHODS International Classification of Disease 9/10 diagnostic codes that comprise the electronic health records of males (N=229) and females (N=229) were categorized by individual characteristics, chronic and mental health conditions, treatment, high-risk behaviors, and infections and the codes were used as predictors of medical resource utilization represented by Charlson comorbidity scores. RESULTS Significant contributors to high Charlson scores in males were age (beta=2.37; 95% CI 1.45-3.29), longer hospital stay (beta=.046; 95% CI 0.009-0.083), malnutrition (beta=2.96; 95% CI 1.72-4.20), kidney failure (beta=2.23; 95% CI 0.934-3.52), chemotherapy (beta=3.58; 95% CI 2.16-5.002), history of tobacco use (beta=1.40; 95% CI 0.200-2.61), and hepatitis C (beta=1.49; 95% CI 0.181-2.79). Significant contributors to high Charlson scores in females were age (beta=1.37; 95% CI 0.361-2.38), longer hospital stay (beta=.042; 95% CI 0.005-0.078), heart failure (beta=2.41; 95% CI 0.833-3.98), chemotherapy (beta=3.48; 95% CI 1.626-5.33), and substance abuse beta=1.94; 95% CI 0.180, 3.702). CONCLUSIONS Our findings identified sex-based differences in medical resource utilization. These include kidney failure for men and heart failure for women. Increased prevalence of comorbidities in people living long with HIV has the potential to overburden global health systems. The development of narrower HIV phenotypes and aging-related comorbidity phenotypes with greater clinical validity will support intervention efficacy.
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Affiliation(s)
- Michelle Odlum
- Columbia University School of Nursing, New York, NY, United States
| | - Sunmoo Yoon
- Columbia University Irving Medical Center, New York, NY, United States
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Ngah H, Hairon SM, Yaacob NM, Yusoff H. Survival Time and Prognostic Factors of Mortality among Patients with Acquired Immunodeficiency Syndrome in North-East Peninsular Malaysia. Malays J Med Sci 2019; 26:70-78. [PMID: 31496895 PMCID: PMC6719878 DOI: 10.21315/mjms2019.26.4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 07/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Death resulting from the acquired immunodeficiency syndrome (AIDS) is a worldwide concern. This study is aimed at determining the overall median survival time, and the prognostic factors of mortality among AIDS-infected patients in North-East Peninsular Malaysia. METHODS In 2018, a retrospective cohort study stretching from January to April was conducted. This study involved a review of data obtained from the National AIDS Registry. A total of 1,073 AIDS cases diagnosed from 1 January 2010 to 31 December 2014 were selected, and follow-up procedures were conducted until 31 March 2015 (a 3-month follow-up). The Kaplan-Meier plot and Cox's proportional hazard regression were used for data analyses. RESULTS 564 (52.5%) patients died due to AIDS, while the remaining 509 (47.4%) were censored. The overall median survival time was 11 months. The probability of survival in 1-year, 2-year, 3-year, 4-year and 5-year periods were 49.1%, 47.8%, 47.3%, 47.0% and 46.7%, respectively. Multiple Cox regression revealed that the significant prognostic factors were age 30-49 years [adjusted hazard ratio (Adj. HR) 1.57; 95% CI: 1.14, 2.16; P = 0.006], male (Adj. HR 1.39; 95% CI: 1.07, 1.79; P = 0.012), unemployed (Adj. HR 1.40; 95% CI: 1.12, 1.75; P = 0.003) and HIV-TB co-infection (Adj. HR 1.78; 95% CI: 1.37, 2.31; P < 0.001). CONCLUSION The overall median survival time among AIDS patients in North-East Peninsular Malaysia was revealed to be short, in comparison to the other studies. The chances for survival can be improved with more emphasis on early detection (to ensure early treatment) and social support, particularly for HIV-TB co-infected patients, as well as for younger and unemployed patients.
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Affiliation(s)
- Hamiza Ngah
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Najib Majdi Yaacob
- Unit of Biostatistics & Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Haniah Yusoff
- HIV/STI/Hep C Unit, Kelantan State Health Department, Ministry of Health Malaysia, Kelantan, Malaysia
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He Q, Ding Y, Zhou W, Li H, Zhang M, Shi Y, Su X. Clinical features of pulmonary cryptococcosis among patients with different levels of peripheral blood CD4 + T lymphocyte counts. BMC Infect Dis 2017; 17:768. [PMID: 29237413 PMCID: PMC5729485 DOI: 10.1186/s12879-017-2865-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background The clinical manifestation of pulmonary cryptococcosis varies notably between immunocompromised and immunocompetent patients. To better understand pulmonary cryptococcosis, we compared the clinical features of pulmonary cryptococcosis patients with or without decreased peripheral blood CD4+ T cell counts. Methods We retrospectively reviewed the medical records of 80 patients with cryptococcosis who had been treated in Jingling Hospital from January 2011 to January 2016. According to the normal range of peripheral blood CD4 + T-lymphocyte counts in our population, we chose CD4 = 378/μL as a cut-off value. Results The proportion of fever in the patients with decreased CD4+ T cells was higher than that of the patients with a normal amount of CD4+ T cells (86.7% vs 28.6%, P < 0.001). The incidence of clinical symptoms, such as cough (60.6% vs 64.7%, P = 0.729), chest pain (9.1% vs 26.5%, P = 0.064), and dyspnea (27.3% vs 23.5%, P = 0.725) showed no difference between patients with low CD4+ T cell counts and those with normal CD4+ T cell counts. The number of asymptomatic patients in the CD4+ T cell normal group was higher than that in the decreased CD4+ T cell group (17.1% vs 0%, P = 0.005). Nodules, masses, and halo signs were more common in the CD4+ T cell normal patients than in the low-CD4+ T cell patients (79.4% vs 54.5%, P = 0.03). The opposite trend was observed for cavitations (14.7% vs 51.5%, P = 0.001). The other CT findings, including pulmonary consolidation (P = 0.205), and pleural effusion (P = 0.641), did not differ significantly between the two groups. Conclusions CD4+ T lymphocytes have a significant impact on the clinical and radiological characteristics of pulmonary cryptococcosis. The patients with normal CD4+ T cell counts were found to have less fever and more nodule-like radiographic findings. Trial registration 2011NJKY-023-01. Registered on January 10, 2011.
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Affiliation(s)
- Qian He
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China
| | - Yuan Ding
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Wei Zhou
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Hongxing Li
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China
| | - Ming Zhang
- Department of Respiratory Medicine, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China. .,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
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Aguiar PADFD, Pedroso RDS, Borges AS, Moreira TDA, Araújo LBD, Röder DVDDB. The epidemiology of cryptococcosis and the characterization of Cryptococcus neoformans isolated in a Brazilian University Hospital. Rev Inst Med Trop Sao Paulo 2017; 59:e13. [PMID: 28423088 PMCID: PMC5398185 DOI: 10.1590/s1678-9946201759013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/13/2017] [Indexed: 12/17/2022] Open
Abstract
Cryptococcosis, a systemic disease caused by the fungus Cryptococcusneoformans/ Cryptococcusgattii is more severe in immunocompromised individuals. This study aimed to analyze the epidemiology of the disease, the molecular characteristics and the antifungal susceptibility of C. neoformans isolated from patients treated in a Brazilian university hospital. This retrospective study was conducted in the Clinical Hospital, Federal University of Uberlândia, and evaluated cases of cryptococcosis and strains of C. neoformans isolated from 2004 to 2013. We evaluated 41 patients, 85% of whom were diagnosed with AIDS. The fungus was isolated from the cerebrospinal fluid (CSF) of 21 patients (51%); 19.5% had fungemia and in 24% the agent was isolated from the CSF and blood, concurrently. Meningoencephalitis was the most frequent (75%) manifestation of infection. Despite adequate treatment, the mortality of the disease was 58.5%. Most isolates (97.5%) presented the VNI genotype (serotype A, var. grubii) and one isolate was genotyped as C. gattii (VGI); all the isolates were determined as mating type MATa and showed susceptibility to the tested antifungals (fluconazole, voriconazole, amphotericin B and 5-flucytosine). Although AIDS detection rates remain stable, opportunistic infections such as cryptococcosis remain as major causes of morbidity and mortality in these patients.
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Affiliation(s)
| | | | - Aércio Sebastião Borges
- Universidade Federal de Uberlândia, Hospital de Clínicas de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Lúcio Borges de Araújo
- Universidade Federal de Uberlândia, Faculdade de Matemática, Uberlândia, Minas Gerais, Brazil
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Mamik MK, Hui E, Branton WG, McKenzie BA, Chisholm J, Cohen EA, Power C. HIV-1 Viral Protein R Activates NLRP3 Inflammasome in Microglia: implications for HIV-1 Associated Neuroinflammation. J Neuroimmune Pharmacol 2016; 12:233-248. [PMID: 27726055 DOI: 10.1007/s11481-016-9708-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 09/09/2016] [Indexed: 02/07/2023]
Abstract
Human Immunodeficiency virus (HIV) enters the brain soon after seroconversion and induces chronic neuroinflammation by infecting and activating brain macrophages. Inflammasomes are cytosolic protein complexes that mediate caspase-1 activation and ensuing cleavage and release of IL-1β and -18 by macrophages. Our group recently showed that HIV-1 infection of human microglia induced inflammasome activation in NLRP3-dependent manner. The HIV-1 viral protein R (Vpr) is an accessory protein that is released from HIV-infected cells, although its effects on neuroinflammation are undefined. Infection of human microglia with Vpr-deficient HIV-1 resulted in reduced caspase-1 activation and IL-1β production, compared to cells infected with a Vpr-encoding HIV-1 virus. Vpr was detected at low nanomolar concentrations in cerebrospinal fluid from HIV-infected patients and in supernatants from HIV-infected primary human microglia. Exposure of human macrophages to Vpr caused caspase-1 cleavage and IL-1β release with reduced cell viability, which was dependent on NLRP3 expression. Increased NLRP3, caspase-1, and IL-1β expression was evident in HIV-1 Vpr transgenic mice compared to wild-type littermates, following systemic immune stimulation. Treatment with the caspase-1 inhibitor, VX-765, suppressed NLRP3 expression with reduced IL-1β expression and associated neuroinflammation. Neurobehavioral deficits showed improvement in Vpr transgenic animals treated with VX-765. Thus, Vpr-induced NLRP3 inflammasome activation, which contributed to neuroinflammation and was abrogated by caspase-1 inhibition. This study provides a new therapeutic perspective for HIV-associated neuropsychiatric disease.
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Affiliation(s)
- Manmeet K Mamik
- Department of Medicine, University of Alberta, T6G 2S2, Edmonton, AB, Canada
| | - Elizabeth Hui
- Department of Medicine, University of Alberta, T6G 2S2, Edmonton, AB, Canada
| | - William G Branton
- Department of Medicine, University of Alberta, T6G 2S2, Edmonton, AB, Canada
| | - Brienne A McKenzie
- Department of Medicine, University of Alberta, T6G 2S2, Edmonton, AB, Canada
| | - Jesse Chisholm
- Department of Medicine, University of Alberta, T6G 2S2, Edmonton, AB, Canada
| | - Eric A Cohen
- Institut de recherches cliniques de Montréal (IRCM) and Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Christopher Power
- Department of Medicine, University of Alberta, T6G 2S2, Edmonton, AB, Canada.
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Dahal S, Chitti SVP, Nair MPN, Saxena SK. Interactive effects of cocaine on HIV infection: implication in HIV-associated neurocognitive disorder and neuroAIDS. Front Microbiol 2015; 6:931. [PMID: 26441868 PMCID: PMC4562305 DOI: 10.3389/fmicb.2015.00931] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/24/2015] [Indexed: 11/13/2022] Open
Abstract
Substantial epidemiological studies suggest that not only, being one of the reasons for the transmission of the human immunodeficiency virus (HIV), but drug abuse also serves its role in determining the disease progression and severity among the HIV infected population. This article focuses on the drug cocaine, and its role in facilitating entry of HIV into the CNS and mechanisms of development of neurologic complications in infected individuals. Cocaine is a powerfully addictive central nervous system stimulating drug, which increases the level of neurotransmitter dopamine (DA) in the brain, by blocking the dopamine transporters (DAT) which is critical for DA homeostasis and neurocognitive function. Tat protein of HIV acts as an allosteric modulator of DAT, where as cocaine acts as reuptake inhibitor. When macrophages in the CNS are exposed to DA, their number increases. These macrophages release inflammatory mediators and neurotoxins, causing chronic neuroinflammation. Cocaine abuse during HIV infection enhances the production of platelet monocyte complexes (PMCs), which may cross transendothelial barrier, and result in HIV-associated neurocognitive disorder (HAND). HAND is characterized by neuroinflammation, including astrogliosis, multinucleated giant cells, and neuronal apoptosis that is linked to progressive virus infection and immune deterioration. Cocaine and viral proteins are capable of eliciting signaling transduction pathways in neurons, involving in mitochondrial membrane potential loss, oxidative stress, activation of JNK, p38, and ERK/MAPK pathways, and results in downstream activation of NF-κB that leads to HAND. Tat-induced inflammation provokes permeability of the blood brain barrier (BBB) in the platelet dependent manner, which can potentially be the reason for progression to HAND during HIV infection. A better understanding on the role of cocaine in HIV infection can give a clue in developing novel therapeutic strategies against HIV-1 infection in cocaine using HIV infected population.
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Affiliation(s)
- Santosh Dahal
- CSIR-Centre for Cellular and Molecular Biology , Hyderabad, India
| | - Sai V P Chitti
- CSIR-Centre for Cellular and Molecular Biology , Hyderabad, India
| | - Madhavan P N Nair
- College of Medicine, Florida International University , Miami, FL, USA
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