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Vance DE, Billings R, Lambert CC, Fazeli PL, Goodin BR, Kempf MC, Rubin LH, Turan B, Wise J, Hellemann G, Lee J. A Systematic Review and Meta-Analysis of Social Cognition Among People Living with HIV: Implications for Non-Social Cognition and Social Everyday Functioning. Neuropsychol Rev 2024:10.1007/s11065-024-09643-5. [PMID: 38869661 DOI: 10.1007/s11065-024-09643-5] [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: 02/07/2023] [Accepted: 05/05/2024] [Indexed: 06/14/2024]
Abstract
Social cognition-the complex mental ability to perceive social stimuli and negotiate the social environment-has emerged as an important cognitive ability needed for social functioning, everyday functioning, and quality of life. Deficits in social cognition have been well documented in those with severe mental illness including schizophrenia and depression, those along the autism spectrum, and those with other brain disorders where such deficits profoundly impact everyday life. Moreover, subtle deficits in social cognition have been observed in other clinical populations, especially those that may have compromised non-social cognition (i.e., fluid intelligence such as memory). Among people living with HIV (PLHIV), 44% experience cognitive impairment; likewise, social cognitive deficits in theory of mind, prosody, empathy, and emotional face recognition/perception are gradually being recognized. This systematic review and meta-analysis aim to summarize the current knowledge of social cognitive ability among PLHIV, identified by 14 studies focused on social cognition among PLHIV, and provides an objective consensus of the findings. In general, the literature suggests that PLHIV may be at-risk of developing subtle social cognitive deficits that may impact their everyday social functioning and quality of life. The causes of such social cognitive deficits remain unclear, but perhaps develop due to (1) HIV-related sequelae that are damaging the same neurological systems in which social cognition and non-social cognition are processed; (2) stress related to coping with HIV disease itself that overwhelms one's social cognitive resources; or (3) may have been present pre-morbidly, possibly contributing to an HIV infection. From this, a theoretical framework is proposed highlighting the relationships between social cognition, non-social cognition, and social everyday functioning.
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Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
| | | | - Leah H Rubin
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Rumelifeneri Caddesi, Turkey
| | - Jenni Wise
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerhard Hellemann
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Andric V, Boban J, Maric D, Kozic D, Brkic S, Bulovic A. Additive Effect of Metabolic Syndrome on Brain Atrophy in People Living with HIV-Magnetic Resonance Volumetry Study. Metabolites 2024; 14:331. [PMID: 38921466 PMCID: PMC11205900 DOI: 10.3390/metabo14060331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
With people living with HIV (PLWH) reaching the senium, the importance of aging-related comorbidities such as metabolic syndrome (MS) becomes increasingly important. This study aimed to determine the additive effect of MS on brain atrophy in PLWH. This prospective study included 43 PLWH, average age of 43.02 ± 10.93 years, and 24 healthy controls, average age of 36.87 ± 8.89 years. PLWH were divided into two subgroups: without MS and with MS, according to NCEP ATP III criteria. All patients underwent brain magnetic resonance imaging (MRI) on a 3T clinical scanner with MR volumetry, used for defining volumes of cerebrospinal fluid (CSF) spaces and white and grey matter structures, including basal ganglia. A Student's t-test was used to determine differences in brain volumes between subject subgroups. The binary classification was performed to determine the sensitivity and specificity of volumetry findings and cut-off values. Statistical significance was set at p < 0.05. PLWH presented with significantly lower volumes of gray matter, putamen, thalamus, globus pallidus, and nc. accumbens compared to healthy controls; cut-off values were: for gray matter 738.130 cm3, putamen 8.535 cm3, thalamus 11.895 cm3, globus pallidus 2.252 cm3, and nc. accumbens 0.715 cm3. The volumes of CSF and left lateral ventricles were found to be higher in PLWH with MS compared to those without MS, where, with a specificity of 0.310 and sensitivity of 0.714, it can be assumed that PLWH with a CSF volume exceeding 212.83 cm3 are likely to also have MS. This suggests that PLWH with metabolic syndrome may exhibit increased CSF volume above 212.83 cm3 as a consequence of brain atrophy. There seems to be an important connection between MS and brain volume reduction in PLWH with MS, which may add to the accurate identification of persons at risk of developing HIV-associated cognitive impairment.
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Affiliation(s)
- Vanja Andric
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
| | - Jasmina Boban
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Department for Radiology, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Daniela Maric
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
| | - Dusko Kozic
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Department for Radiology, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Snezana Brkic
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
| | - Aleksandra Bulovic
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
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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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Wiseman RL, Bigos KL, Dastgheyb RM, Barker PB, Rubin LH, Slusher BS. Brain N -acetyl-aspartyl-glutamate is associated with cognitive function in older virally suppressed people with HIV. AIDS 2024; 38:1003-1011. [PMID: 38411600 PMCID: PMC11062820 DOI: 10.1097/qad.0000000000003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Cognitive impairment persists in virally suppressed people with HIV (VS-PWH) especially in higher order domains. One cortical circuit, linked to these domains, is regulated by N -acetyl-aspartyl glutamate (NAAG), the endogenous agonist of the metabotropic glutamate receptor 3. The enzyme glutamate carboxypeptidase II (GCPII) catabolizes NAAG and is upregulated in aging and disease. Inhibition of GCPII increases brain NAAG and improves learning and memory in rodent and primate models. DESIGN As higher order cognitive impairment is present in VS-PWH, and NAAG has not been investigated in earlier magnetic resonance spectroscopy studies (MRS), we investigated if brain NAAG levels measured by MRS were associated with cognitive function. METHODS We conducted a retrospective analysis of 7-Tesla MRS data from a previously published study on cognition in older VS-PWH. The original study did not separately quantify NAAG, therefore, work for this report focused on relationships between regional NAAG levels in frontal white matter (FWM), left hippocampus, left basal ganglia and domain-specific cognitive performance in 40 VS-PWH after adjusting for confounds. Participants were older than 50 years, negative for affective and neurologic disorders, and had no prior 3-month psychoactive-substance use. RESULTS Higher NAAG levels in FWM were associated with better attention/working memory. Higher left basal ganglia NAAG related to better verbal fluency. There was a positive relationship between hippocampal NAAG and executive function which lost significance after correction for confounds. CONCLUSION These data suggest brain NAAG serves as a biomarker of cognition in VS-PWH. Pharmacological modulation of brain NAAG warrants investigation as a therapeutic approach for cognitive deficits in VS-PWH.
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Affiliation(s)
- Robyn L. Wiseman
- Department of Pharmacology and Molecular Sciences
- Johns Hopkins Drug Discovery
- Department of Medicine, Division of Clinical Pharmacology
| | - Kristin L. Bigos
- Department of Pharmacology and Molecular Sciences
- Department of Medicine, Division of Clinical Pharmacology
- Department of Psychiatry and Behavioral Sciences
| | | | - Peter B. Barker
- Russell H. Morgan Department of Radiology and Radiological Sciences
| | - Leah H. Rubin
- Department of Psychiatry and Behavioral Sciences
- Department of Neurology
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Barbara S. Slusher
- Department of Pharmacology and Molecular Sciences
- Johns Hopkins Drug Discovery
- Department of Medicine, Division of Clinical Pharmacology
- Department of Psychiatry and Behavioral Sciences
- Department of Neurology
- Department of Oncology
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ayoub SM, Holloway BM, Miranda AH, Roberts BZ, Young JW, Minassian A, Ellis RJ. The Impact of Cannabis Use on Cognition in People with HIV: Evidence of Function-Dependent Effects and Mechanisms from Clinical and Preclinical Studies. Curr HIV/AIDS Rep 2024; 21:87-115. [PMID: 38602558 PMCID: PMC11129923 DOI: 10.1007/s11904-024-00698-w] [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] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE OF REVIEW Cannabis may have beneficial anti-inflammatory effects in people with HIV (PWH); however, given this population's high burden of persisting neurocognitive impairment (NCI), clinicians are concerned they may be particularly vulnerable to the deleterious effects of cannabis on cognition. Here, we present a systematic scoping review of clinical and preclinical studies evaluating the effects of cannabinoid exposure on cognition in HIV. RECENT FINDINGS Results revealed little evidence to support a harmful impact of cannabis use on cognition in HIV, with few eligible preclinical data existing. Furthermore, the beneficial/harmful effects of cannabis use observed on cognition were function-dependent and confounded by several factors (e.g., age, frequency of use). Results are discussed alongside potential mechanisms of cannabis effects on cognition in HIV (e.g., anti-inflammatory), and considerations are outlined for screening PWH that may benefit from cannabis interventions. We further highlight the value of accelerating research discoveries in this area by utilizing translatable cross-species tasks to facilitate comparisons across human and animal work.
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Affiliation(s)
- Samantha M Ayoub
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA.
| | - Breanna M Holloway
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
| | - Alannah H Miranda
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
| | - Benjamin Z Roberts
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
- VA Center of Excellence for Stress and Mental Health, Veterans Administration San Diego HealthCare System, 3350 La Jolla Village Drive, San Diego, CA, USA
| | - Ronald J Ellis
- Department of Neuroscience, University of California San Diego, La Jolla, CA, USA
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Akay-Espinoza C, Newton SEB, Dombroski BA, Kallianpur A, Bharti A, Franklin DR, Schellenberg GD, Heaton RK, Grant I, Ellis RJ, Letendre SL, Jordan-Sciutto KL. Genetic Variations in EIF2AK3 are Associated with Neurocognitive Impairment in People Living with HIV. J Neuroimmune Pharmacol 2024; 19:25. [PMID: 38789639 PMCID: PMC11126443 DOI: 10.1007/s11481-024-10125-x] [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: 11/21/2023] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Based on emerging evidence on the role for specific single-nucleotide variants (SNVs) in EIF2AK3 encoding the integrated stress response kinase PERK, in neurodegeneration, we assessed the association of EIF2AK3 SNVs with neurocognitive performance in people with HIV (PWH) using a candidate gene approach. This retrospective study included the CHARTER cohort participants, excluding those with severe neuropsychiatric comorbidities. Genome-wide data previously obtained for 1047 participants and targeted sequencing of 992 participants with available genomic DNA were utilized to interrogate the association of three noncoding and three coding EIF2AK3 SNVs with the continuous global deficit score (GDS) and global neurocognitive impairment (NCI; GDS ≥ 0.5) using univariable and multivariable methods, with demographic, disease-associated, and treatment characteristics as covariates. The cohort characteristics were as follows: median age, 43.1 years; females, 22.8%; European ancestry, 41%; median CD4 + T cell counts, 175/µL (nadir) and 428/µL (current). At first assessment, 70.5% used ART and 68.3% of these had plasma HIV RNA levels ≤ 200 copies/mL. All three noncoding EIF2AK3 SNVs were associated with GDS and NCI (all p < 0.05). Additionally, 30.9%, 30.9%, and 41.2% of participants had at least one risk allele for the coding SNVs rs1805165 (G), rs867529 (G), and rs13045 (A), respectively. Homozygosity for all three coding SNVs was associated with significantly worse GDS (p < 0.001) and more NCI (p < 0.001). By multivariable analysis, the rs13045 A risk allele, current ART use, and Beck Depression Inventory-II value > 13 were independently associated with GDS and NCI (p < 0.001) whereas the other two coding SNVs did not significantly correlate with GDS or NCI after including rs13045 in the model. The coding EIF2AK3 SNVs were associated with worse performance in executive functioning, motor functioning, learning, and verbal fluency. Coding and non-coding SNVs of EIF2AK3 were associated with global NC and domain-specific performance. The effects were small-to-medium in size but present in multivariable analyses, raising the possibility of specific SNVs in EIF2AK3 as an important component of genetic vulnerability to neurocognitive complications in PWH.
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Affiliation(s)
- Cagla Akay-Espinoza
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 S. 40th St, Rm 312 Levy, Philadelphia, PA, 19104, USA
| | - Sarah E B Newton
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 S. 40th St, Rm 312 Levy, Philadelphia, PA, 19104, USA
| | - Beth A Dombroski
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Asha Kallianpur
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ajay Bharti
- Departments of Medicine, University of California, San Diego, CA, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Gerard D Schellenberg
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Kelly L Jordan-Sciutto
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 S. 40th St, Rm 312 Levy, Philadelphia, PA, 19104, USA.
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Fotheringham L, Lawson RA, Urasa S, Boshe J, Mukaetova-Ladinska EB, Rogathi J, Howlett W, Dekker MCJ, Gray WK, Evans J, Walker RW, Makupa PC, Paddick SM. Neuropsychological tests associated with symptomatic HIV-associated neurocognitive disorder (HAND) in a cohort of older adults in Tanzania. J Int Neuropsychol Soc 2024:1-11. [PMID: 38766814 DOI: 10.1017/s1355617724000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting. METHOD This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history. RESULTS Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70-0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background. CONCLUSIONS A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.
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Affiliation(s)
- Lachlan Fotheringham
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, UK
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | | | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Marieke C J Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Philip C Makupa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Mawenzi Regional Referral Hospital, Kilimanjaro, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Gateshead, UK
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8
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Kelebie MA, Tinsae T, Alemayehu BF, Walelign GK, Takelle GM. Prevalence and associated factors of neurocognitive disorder among people living with HIV/AIDS in the South Gondar zone primary hospitals, North-West Ethiopia: an institution-based cross-sectional study. BMJ Open 2024; 14:e082773. [PMID: 38697760 PMCID: PMC11086442 DOI: 10.1136/bmjopen-2023-082773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To assess the prevalence and associated factors of neurocognitive disorder among people living with HIV/AIDS in South Gondar primary hospitals, North-West Ethiopia, 2023. DESIGN Institution-based cross-sectional study design. SETTING South Gondar primary hospitals, North-West Ethiopia. PARTICIPANTS 608 participants were recruited using the systematic random sampling technique. MEASUREMENT Data were collected using an interviewer-administered questionnaire and medical chart reviews. The International HIV Dementia Scale was used to screen for neurocognitive disorder. The data were entered through EPI-DATA V.4.6 and exported to SPSS V.21 statistical software for analysis. In the bivariable logistic regression analyses, variables with a value of p<0.25 were entered into a multivariable logistic regression analysis to identify factors independently associated with neurocognitive disorder. Statistical significance was declared at a value of p<0.05. RESULTS The prevalence of neurocognitive disorder among HIV-positive participants was 39.1%. In multivariable logistic regression, lower level of education (adjusted OR (AOR)=2.94; 95% CI 1.29 to 6.82), unemployment (AOR=2.74; 95% CI 1.29 to 6.84) and comorbid medical illness (AOR=1.80; 95% CI 1.03 to 3.14) were significantly associated with neurocognitive disorder. CONCLUSION HIV-associated neurocognitive problems affected over a third of the participants. According to the current study, comorbid medical conditions, unemployment and low educational attainment are associated with an increased risk of neurocognitive disorder. Therefore, early detection and treatment are essential.
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Affiliation(s)
- Mulualem Admasu Kelebie
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Biruk Fanta Alemayehu
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Getasew Kibralew Walelign
- Department of Psychiatry, School of Medicine and Health Science, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, School of Medicine and Health Sciences, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara, Ethiopia
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9
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Kong W, Frouard J, Xie G, Corley MJ, Helmy E, Zhang G, Schwarzer R, Montano M, Sohn P, Roan NR, Ndhlovu LC, Gan L, Greene WC. Neuroinflammation generated by HIV-infected microglia promotes dysfunction and death of neurons in human brain organoids. PNAS NEXUS 2024; 3:pgae179. [PMID: 38737767 PMCID: PMC11086946 DOI: 10.1093/pnasnexus/pgae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Abstract
Despite the success of combination antiretroviral therapy (ART) for individuals living with HIV, mild forms of HIV-associated neurocognitive disorder (HAND) continue to occur. Brain microglia form the principal target for HIV infection in the brain. It remains unknown how infection of these cells leads to neuroinflammation, neuronal dysfunction, and/or death observed in HAND. Utilizing two different inducible pluripotent stem cell-derived brain organoid models (cerebral and choroid plexus [ChP] organoids) containing microglia, we investigated the pathogenic changes associated with HIV infection. Infection of microglia was associated with a sharp increase in CCL2 and CXCL10 chemokine gene expression and the activation of many type I interferon stimulated genes (MX1, ISG15, ISG20, IFI27, IFITM3 and others). Production of the proinflammatory chemokines persisted at low levels after treatment of the cell cultures with ART, consistent with the persistence of mild HAND following clinical introduction of ART. Expression of multiple members of the S100 family of inflammatory genes sharply increased following HIV infection of microglia measured by single-cell RNA-seq. However, S100 gene expression was not limited to microglia but was also detected more broadly in uninfected stromal cells, mature and immature ChP cells, neural progenitor cells and importantly in bystander neurons suggesting propagation of the inflammatory response to bystander cells. Neurotransmitter transporter expression declined in uninfected neurons, accompanied by increased expression of genes promoting cellular senescence and cell death. Together, these studies underscore how an inflammatory response generated in HIV-infected microglia is propagated to multiple uninfected bystander cells ultimately resulting in the dysfunction and death of bystander neurons.
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Affiliation(s)
- Weili Kong
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
| | - Julie Frouard
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Guorui Xie
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Michael J Corley
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ekram Helmy
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
| | - Gang Zhang
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
| | - Roland Schwarzer
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
| | - Mauricio Montano
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
| | - Peter Sohn
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Nadia R Roan
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Lishomwa C Ndhlovu
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10021, USA
| | - Li Gan
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10021, USA
- Helen and Robert Appel Alzheimer's Disease Research Institute, Weill Cornell Medicine, New York, NY 10021, USA
| | - Warner C Greene
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA 94158, USA
- Gladstone Institute of Virology, San Francisco, CA 94158, USA
- Departments of Medicine and Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA
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Chien A, Wu T, Lau CY, Pandya D, Wiebold A, Agan B, Snow J, Smith B, Nath A, Nair G. White and Gray Matter Changes are Associated With Neurocognitive Decline in HIV Infection. Ann Neurol 2024; 95:941-950. [PMID: 38362961 PMCID: PMC11060903 DOI: 10.1002/ana.26896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To investigate the relationship between neurocognitive deficits and structural changes on brain magnetic resonance imaging in people living with HIV (PLWH) with good virological control on combination antiretroviral therapy, compared with socioeconomically matched control participants recruited from the same communities. METHODS Brain magnetic resonance imaging scans, and clinical and neuropsychological data were obtained from virologically controlled PLWH (viral load of <50 c/mL and at least 1 year of combination antiretroviral therapy) and socioeconomically matched control participants. Magnetic resonance imaging was carried out on 3 T scanner with 8-channel head coils and segmented using Classification using Derivative-based Features. Multiple regression analysis was performed to examine the association between brain volume and various clinical and neuropsychiatric parameters adjusting for age, race, and sex. To evaluate longitudinal changes in brain volumes, a random coefficient model was used to evaluate the changes over time (age) adjusting for sex and race. RESULTS The cross-sectional study included 164 PLWH and 51 controls, and the longitudinal study included 68 PLWH and 20 controls with 2 or more visits (mean 2.2 years, range 0.8-5.1 years). Gray matter (GM) atrophy rate was significantly higher in PLWH compared with control participants, and importantly, the GM and global atrophy was associated with the various neuropsychological domain scores. Higher volume of white matter hyperintensities were associated with increased atherosclerotic cardiovascular disease risk score, and decreased executive functioning and memory domain scores in PLWH. INTERPRETATION These findings suggest ongoing neurological damage even in virologically controlled participants, with significant implications for clinical management of PLWH. ANN NEUROL 2024;95:941-950.
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Affiliation(s)
- Alice Chien
- National Institute of Neurological Disorders and Stroke, MD, USA
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke, MD, USA
| | - Chuen-Yen Lau
- National Institute of Allergy and Infectious Diseases, MD, USA
| | - Darshan Pandya
- National Institute of Neurological Disorders and Stroke, MD, USA
| | - Amanda Wiebold
- National Institute of Neurological Disorders and Stroke, MD, USA
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Joseph Snow
- National Institute of Mental Health, MD, USA
| | - Bryan Smith
- National Institute of Neurological Disorders and Stroke, MD, USA
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, MD, USA
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, MD, USA
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11
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Marques de Menezes EG, Bowler SA, Shikuma CM, Ndhlovu LC, Norris PJ. Circulating plasma-derived extracellular vesicles expressing bone and kidney markers are associated with neurocognitive impairment in people living with HIV. Front Neurol 2024; 15:1383227. [PMID: 38725641 PMCID: PMC11079819 DOI: 10.3389/fneur.2024.1383227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Background Although effective antiretroviral therapy (ART) has improved the life expectancy of people with HIV (PWH), the prevalence of milder forms of HIV-associated neurocognitive disorders (HAND) persist, and it is associated with systemic and neuro-inflammatory processes that could impact other organ systems. However, the complex signaling mechanisms between the bone-kidney systems and the brain in HAND remain unknown. Extracellular vesicles (EVs) play a potential role in inter-organ communication and are involved in regulating cell activity in distant tissues. In this study, we examined whether levels of EVs from bone-and kidney-related cells associate with cognitive dysfunction and explored the relationship between kidney-bone EV axis in PWH experiencing cognitive deficits. Methods EV subtypes were characterized in plasma from 61 PWH with either cognitive impairment (CI, n = 53) or normal cognition (NC, n = 8) based on the American Academy of Neurology criteria for HIV-associated dementia (HAD, n = 11), minor cognitive motor disorder (MCMD, n = 25) or asymptomatic neurocognitive impairment (ANI, n = 17) by spectral flow cytometry. EVs were profiled with markers reflecting bone and kidney cell origin. A support vector machine learning-based model was employed for analyses of EV phenotypes to predict the cognitive dysfunction. Results Plasma-EVs expressing osteocalcin, sclerostin, and nephrin were significantly higher in the cognitive impairment group compared to the normal cognition group. EVs bearing kidney cell markers correlated significantly with bone-derived EVs. A machine learning-based model, comprised of osteocalcin+, nephrin+, and CD24+ EVs predicted cognitive impairment in PWH on ART. Conclusion Our study reveals that neurocognitive impairment in PWH is associated with increased levels of plasma EVs enriched with the bone markers osteocalcin and sclerostin and the kidney marker nephrin, suggesting that these EV subtypes may be novel candidate biomarkers for disease-spanning neurocognitive dysfunction. Moreover, the relationship between bone-derived EVs with kidney-derived EVs may suggest their role in mediating inter-organ crosstalk in the pathogenesis of HIV-associated cognitive impairment.
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Affiliation(s)
- Erika G. Marques de Menezes
- Vitalant Research Institute, San Francisco, CA, United States
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Scott A. Bowler
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Cecilia M. Shikuma
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Lishomwa C. Ndhlovu
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Philip J. Norris
- Vitalant Research Institute, San Francisco, CA, United States
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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12
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Moschopoulos CD, Stanitsa E, Protopapas K, Kavatha D, Papageorgiou SG, Antoniadou A, Papadopoulos A. Multimodal Approach to Neurocognitive Function in People Living with HIV in the cART Era: A Comprehensive Review. Life (Basel) 2024; 14:508. [PMID: 38672778 PMCID: PMC11050956 DOI: 10.3390/life14040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Combination antiretroviral treatment (cART) has revolutionized the management of human immunodeficiency virus (HIV) and has markedly improved the disease burden and life expectancy of people living with HIV. HIV enters the central nervous system (CNS) early in the course of infection, establishes latency, and produces a pro-inflammatory milieu that may affect cognitive functions, even in the cART era. Whereas severe forms of neurocognitive impairment (NCI) such as HIV-associated dementia have declined over the last decades, milder forms have become more prevalent, are commonly multifactorial, and are associated with comorbidity burdens, mental health, cART neurotoxicity, and ageing. Since 2007, the Frascati criteria have been used to characterize and classify HIV-associated neurocognitive disorders (HAND) into three stages, namely asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). These criteria are based on a comprehensive neuropsychological assessment that presupposes the availability of validated, demographically adjusted, and normative population data. Novel neuroimaging modalities and biomarkers have been proposed in order to complement NCI assessments, elucidate neuropathogenic mechanisms, and support HIV-associated NCI diagnosis, monitoring, and prognosis. By integrating neuropsychological assessments with biomarkers and neuroimaging into a holistic care approach, clinicians can enhance diagnostic accuracy, prognosis, and patient outcomes. This review interrogates the value of these modes of assessment and proposes a unified approach to NCI diagnosis.
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Affiliation(s)
- Charalampos D. Moschopoulos
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Evangelia Stanitsa
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.S.); (S.G.P.)
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Dimitra Kavatha
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.S.); (S.G.P.)
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
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13
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Ranuschio B, Bell S, Flatt J, Barnes L, Puno T, Navarro A, Ribeiro A, Sheik-Yosef N, Villalobos E, Wackens J, Liboro RM. Awareness and Knowledge of HIV-Associated Neurocognitive Disorder Among Middle-Aged and Older People Living With HIV/AIDS in Southern Nevada: Implications for HIV/AIDS Community-Based Education Programs. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:141-154. [PMID: 38648176 DOI: 10.1521/aeap.2024.36.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Although a significant amount of biomedical research has been conducted to study HIV-associated neurocognitive disorder (HAND), there has been scant research done to assess the awareness and knowledge of this public health concern among middle-aged and older people living with HIV/AIDS (PLWH). Our qualitative community-based participatory research study sought to address this research gap by examining the awareness and knowledge of HAND among relevant stakeholders in southern Nevada, USA. We conducted 15 semistructured interviews with middle-aged and older PLWH to examine their awareness and knowledge of HAND and access to pertinent resources. After our thematic analysis of our interviews, we identified two overarching themes: (1) limited awareness and knowledge of HAND among PLWH, and (2) southern Nevada social determinants of health. Our findings underscore the importance of raising awareness and knowledge of HAND among PLWH through community-based education programs, and improving access to resources related to social determinants of health.
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Affiliation(s)
- Brandon Ranuschio
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Sherry Bell
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
- Department of Psychology, University of Oregon, Eugene, Oregon
| | - Jason Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas
| | - Lianne Barnes
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Trinity Puno
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Andrea Navarro
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Alexander Ribeiro
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Nadia Sheik-Yosef
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Esmeralda Villalobos
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Janelle Wackens
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
| | - Renato M Liboro
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas
- Centre for Addiction and Mental Health, Toronto, Canada
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14
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Hernandez C, Gorska AM, Eugenin E. Mechanisms of HIV-mediated blood-brain barrier compromise and leukocyte transmigration under the current antiretroviral era. iScience 2024; 27:109236. [PMID: 38487019 PMCID: PMC10937838 DOI: 10.1016/j.isci.2024.109236] [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: 11/06/2023] [Revised: 12/18/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
HIV-associated neurological compromise is observed in more than half of all people with HIV (PWH), even under antiretroviral therapy (ART). The mechanism has been associated with the early transmigration of HIV-infected monocytes across the BBB in a CCL2 and HIV replication-dependent manner. However, the mechanisms of chronic brain damage are unknown. We demonstrate that all PWH under ART have elevated circulating ATP levels that correlate with the onset of cognitive impairment even in the absence of a circulating virus. Serum ATP levels found in PWH with the most severe neurocognitive impairment trigger the transcellular migration of HIV-infected leukocytes across the BBB in a JAM-A and LFA-1-dependent manner. We propose that targeting transcellular leukocyte transmigration could reduce or prevent the devastating consequences of HIV within the brains of PWH under ART.
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Affiliation(s)
- Cristian Hernandez
- Department of Neurobiology, The University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - Anna Maria Gorska
- Department of Neurobiology, The University of Texas Medical Branch (UTMB), Galveston, TX, USA
- Department of Pathology, University of Oslo, Oslo, Norway
| | - Eliseo Eugenin
- Department of Neurobiology, The University of Texas Medical Branch (UTMB), Galveston, TX, USA
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15
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Vance DE, Fazeli PL, Azuero A, Frank JS, Wadley VG, Raper JL, Pope CN, Ball KK. A 2-year longitudinal randomized controlled trial examining the transfer of speed of processing training to secondary cognitive domains in middle-aged and older adults with HIV-associated neurocognitive disorder: Results of the think fast study. Clin Neuropsychol 2024; 38:471-492. [PMID: 37191339 PMCID: PMC10651797 DOI: 10.1080/13854046.2023.2212867] [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: 12/12/2022] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE As people with HIV (PWH) age, they are at-risk of developing cognitive impairments compared to their seronegative counterparts. Although speed of processing (SOP) training may help improve this cognitive ability, less work has examined transfer to other cognitive domains. This study examined the effect of SOP training has on secondary cognitive domains in PWH aged 40+ years. METHOD In this 3-group 2-year longitudinal study, 216 PWH with HIV-associated neurocognitive disorder (HAND) or borderline HAND were randomized to either: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of an active control training (n = 73). Participants completed a comprehensive cognitive battery at baseline, immediately after training, and at 1 and 2 years. This battery yielded global and domain specific T-scores as well as a cognitive impairment variable. Generalized linear mixed-effect models were fitted to estimate between-group mean differences at the follow-up time-points adjusted for baseline. RESULTS No clinically or statistically significant improvements in any of the cognitive outcomes were observed. A sensitivity analysis was conducted; conclusions replicated those of the main analysis, with two exceptions: Global Function T and Psychomotor Speed T showed relevant training improvements among the intervention groups over the control group at the immediate post time point. CONCLUSIONS Although SOP training has been shown to improve cognitive abilities that correspond to driving and mobility, such training has limited therapeutic utility in improving cognition in other domains in PWH with HAND.
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Affiliation(s)
- David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer S. Frank
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G. Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James L. Raper
- The 1917 (HIV/AIDS) Clinic, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin N. Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
| | - Karlene K. Ball
- UAB Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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16
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Figarola-Centurión I, Escoto-Delgadillo M, González-Enríquez GV, Gutiérrez-Sevilla JE, Vázquez-Valls E, Cárdenas-Bedoya J, Torres-Mendoza BM. HIV-1 Tat Induces Dysregulation of PGC1-Alpha and Sirtuin 3 Expression in Neurons: The Role of Mitochondrial Biogenesis in HIV-Associated Neurocognitive Disorder (HAND). Int J Mol Sci 2023; 24:17566. [PMID: 38139395 PMCID: PMC10743616 DOI: 10.3390/ijms242417566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
During the antiretroviral era, individuals living with HIV continue to experience milder forms of HIV-associated neurocognitive disorder (HAND). Viral proteins, including Tat, play a pivotal role in the observed alterations within the central nervous system (CNS), with mitochondrial dysfunction emerging as a prominent hallmark. As a result, our objective was to examine the expression of genes associated with mitophagy and mitochondrial biogenesis in the brain exposed to the HIV-1 Tat protein. We achieved this by performing bilateral stereotaxic injections of 100 ng of HIV-1 Tat into the hippocampus of Sprague-Dawley rats, followed by immunoneuromagnetic cell isolation. Subsequently, we assessed the gene expression of Ppargc1a, Pink1, and Sirt1-3 in neurons using RT-qPCR. Additionally, to understand the role of Tert in telomeric dysfunction, we quantified the activity and expression of Tert. Our results revealed that only Ppargc1a, Pink1, and mitochondrial Sirt3 were downregulated in response to the presence of HIV-1 Tat in hippocampal neurons. Interestingly, we observed a reduction in the activity of Tert in the experimental group, while mRNA levels remained relatively stable. These findings support the compelling evidence of dysregulation in both mitophagy and mitochondrial biogenesis in neurons exposed to HIV-1 Tat, which in turn induces telomeric dysfunction.
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Affiliation(s)
- Izchel Figarola-Centurión
- Doctorado en Genética Humana, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Laboratorio de Inmunodeficiencias y Retrovirus Humanos, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (J.E.G.-S.); (J.C.-B.)
| | - Martha Escoto-Delgadillo
- Laboratorio de Inmunodeficiencias y Retrovirus Humanos, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (J.E.G.-S.); (J.C.-B.)
- Centro Universitario de Ciencias Biológicas y Agropecuarias, Universidad de Guadalajara, Guadalajara 44600, Mexico
| | - Gracia Viviana González-Enríquez
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Juan Ernesto Gutiérrez-Sevilla
- Laboratorio de Inmunodeficiencias y Retrovirus Humanos, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (J.E.G.-S.); (J.C.-B.)
- Doctorado en Microbiología Médica, Departamento de Microbiología y Patología, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | | | - Jhonathan Cárdenas-Bedoya
- Laboratorio de Inmunodeficiencias y Retrovirus Humanos, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (J.E.G.-S.); (J.C.-B.)
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Blanca Miriam Torres-Mendoza
- Laboratorio de Inmunodeficiencias y Retrovirus Humanos, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (J.E.G.-S.); (J.C.-B.)
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
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17
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Ross EJ, Williams RS, Viamonte M, Reynolds JM, Duncan DT, Paul RH, Carrico AW. Overamped: Stimulant Use and HIV Pathogenesis. Curr HIV/AIDS Rep 2023; 20:321-332. [PMID: 37971597 DOI: 10.1007/s11904-023-00672-y] [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] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW In the era of HIV treatment as prevention (TasP), more clarity is needed regarding whether people with HIV who use stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) display elevated HIV viral load and greater immune dysregulation. RECENT FINDINGS Although rates of viral suppression have improved in the TasP era, stimulant use was independently associated with elevated viral load in 23 of 28 studies included in our review. In the 12 studies examining other HIV disease markers, there was preliminary evidence for stimulant-associated alterations in gut-immune dysfunction and cellular immunity despite effective HIV treatment. Studies generally focused on documenting the direct associations of stimulant use with biomarkers of HIV pathogenesis without placing these in the context of social determinants of health. Stimulant use is a key barrier to optimizing the effectiveness of TasP. Elucidating the microbiome-gut-brain axis pathways whereby stimulants alter neuroimmune functioning could identify viable targets for pharmacotherapies for stimulant use disorders. Examining interpersonal, neighborhood, and structural determinants that could modify the associations of stimulant use with biomarkers of HIV pathogenesis is critical to guiding the development of comprehensive, multi-level interventions.
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Affiliation(s)
- Emily J Ross
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Renessa S Williams
- University of Miami School of Nursing and Health Sciences, Coral Gables, FL, USA
| | | | - John M Reynolds
- Calder Memorial Library, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dustin T Duncan
- Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Robert H Paul
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Adam W Carrico
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, #407, Miami, FL, 33199, USA.
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18
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Ayu AP, Rahadi A, Kristian K, Sani TP, Putra A, Halim G, Mangkuliguna G, Kusumoputri TP, Turana Y. Mode of HIV exposure and excess burden of neurocognitive impairment in people living with HIV: a protocol for systematic review and meta-analysis of controlled studies. Syst Rev 2023; 12:214. [PMID: 37968747 PMCID: PMC10652586 DOI: 10.1186/s13643-023-02371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/24/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Chronic HIV infection significantly elevates the risk of brain pathology, precipitating neurocognitive impairment (NCI) among people living with HIV (PLWH). The diagnosis of NCI in PLWH hinges on evaluating deviations in neuropsychological test performance in comparison to HIV-seronegative normative controls. However, the adverse psychosocial conditions experienced by PLWH can also result in reduced test performance, potentially confounding the accurate NCI attribution to HIV infection. This planned systematic review aims to investigate potential disparities in the excess burden of NCI among PLWH in two groups of studies: (a) studies enrolling controls who shared a similar mode of HIV exposure (MoHE) with the PLWH participants (MoHE-adjusted) and (b) studies enrolling normative controls or controls without undefined MoHE (MoHE-naive). METHODS We will systematically search five electronic databases (MEDLINE, Embase, PsycINFO, Web of Science, ProQuest) and registries (OpenGrey, ClinicalTrials.gov, ISRCTN registry). Studies reporting NCI in PLWH and HIV-seronegative controls with cross-sectional or baseline measurements, published from January 2007 to September 2023, will be included. To be classified as MoHE adjusted, a study must evidence ≥ 90% enrolment of both PLWH and their seronegative controls from the same MoHE group (e.g. men who have sex with men, people who use drugs or alcohol). Reports of test performance scores will be transformed into NCI proportions using simulated score distributions, applying a global deficit score cut-off ≥ 0.5 to estimate NCI cases. The Newcastle-Ottawa scale adapted to the purpose of the review will be used to appraise study quality. Random-effects meta-analysis will be used to pool the excess burden of NCI in prevalence ratios and test the difference between MoHE-adjusted and MoHE-naive studies. Furthermore, subgroup analyses and meta-regression will be undertaken across categorical study-level covariates (e.g. study locations, NCI diagnostic criteria) and continuous/ordinal covariates (nadir CD4, number of neurocognitive domains assessed), respectively. DISCUSSION This systematic review will contribute towards a greater appreciation of the unique psychosocial conditions of PLWH that are missing from the current case definition of HIV-associated neurocognitive disorder. The findings will additionally highlight possible disparities in the distribution of the excess burden of NCI by MoHE groups, thereby guiding the prioritization of mitigation efforts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021271358.
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Affiliation(s)
- Astri Parawita Ayu
- Department of Psychiatry and Behavioural Sciences, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, 14440, Indonesia
- HIV AIDS Research Center (ARC) - University Center of Excellence in Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, South Jakarta, 12930, Indonesia
| | - Arie Rahadi
- HIV AIDS Research Center (ARC) - University Center of Excellence in Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, South Jakarta, 12930, Indonesia
| | - Kevin Kristian
- Department of Public Health and Nutrition, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, 14440, Indonesia.
| | | | - Aditya Putra
- HIV AIDS Research Center (ARC) - University Center of Excellence in Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, South Jakarta, 12930, Indonesia
| | - Glenardi Halim
- HIV AIDS Research Center (ARC) - University Center of Excellence in Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, South Jakarta, 12930, Indonesia
| | - Ghea Mangkuliguna
- HIV AIDS Research Center (ARC) - University Center of Excellence in Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, South Jakarta, 12930, Indonesia
| | - Theresia Puspoarum Kusumoputri
- HIV AIDS Research Center (ARC) - University Center of Excellence in Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, South Jakarta, 12930, Indonesia
| | - Yuda Turana
- Alzheimer Indonesia, South Jakarta, 12930, Indonesia
- Department of Neurology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, 14440, Indonesia
- Atma Jaya Neuroscience and Cognitive Centre, Atma Jaya Hospital, North Jakarta, 14440, Indonesia
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19
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Weng YW, Lee SSJ, Tsai HC, Hsu CH, Lin SH. Prediction of incidence of neurological disorders in HIV-infected persons in Taiwan: a nested case-control study. BMC Infect Dis 2023; 23:759. [PMID: 37924043 PMCID: PMC10625280 DOI: 10.1186/s12879-023-08761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Neurological disorders are still prevalent in HIV-infected people. We aimed to determine the prevalence of neurological disorders and identify their risk factors in HIV-infected persons in Taiwan. METHODS We identified 30,101 HIV-infected people between 2002 and 2016 from the National Health Insurance Research Database in Taiwan, and analyzed the incidence of neurological disorders. We applied a retrospective, nested case-control study design. The individuals with (case group) and without (control group) a neurological disorder were then matched by age, sex and time. Factors associated with neurological disorders were analyzed using a conditional logistic regression model, and a nomogram was generated to estimate the risk of developing a neurological disorder. RESULTS The incidence of neurological disorders was 13.67 per 1000 person-years. The incidence remained stable during the observation period despite the use of early treatment and more tolerable modern anti-retroviral therapy. The conditional logistic regression model identified nine clinical factors and comorbidities that were associated with neurological disorders, namely age, substance use, traumatic brain injury, psychiatric illness, HIV-associated opportunistic infections, frequency of emergency department visits, cART adherence, urbanization, and monthly income. These factors were used to establish the nomogram. CONCLUSION Neurological disorders are still prevalent in HIV-infected people in Taiwan. To efficiently identify those at risk, we established a nomogram with nine risk factors. This nomogram could prompt clinicians to initiate further evaluations and management of neurological disorders in this population.
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Affiliation(s)
- Ya-Wei Weng
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hung-Chin Tsai
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chih-Hui Hsu
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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20
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Wu HC, Lu PL, Yang YH, Feng MC. Prevalence and the associated factors of cognitive impairment among people living with HIV in Taiwan: a cross-sectional study. AIDS Care 2023; 35:1647-1653. [PMID: 37186954 DOI: 10.1080/09540121.2023.2206094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
Cognitive impairment impacts the quality of life and increases morbidity and mortality rates. The prevalence of and factors associated with cognitive impairment have become important issues as the age of people living with HIV(PLWH) increases. In 2020, We conducted a cross-sectional study to survey the cognitive impairment among PLWH in three hospitals in Taiwan with Alzheimer Disease-8 (AD8) questionnaire. The average age of 1,111 individuals was 37.54 ± 10.46 years old, and their average duration to live with HIV was 7.12 ± 4.85 years. The rate of impaired cognitive function was 2.25% (N = 25) when AD8 score ≥ 2 was a positive finding for cognitive impairment. Aging (p = .012), being less educated (p = 0.010), and having a longer duration to live with HIV (p = .025) were significantly associated with cognitive impairment. Multivariate logistic regression analysis revealed that only the duration of living with HIV was a significant factor related to the tendency of cognitive impairment (p = .032). The risk of cognitive impairment increased by 1.098 times for every additional year to live with HIV. In conclusion, the prevalence of cognitive impairment among PLWH in Taiwan was 2.25%. Healthcare personnel should be sensitive to the changes in PLWH's cognitive function as they age.
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Affiliation(s)
- Hsiang-Chun Wu
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chu Feng
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Nursing, Fooyin University, Kaohsiung City, Taiwan
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21
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Torre P, Sundermann EE, Brandino A, Heaton A, Devore J, Anderson AM, Moore RC. Auditory and cognitive function in older adults living with and without HIV. AIDS 2023; 37:1971-1978. [PMID: 37289579 PMCID: PMC10538433 DOI: 10.1097/qad.0000000000003618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the peripheral hearing sensitivity and central auditory processing in persons with HIV (PWH) and persons without HIV (PWoH); and the association between cognitive function and central auditory processing in PWH and PWoH. DESIGN Cross-sectional, observational study. METHODS Participants included 67 PWH {70.2% men; mean age = 66.6 years [standard deviation (SD) = 4.7 years]} and 35 PWoH [51.4% men; mean age = 72.9 years (SD = 7.0 years)]. Participants completed a hearing assessment and a central auditory processing assessment that included dichotic digits testing (DDT). Pure-tone air-conduction thresholds were obtained at octave frequencies from 0.25 through 8 kHz. A pure-tone average (PTA) was calculated from 0.5, 1, 2, and 4 kHz thresholds for each ear. Participants also completed a neuropsychological battery assessing cognition in seven domains. RESULTS PWH had slightly lower (i.e. better) PTAs compared with PWoH, but this was not statistically significant. Conversely, PWH and PWoH had similar DDT results for both ears. Poorer verbal fluency, learning, and working memory performance was significantly related to lower DDT scores, and those defined as having verbal fluency, learning, and working memory impairment had significantly poorer DDT scores (8-18% lower) in both ears. CONCLUSION Hearing and DDT results were similar in PWH and PWoH. The relationship between verbal fluency, learning, and working memory impairment and poorer DDT results did not differ by HIV serostatus. Clinicians, particularly audiologists, should be mindful of cognitive functioning abilities when evaluating central auditory processing.
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Affiliation(s)
- Peter Torre
- San Diego State University, School of Speech, Language, and Hearing Sciences, San Diego
| | - Erin E Sundermann
- University of California San Diego, Department of Psychiatry, La Jolla, California
| | | | - Anne Heaton
- University of California San Diego, Department of Psychiatry, La Jolla, California
| | - Julia Devore
- San Diego State University, School of Speech, Language, and Hearing Sciences, San Diego
| | | | - Raeanne C Moore
- University of California San Diego, Department of Psychiatry, La Jolla, California
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22
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Webb AJ, Borrelli EP, Vyas A, Taylor LE, Buchanan AL. The effect of antiretroviral therapy with high central nervous system penetration on HIV-related cognitive impairment: a systematic review and meta-analysis. AIDS Care 2023; 35:1635-1646. [PMID: 35850626 PMCID: PMC9845421 DOI: 10.1080/09540121.2022.2098231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 06/30/2022] [Indexed: 01/21/2023]
Abstract
Chronic complications are a significant concern for people living with HIV/AIDS (PLWHA) infection. HIV-associated neurocognitive disorders (HAND) are prevalent in PLWHA. Yet, the efficacy of medications that penetrate the central nervous system (CNS) at preventing or slowing the progression of HAND remains largely unknown. The objective of this study was to determine whether high CNS penetration effectiveness (CPE) regimens improve neurocognitive test scores in PLWHA on combined antiretroviral therapy (cART). Primary literature evaluating cognitive outcomes based on CPE score of cART regimens in PLWHA was assembled from PubMed/Medline and EMBASE. Both randomized controlled trials and observational studies with at least 12 weeks of follow-up were included. A meta-analysis was conducted to calculate the standardized mean difference. Eight trials including a total of 3,303 patients with 13,103 person-years of follow-up were included in the systematic review. Four trials (n = 366 patients) met our inclusion criteria and were included in the meta-analysis. In the meta-analysis, HIV regimens with a high CPE score did not affect NPZ-4 or GDS scores (standardized mean difference (SMD) 0.10, 95% CI -0.19, 0.38; I2 = 26%). Future studies with larger sample sizes are warranted to prospectively evaluate the relationship between CPE and progression of HAND.
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Affiliation(s)
| | | | - Ami Vyas
- University of Rhode Island, College of Pharmacy
| | - Lynn E. Taylor
- University of Rhode Island, College of Pharmacy
- CODAC Behavioral Health, HIV and Viral Hepatitis Services
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23
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Shikuma CM, Wojna V, De Gruttola V, Siriwardhana C, Souza SA, Rodriguez-Benitez RJ, Turner EH, Kallianpur K, Bolzenius J, Chow D, Matos M, Shiramizu B, Clements DM, Premeaux TA, Ndhlovu LC, Paul R. Impact of antiretroviral therapy intensification with C-C motif chemokine receptor 5 antagonist maraviroc on HIV-associated neurocognitive impairment. AIDS 2023; 37:1987-1995. [PMID: 37418541 PMCID: PMC10538417 DOI: 10.1097/qad.0000000000003650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Chemokine receptor CCR5 is the principal co-receptor for entry of M-tropic HIV virus into immune cells. It is expressed in the central nervous system and may contribute to neuro-inflammation. The CCR5 antagonist maraviroc (MVC) has been suggested to improve HIV-associated neurocognitive impairment (NCI). DESIGN A double-blind, placebo-controlled, 48-week, randomized study of MVC vs. placebo in people with HIV (PWH) on stable antiretroviral therapy (ART) for more than one year in Hawaii and Puerto Rico with plasma HIV RNA less than 50 copies/ml and at least mild NCI defined as an overall or domain-specific neuropsychological z (NPZ) score less than -0.5. METHODS Study participants were randomized 2 : 1 to intensification of ART with MVC vs. placebo. The primary endpoint was change in global and domain-specific NPZ modeled from study entry to week 48. Covariate adjusted treatment comparisons of average changes in cognitive outcome were performed using winsorized NPZ data. Monocyte subset frequencies and chemokine expression as well as plasma biomarker levels were assessed. RESULTS Forty-nine participants were enrolled with 32 individuals randomized to MVC intensification and 17 to placebo. At baseline, worse NPZ scores were seen in the MVC arm. Comparison of 48-week NPZ change by arm revealed no differences except for a modest improvement in the Learning and Memory domain in the MVC arm, which did not survive multiplicity correction. No significant changes between arms were seen in immunologic parameters. CONCLUSION This randomized controlled study found no definitive evidence in favor of MVC intensification among PWH with mild cognitive difficulties.
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Affiliation(s)
- Cecilia M. Shikuma
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Valerie Wojna
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Victor De Gruttola
- Wertheim School of Public Health, University of California San Diego, California
| | | | - Scott A. Souza
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | | | - Emilee H. Turner
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Kalpana Kallianpur
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
- Kamehameha Schools - Kapalama, Honolulu, Hawaii
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri – St. Louis, St. Louis, Missouri
| | - Dominic Chow
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Miriam Matos
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Bruce Shiramizu
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Danielle M. Clements
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | | | | | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri – St. Louis, St. Louis, Missouri
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Ranuschio B, Bell S, Flatt JD, Barnes L, Puno T, Ribeiro A, Sheik-Yosef N, Villalobos E, Wackens J, Liboro RM. A Focus on Aging, HIV/AIDS, and Neurocognitive Challenges: Examining Southern Nevada HIV Sector Providers' Awareness and Prospective Roles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6876. [PMID: 37835146 PMCID: PMC10572135 DOI: 10.3390/ijerph20196876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
Although abundant research has been carried out to investigate the underlying mechanisms that may cause neurocognitive challenges among middle-aged and older people living with HIV/AIDS (PLWH), to monitor the prevalence rates of HIV-related neurocognitive deficits, and to identify factors related to the improvement of diagnostic screening tools, classification and nosology, and clinical and rehabilitative treatment of HIV-Associated Neurocognitive Disorder (HAND); to date, there have been only a few studies that have explored and examined the awareness and work experiences HIV sector healthcare and service providers have related to HAND. To address this research gap, we conducted a qualitative, community-based participatory research study and interviewed 12 HIV sector providers in Southern Nevada, USA, from January to April 2022. After performing a thematic analysis of our interviews, we were able to identify two major themes and several sub-themes. Under our first major theme, provider awareness and knowledge, we identified four sub-themes: (1) prior knowledge and current awareness; (2) lived experiences of patients and clients with neurocognitive challenges; (3) lack of knowledge as a barrier to providing needed care; and (4) continuing education and professional development. Under our second major theme, prospective provider roles, we identified three sub-themes: (1) early detection; (2) direct and practical support; and (3) appropriate and timely referrals. In this article, we discuss our findings and lessons learned from our study, as well as their implications for the future work of researchers and providers in the HIV sector related to improving care and support for people aging with HIV/AIDS and experiencing neurocognitive challenges.
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Affiliation(s)
- Brandon Ranuschio
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Sherry Bell
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Jason D. Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA;
| | - Lianne Barnes
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Trinity Puno
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Alexander Ribeiro
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Nadia Sheik-Yosef
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Esmeralda Villalobos
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Janelle Wackens
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
| | - Renato M. Liboro
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (T.P.); (A.R.); (N.S.-Y.); (E.V.); (J.W.)
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
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Ahmed MH, Ahmed F, Abu-Median AB, Panourgia M, Owles H, Ochieng B, Ahamed H, Wale J, Dietsch B, Mital D. HIV and an Ageing Population-What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions. Microorganisms 2023; 11:2426. [PMID: 37894084 PMCID: PMC10608969 DOI: 10.3390/microorganisms11102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug-drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review.
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Affiliation(s)
- Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Fatima Ahmed
- Tele-Geriatric Research Fellowship, Geriatric Division, Family Medicine Department, Michigan State University, East Lansing, MI 48824, USA
| | - Abu-Bakr Abu-Median
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, UK
| | - Maria Panourgia
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Henry Owles
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Bertha Ochieng
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, UK
| | - Hassan Ahamed
- Tele-Geriatric Research Fellowship, Geriatric Division, Family Medicine Department, Michigan State University, East Lansing, MI 48824, USA
| | - Jane Wale
- Department of Palliative Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Benjamin Dietsch
- Department of Palliative Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Dushyant Mital
- Department of HIV and Blood Borne Virus, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
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Rodrigues J, Lowton K. Neurocognitive improvement in HIV-positive patients treated with dolutegravir-based regimens. S Afr J Psychiatr 2023; 29:2071. [PMID: 37795459 PMCID: PMC10546244 DOI: 10.4102/sajpsychiatry.v29i0.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Neurocognitive disorders due to human immunodeficiency virus (HIV) remain highly prevalent, specifically mild forms despite effective antiretroviral therapy (ART). Dolutegravir-based regimens are the first line of treatment for adult HIV-positive patients. Controversies exist regarding the neurocognitive effects of dolutegravir. Evidence regarding the neurocognitive effects of dolutegravir is important, in support of its use in patients with HIV-associated neurocognitive disorders (HAND). Aim This study aimed to describe the change in cognitive function using the International HIV Dementia Scale (IHDS) and Brief Neuropsychological Cognitive Examination (BNCE) in HIV positive, treatment naïve patients before and 3 months after initiation of ART using a dolutegravir-based regimen. Setting The HIV initiation clinic of Hillbrow Community Health Centre in Johannesburg. Methods This prospective, quantitative cohort study assessed adult HIV-positive patients who were ART naïve being initiated on a dolutegravir-based regimen, using the BNCE and IHDS at baseline and after 3 months of treatment. Results Neurocognitive test results of 26 participants showed significant improvements for IHDS (Z = 1.84, p = 0.033) and time to complete BNCE (Z = 2.47, p = 0.007). BNCE total results showed improvements that were not significant (Z = 1.44, p = 0.075); however, Part 2 of the BNCE reflecting that of executive function showed significant improvements (Z = 66.5, p = 0.043). Conclusion The trend of neurocognitive function is towards improvement in HIV-positive treatment naïve patients who receive 3 months of dolutegravir-based ART. Contribution The findings support the use of dolutegravir-based regimens in the treatment of patients with HIV-associated neurocognitive disorders. Keywords HIV-associated neurocognitive disorders; BNCE; IHDS; dolutegravir; neurocognitive screening; neurocognitive impairment; South Africa.
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Affiliation(s)
- Janine Rodrigues
- Department of Psychiatry, Faculty of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Karishma Lowton
- Department of Psychiatry, Faculty of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Van Zandt AR, MacLean AG. Advances in HIV therapeutics and cure strategies: findings obtained through non-human primate studies. J Neurovirol 2023; 29:389-399. [PMID: 37635184 DOI: 10.1007/s13365-023-01162-y] [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: 02/24/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023]
Abstract
Human immunodeficiency virus (HIV), the main contributor of the ongoing AIDS epidemic, remains one of the most challenging and complex viruses to target and eradicate due to frequent genome mutation and immune evasion. Despite the development of potent antiretroviral therapies, HIV remains an incurable infection as the virus persists in latent reservoirs throughout the body. To innovate a safe and effective cure strategy for HIV in humans, animal models are needed to better understand viral proliferation, disease progression, and therapeutic response. Nonhuman primates infected with simian immunodeficiency virus (SIV) provide an ideal model to study HIV infection and pathogenesis as they are closely related to humans genetically and express phenotypically similar immune systems. Examining the clinical outcomes of novel treatment strategies within nonhuman primates facilitates our understanding of HIV latency and advances the development of a true cure to HIV.
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Affiliation(s)
- Alison R Van Zandt
- Tulane National Primate Research Center, Covington, LA, USA
- Biomedical Sciences Training Program, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew G MacLean
- Tulane National Primate Research Center, Covington, LA, USA.
- Biomedical Sciences Training Program, Tulane University School of Medicine, New Orleans, LA, USA.
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, USA.
- Tulane Brain Institute, New Orleans, LA, USA.
- Tulane Center for Aging, New Orleans, LA, USA.
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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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29
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McMahan C, Dietrich DK, Horne EF, Kelly E, Geannopoulos K, Siyahhan Julnes PS, Ham L, Santamaria U, Lau CY, Wu T, Hsieh HC, Ganesan A, Berjohn C, Kapetanovic S, Reich DS, Nair G, Snow J, Agan BK, Nath A, Smith BR. Neurocognitive Dysfunction With Neuronal Injury in People With HIV on Long-Duration Antiretroviral Therapy. Neurology 2023; 100:e2466-e2476. [PMID: 37105760 PMCID: PMC10264056 DOI: 10.1212/wnl.0000000000207339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Neurologic outcomes in people with HIV (PWH) on long-duration antiretroviral therapy (ART) are not fully understood, and the underlying pathophysiology is unclear. To address this, we established a cohort of such individuals and compared them with HIV-negative controls using a novel matching technique. Both groups underwent extensive cognitive testing, evaluation for psychiatric measures, and MRI and CSF analyses. METHODS Participants underwent comprehensive neuropsychological testing and completed standardized questionnaires measuring depressive symptoms, perceptions of own functioning, and activities of daily living as part of an observational study. Brain MRI and lumbar puncture were optional. Coarsened Exact Matching was used to reduce between-group differences in age and sex, and weighted linear/logistic regression models were used to assess the effect of HIV on outcomes. RESULTS Data were analyzed from 155 PWH on ART for at least 15 years and 100 HIV-negative controls. Compared with controls, PWH scored lower in the domains of attention/working memory (PWH least square mean [LSM] = 50.4 vs controls LSM = 53.1, p = 0.008) and motor function (44.6 vs 47.7, p = 0.009) and a test of information processing speed (symbol search 30.3 vs 32.2, p = 0.003). They were more likely to self-report a higher number of cognitive difficulties in everyday life (p = 0.011). PWH also reported more depressive symptoms, general anxiety, and use of psychiatric medications (all with p < 0.05). PWH had reduced proportions of subcortical gray matter on MRI (β = -0.001, p < 0.001), and CSF showed elevated levels of neurofilament light chain (664 vs 529 pg/mL, p = 0.01) and tumor necrosis factor α (0.229 vs 0.156 ng/mL, p = 0.0008). DISCUSSION PWH, despite effective ART for over a decade, displayed neurocognitive deficits and mood abnormalities. MRI and CSF analyses revealed reduced brain volume and signs of ongoing neuronal injury and neuroinflammation. As the already large proportion of virologically controlled PWH continues to grow, longitudinal studies should be conducted to elucidate the implications of cognitive, psychiatric, MRI, and CSF abnormalities in this group.
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Affiliation(s)
- Cynthia McMahan
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Devon K Dietrich
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Elizabeth F Horne
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Erin Kelly
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Katrina Geannopoulos
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Peter Selim Siyahhan Julnes
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Lillian Ham
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Ulisses Santamaria
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Chuen-Yen Lau
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Tianxia Wu
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Hsing-Chuan Hsieh
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Anuradha Ganesan
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Catherine Berjohn
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Suad Kapetanovic
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Daniel S Reich
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Govind Nair
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Joseph Snow
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Brian K Agan
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Avindra Nath
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Bryan R Smith
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles.
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Vance DE, Fazeli PL, Azuero A, Khalidi S, Frank JS, Wadley VG, Raper JL, Pope CN, Jacob AE, Ball KK. Two-year clinical trial examining the effects of speed of processing training on everyday functioning in adults with human immunodeficiency virus-associated neurocognitive disorder (HAND) and borderline HAND in the U.S. Deep South: Findings of the Think Fast Study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-14. [PMID: 37200482 PMCID: PMC10656361 DOI: 10.1080/23279095.2023.2209900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient's Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen's d) ranging 0.13-0.41 for MAQ and 0.02-0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.
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Affiliation(s)
- David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer S. Frank
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G. Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James L. Raper
- The 1917 (HIV/AIDS) Clinic, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin N. Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
| | - Alexandra E. Jacob
- UAB Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karlene K. Ball
- UAB Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rogers JM, Iudicello JE, Marcondes MCG, Morgan EE, Cherner M, Ellis RJ, Letendre SL, Heaton RK, Grant I. The Combined Effects of Cannabis, Methamphetamine, and HIV on Neurocognition. Viruses 2023; 15:674. [PMID: 36992383 PMCID: PMC10058939 DOI: 10.3390/v15030674] [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: 12/01/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE Methamphetamine and cannabis are two widely used substances among people living with HIV (PLWH). Whereas methamphetamine use has been found to worsen HIV-associated neurocognitive impairment, the effects of combined cannabis and methamphetamine use disorder on neurocognition in PLWH are not understood. In the present study, we aimed to determine the influence of these substance use disorders on neurocognition in PLWH and to explore if methamphetamine-cannabis effects interacted with HIV status. METHOD AND PARTICIPANTS After completing a comprehensive neurobehavioral assessment, PLWH (n = 472) were stratified by lifetime methamphetamine (M-/M+) and cannabis (C-/C+) DSM-IV abuse/dependence disorder into four groups: M-C- (n = 187), M-C+ (n = 68), M+C-, (n = 82), and M+C+ (n = 135). Group differences in global and domain neurocognitive performances and impairment were examined using multiple linear and logistic regression, respectively, while holding constant other covariates that were associated with study groups and/or cognition. Data from participants without HIV (n = 423) were added, and mixed-effect models were used to examine possible interactions between HIV and substance use disorders on neurocognition. RESULTS Compared with M+C+, M+C- performed worse on measures of executive functions, learning, memory, and working memory and were more likely to be classified as impaired in those domains. M-C- performed better than M+C+ on measures of learning and memory but worse than M-C+ on measures of executive functions, learning, memory, and working memory. Detectable plasma HIV RNA and nadir CD4 < 200 were associated with lower overall neurocognitive performance, and these effects were greater for M+C+ compared with M-C-. CONCLUSIONS In PLWH, lifetime methamphetamine use disorder and both current and legacy markers of HIV disease severity are associated with worse neurocognitive outcomes. There was no evidence of an HIV × M+ interaction across groups, but neurocognition was most impacted by HIV among those with polysubstance use disorder (M+C+). Better performance by C+ groups is consistent with findings from preclinical studies that cannabis use may protect against methamphetamine's deleterious effects.
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Affiliation(s)
- Jeffrey M. Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
| | - Jennifer E. Iudicello
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | | | - Erin E. Morgan
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
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32
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Thela L, Decloedt E, Zetterberg H, Gisslén M, Lesosky M, Gleich M, Koutsilieri E, Scheller C, Hye A, Joska J. Blood and cerebrospinal fluid biomarker changes in patients with HIV-associated neurocognitive impairment treated with lithium: analysis from a randomised placebo-controlled trial. J Neurovirol 2023; 29:156-166. [PMID: 36790601 DOI: 10.1007/s13365-023-01116-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/15/2022] [Accepted: 01/21/2023] [Indexed: 02/16/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) persist in the era of antiretroviral therapy (ART). Thus, ART does not completely halt or reverse the pathological processes behind HAND. Adjuvant mitigating treatments are, therefore, prudent. Lithium treatment is known to promote neuronal brain-derived neurotrophic factors (BDNF). Lithium is also an inhibitor of glycogen synthase kinase-3 beta (GSK-3-β). We analyzed biomarkers obtained from participants in a randomized placebo-controlled trial of lithium in ART-treated individuals with moderate or severe HAND. We assayed markers at baseline and 24 weeks across several pathways hypothesized to be affected by HIV, inflammation, or degeneration. Investigated biomarkers included dopamine, BDNF, neurofilament light chain, and CD8 + lymphocyte activation (CD38 + HLADR +). Alzheimer's Disease (AD) biomarkers included soluble amyloid precursor protein alpha and beta (sAPPα/β), Aβ38, 40, 42, and ten other biomarkers validated as predictors of mild cognitive impairment and progression in previous studies. These include apolipoprotein C3, pre-albumin, α1-acid glycoprotein, α1-antitrypsin, PEDF, CC4, ICAM-1, RANTES, clusterin, and cystatin c. We recruited 61 participants (placebo = 31; lithium = 30). The age baseline mean was 40 (± 8.35) years and the median CD4 + T-cell count was 498 (IQR: 389-651) cells/μL. Biomarker concentrations between groups did not differ at baseline. However, both groups' blood dopamine levels decreased significantly after 24 weeks (adj. p < 002). No other marker was significantly different between groups, and we concluded that lithium did not confer neuroprotection following 24 weeks of treatment. However, the study was limited in duration and sample size.
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Affiliation(s)
- Lindokuhle Thela
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, E Floor, Neuroscience Centre, Anzio Road, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa.
| | - Eric Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Magnus Gisslén
- Department of Infectious Disease, Institute of Biomedicine, the Sahlngreska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Disease, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Melanie Gleich
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Eleni Koutsilieri
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Carsten Scheller
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Abdul Hye
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, E Floor, Neuroscience Centre, Anzio Road, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa
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33
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Wilson KM, He JJ. HIV Nef Expression Down-modulated GFAP Expression and Altered Glutamate Uptake and Release and Proliferation in Astrocytes. Aging Dis 2023; 14:152-169. [PMID: 36818564 PMCID: PMC9937695 DOI: 10.14336/ad.2022.0712] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
HIV infection of astrocytes leads to restricted gene expression and replication but abundant expression of HIV early genes Tat, Nef and Rev. A great deal of neuroHIV research has so far been focused on Tat protein, its effects on astrocytes, and its roles in neuroHIV. In the current study, we aimed to determine effects of Nef expression on astrocytes and their function. Using transfection or infection of VSVG-pseudotyped HIV viruses, we showed that Nef expression down-modulated glial fibrillary acidic protein (GFAP) expression. We then showed that Nef expression also led to decreased GFAP mRNA expression. The transcriptional regulation was further confirmed using a GFAP promoter-driven reporter gene assay. We performed transcription factor profiling array to compare the expression of transcription factors between Nef-intact and Nef-deficient HIV-infected cells and identified eight transcription factors with expression changes of 1.5-fold or higher: three up-regulated by Nef (Stat1, Stat5, and TFIID), and five down-regulated by Nef (AR, GAS/ISRE, HIF, Sp1, and p53). We then demonstrated that removal of the Sp1 binding sites from the GFAP promoter resulted in a much lower level of the promoter activity and reversal of Nef effects on the GFAP promoter, confirming important roles of Sp1 in the GFAP promoter activity and for Nef-induced GFAP expression. Lastly, we showed that Nef expression led to increased glutamate uptake and decreased glutamate release by astrocytes and increased astrocyte proliferation. Taken together, these results indicate that Nef leads to down-modulation of GFAP expression and alteration of glutamate metabolism in astrocytes, and astrocyte proliferation and could be an important contributor to neuroHIV.
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Affiliation(s)
- Kelly M Wilson
- Department of Microbiology and Immunology, Center for Cancer Cell Biology, Immunology and Infection, School of Graduate and Postdoctoral Studies, Rosalind Franklin University, Chicago Medical School, North Chicago, IL 60064, USA
| | - Johnny J He
- Department of Microbiology and Immunology, Center for Cancer Cell Biology, Immunology and Infection, School of Graduate and Postdoctoral Studies, Rosalind Franklin University, Chicago Medical School, North Chicago, IL 60064, USA
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Cornea A, Lata I, Simu M, Rosca EC. Assessment and Diagnosis of HIV-Associated Dementia. Viruses 2023; 15:v15020378. [PMID: 36851592 PMCID: PMC9966987 DOI: 10.3390/v15020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The modern combined antiretroviral treatment (cART) for human immunodeficiency virus (HIV) infection has substantially lowered the incidence of HIV-associated dementia (HAD). The dominant clinical features include deficits in cognitive processing speed, concentration, attention, and memory. As people living with HIV become older, with high rates of comorbidities and concomitant treatments, the prevalence and complexity of cognitive impairment are expected to increase. Currently, the management of HAD and milder forms of HAND is grounded on the best clinical practice, as there is no specific, evidence-based, proven intervention for managing cognitive impairment. The present article acknowledges the multifactorial nature of the cognitive impairments found in HIV patients, outlining the current concepts in the field of HAD. Major areas of interest include neuropsychological testing and neuroimaging to evaluate CNS status, focusing on greater reliability in the exclusion of associated diseases and allowing for earlier diagnosis. Additionally, we considered the evidence for neurological involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the impact of the coronavirus (COVID-19) pandemic, with wider consequences to population health than can be attributed to the virus itself. The indirect effects of COVID-19, including the increased adoption of telehealth, decreased access to community resources, and social isolation, represent a significant health burden, disproportionately affecting older adults with dementia who have limited social networks and increased functional dependence on the community and health system. This synopsis reviews these aspects in greater detail, identifying key gaps and opportunities for researchers and clinicians; we provide an overview of the current concepts in the field of HAD, with suggestions for diagnosing and managing this important neurological complication, which is intended to be applicable across diverse populations, in line with clinical observations, and closely representative of HIV brain pathology.
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Affiliation(s)
- Amalia Cornea
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Irina Lata
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
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Vance D, Fazeli P, Azuero A, Frank JS, Wadley VG, Raper JL, Pope CN, Ball K. Can individualized-targeted computerized cognitive training improve everyday functioning in adults with HIV-associated neurocognitive disorder? APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:8-19. [PMID: 34000940 PMCID: PMC9881593 DOI: 10.1080/23279095.2021.1906678] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Half of people with human immunodeficiency virus (HIV) have HIV-associated neurocognitive disorder (HAND). Fortunately, cognitive training programs can improve function across cognitive domains, which may translate to everyday functioning. The Training on Purpose (TOPS) Study was designed to reverse HAND by targeting cognitive training to specific cognitive impairments that contributed to the diagnosis. A secondary aim of TOPS was to determine whether such cognitive training improved subjective and objective everyday functioning. In this two-group pre-post experimental design study, 109 adults with HAND were randomized to either: (1) a no-contact control group (no training) or (2) the Individualized-Targeted Cognitive Training group. Each participant received approximately 10 hours of cognitive training in two selected cognitive domains based on her/his individual baseline cognitive performance. Thus, 20 hours of individualized training on these two cognitive domains occurred over a course of 12 weeks in 1-2 hour sessions. Specific to the secondary aim of TOPS, measures of everyday functioning were administered before and after cognitive training to examine transfer effects. The analyses revealed that in general, speed of processing training produced benefits in everyday functioning as measured by the medication adherence visual analogue scale and the Timed Instrumental Activities of Daily Living test. Inconsistent findings were found for the other seven cognitive training protocols in either improving everyday functioning or reducing perceived everyday functioning; however, there may be other contributing factors that obscured such effects needing further research. This study demonstrated that some training protocols vary in efficacy in altering both objective and subjective everyday functioning ability.
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Affiliation(s)
- David Vance
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya Fazeli
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer S Frank
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia G Wadley
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - James L Raper
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caitlin N Pope
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA
- Unit of Health, Behavior & Society, University of Kentucky, Lexington, KY, USA
| | - Karlene Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Cody SL, Miller GH, Fazeli PL, Wang G, Li W, Goodin BR, Vance DE. Preventing Neurocognitive Decline in Adults Aging with HIV: Implications for Practice and Research. J Alzheimers Dis 2023; 95:753-768. [PMID: 37599532 DOI: 10.3233/jad-230203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Mild to moderate forms of neurocognitive impairment persist among people living with HIV (PLWH), despite being virally suppressed on antiretroviral therapy. PLWH are disproportionally impacted by physiological and psychosocial comorbidities compared to those without HIV. As adults live longer with HIV, the neurocognitive burden of physiological and psychosocial stressors can impair everyday functioning and may contribute to the development of neurodegenerative diseases such as Alzheimer's disease. This article outlines neurocognitive consequences of everyday stressors in PLWH. While some lifestyle factors can exacerbate inflammatory processes and promote negative neurocognitive health, novel interventions including the use of cannabinoids may be neuroprotective for aging PLWH who are at risk for elevated levels of inflammation from comorbidities. Studies of integrated neurocognitive rehabilitation strategies targeting lifestyle factors are promising for improving neurocognitive health, and may over time, reduce the risk of Alzheimer's disease in PLWH.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | - Gabe H Miller
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ge Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Ham L, Tang B, Kohli M, Jeste DV, Grant I, Moore DJ. Four-Year Trajectories of Internal Strengths and Socioemotional Support Among Middle-Aged and Older Adults with HIV. AIDS Behav 2023; 27:628-640. [PMID: 35908270 PMCID: PMC9908640 DOI: 10.1007/s10461-022-03798-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/31/2023]
Abstract
Positive psychological attributes are associated with better health outcomes, yet few studies have identified their underlying constructs and none have examined their temporal trajectories in clinical vs. non-clinical samples. From data collected over 4 years from people with HIV (PWH) and HIV-uninfected (HIV-) participants, we identified two latent factors (internal strengths; socioemotional support) based on responses to seven positive psychological attributes. Internal strengths increased over 4 years for PWH, but not for HIV- comparisons. Socioemotional support did not change significantly in either group. Lower internal strengths and worse socioemotional support were related to greater depressive symptoms. We speculate that improvement in internal strengths in PWH could reflect their being in care, but this requires further study to include PWH not in care. Given the apparent malleability of internal strengths and their association with improved health outcomes, these attributes can serve as promising intervention targets for PWH.
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Affiliation(s)
- Lillian Ham
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 220 Dickinson Street, San Diego, CA, 92103, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Maulika Kohli
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 220 Dickinson Street, San Diego, CA, 92103, USA
- HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA.
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de Menezes EGM, Liu JS, Bowler SA, Giron LB, D’Antoni ML, Shikuma CM, Abdel-Mohsen M, Ndhlovu LC, Norris PJ. Circulating brain-derived extracellular vesicles expressing neuroinflammatory markers are associated with HIV-related neurocognitive impairment. Front Immunol 2022; 13:1033712. [PMID: 36601110 PMCID: PMC9806169 DOI: 10.3389/fimmu.2022.1033712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background Neurocognitive impairment remains prevalent in people with HIV (PWH) despite long term virological suppression by antiretroviral therapy (ART) regimens. Systemic and neuro-inflammatory processes are suggested to contribute to the complex pathology leading to cognitive impairment in this population, yet the underlying mechanisms remain unresolved. Extracellular vesicles (EVs) play a central role in intracellular communication and have emerged as key modulators of immunological and inflammatory responses. In this report, we examined the impact of EVs in PWH experiencing cognitive deficits to determine their relevance in HIV associated neuropathology. Methods EV phenotypes were measured in plasma samples from 108 PWH with either cognitive impairment (CI, n=92) or normal cognition (NC, n=16) by flow cytometry. Matched cerebrospinal fluid (CSF)-derived EVs were similarly profiled from a subgroup of 84 individuals who underwent a lumbar puncture. Peripheral blood mononuclear cells were assayed by flow cytometry to measure monocyte frequencies in a subset of 32 individuals. Results Plasma-EVs expressing CD14, CD16, CD192, C195, and GFAP were significantly higher in HIV-infected individuals with cognitive impairment compared to individuals with normal cognition. Increased CSF-EVs expressing GFAP and CD200 were found in the cognitive impairment group compared to the normal cognition group. Frequencies of patrolling monocytes correlated with plasma-EVs expressing CD14, CD66b, MCSF, MAP2, and GFAP. Frequencies of CD195 expression on monocytes correlated positively with plasma-EVs expressing CD41a, CD62P, and CD63. Expression of CD163 on monocytes correlated positively with CSF-EVs expressing GFAP and CD200. Finally, the expression of CD192 on total monocytes correlated with CSF-EVs expressing CD200, CD62P, and CD63. Conclusions EVs expressing monocyte activation and neuronal markers associated with HIV associated cognitive impairment, suggesting that distinct EV subsets may serve as novel biomarkers of neuronal injury in HIV infection. Further circulating platelet EV levels were linked to monocyte activation indicating a potential novel interaction in the pathogenesis of HIV-related cognitive impairment.
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Affiliation(s)
- Erika G. Marques de Menezes
- Vitalant Research Institute, San Francisco, CA, United States,Department of Laboratory Medicine, University of California, San Francisco, CA, United States,*Correspondence: Erika G. Marques de Menezes,
| | - Jocelyn S. Liu
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Scott A. Bowler
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | | | - Michelle L. D’Antoni
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Cecilia M. Shikuma
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | | | - Lishomwa C. Ndhlovu
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States,Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States,Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Philip J. Norris
- Vitalant Research Institute, San Francisco, CA, United States,Department of Laboratory Medicine, University of California, San Francisco, CA, United States,Department of Medicine, University of California, San Francisco, CA, United States
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Boonyagars L, Kiatsoongsong N, Winitprichagul S. HIV-Associated Dementia: Associated Factors and Characteristics of Cognitive Domain Abnormalities in Elderly People Living with HIV Treated with Highly Active Antiretroviral Therapy. Am J Trop Med Hyg 2022; 107:1250-1257. [PMID: 36315995 PMCID: PMC9768268 DOI: 10.4269/ajtmh.22-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/05/2022] [Indexed: 12/30/2022] Open
Abstract
This study aimed to evaluate the prevalence and associated factors of HIV-associated dementia (HAD) in people living with HIV (PLWH) aged ≥ 60 years who are currently treated with highly active antiretroviral therapy. A cross-sectional study was conducted on adult (age ≥ 60 years) PLWH at the infectious clinic, Vajira Hospital, Navamindradhiraj University, Thailand, between August 2019 and March 2021. We collected the patients' characteristics and performed Montreal Cognitive Assessment and Instrumental Activities of Daily Living test to determine whether they have HIV-associated neurocognitive disorders (HAND), which we further classified into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HAD. Finally, we evaluated the prevalence, associated factors, and characteristics of cognitive domain abnormalities in these patients. We enrolled 84 elderly PLWH patients consisting of 43 (51.2%) males. The mean patient age was 63 years (SD ± 3.9), and the median duration of HIV infection was 13 (SD ± 5.7) years. All the patients had undetectable HIV viral load. Among them, seven (8.3%) had no neurocognitive impairment, 61 (72.6%) had ANI, three (3.6%) had MND, and 13 (15.5%) had HAD. After confounder adjustment, the patient age of ≥ 65 years was found to be significantly associated with dementia (odds ratio = 5.97, 95% CI: 1.51-23.57). Significant difference in the mean score of all cognitive domains was observed between the patients with HAD and those with normal cognitive status. HAND is common in PLWH. Age older than ≥ 65 years is a risk factor of HAD.
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Affiliation(s)
- Lakkana Boonyagars
- Division of Infectious Diseases, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand
| | - Nucharee Kiatsoongsong
- Department of Internal Medicine, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand
| | - Supharat Winitprichagul
- Division of Neurology, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand,Address correspondence to Supharat Winitprichagul, Division of Neurology, Faculty of Medicine, Navamindradhiraj University, Bangkok 10300, Thailand. E-mail:
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40
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Cody SL, Hobson JM, Gilstrap SR, Thomas SJ, Galinat D, Goodin BR. Sleep Disturbances and Chronic Pain in People with HIV: Implications for HIV-Associated Neurocognitive Disorders. CURRENT SLEEP MEDICINE REPORTS 2022; 8:124-131. [PMID: 36687512 PMCID: PMC9851157 DOI: 10.1007/s40675-022-00236-3] [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] [Accepted: 10/20/2022] [Indexed: 11/14/2022]
Abstract
Purpose of Review Antiretroviral therapy has significantly reduced morbidity and mortality in people with HIV. Despite being virally suppressed, sleep disturbances, chronic pain, and neurocognitive impairments persist which can negatively impact quality of life for people with HIV. This article presents relevant literature related to sleep disturbances and chronic pain in people with HIV. The potential impact of these comorbidities on cognition is discussed with implications for managing HIV-associated neurocognitive disorder (HAND). Recent Findings People with HIV and chronic pain report greater insomnia and depressive symptoms compared to those without chronic pain. The neurotoxic effects of HIV itself and sleep and chronic pain induced inflammation can contribute to poorer cognitive outcomes. Summary Sleep disturbances and chronic pain are prevalent conditions in people with HIV that may perpetuate the development and exacerbation of HAND. Sleep and pain interventions may preserve cognitive function and improve quality of life for people aging with HIV.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, U.S.A
| | - Joanna M Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Shannon R Gilstrap
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - S Justin Thomas
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - David Galinat
- Alabama Water Institute, The University of Alabama, Tuscaloosa, Alabama, U.S.A
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
- Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, U.S.A
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Arjona SP, Allen CNS, Santerre M, Gross S, Soboloff J, Booze R, Sawaya BE. Disruption of Mitochondrial-associated ER membranes by HIV-1 tat protein contributes to premature brain aging. CNS Neurosci Ther 2022; 29:365-377. [PMID: 36419337 PMCID: PMC9804058 DOI: 10.1111/cns.14011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Mitochondrial-associated ER membranes (MAMs) control many cellular functions, including calcium and lipid exchange, intracellular trafficking, and mitochondrial biogenesis. The disruption of these functions contributes to neurocognitive disorders, such as spatial memory impairment and premature brain aging. Using neuronal cells, we demonstrated that HIV-1 Tat protein deregulates the mitochondria. METHODS& RESULTS To determine the mechanisms, we used a neuronal cell line and showed that Tat-induced changes in expression and interactions of both MAM-associated proteins and MAM tethering proteins. The addition of HIV-1 Tat protein alters expression levels of PTPIP51 and VAPB proteins in the MAM fraction but not the whole cell. Phosphorylation of PTPIP51 protein regulates its subcellular localization and function. We demonstrated that the Tat protein promotes PTPIP51 phosphorylation on tyrosine residues and prevents its binding to VAPB. Treatment of the cells with a kinase inhibitor restores the PTPIP51-VAPB interaction and overcomes the effect of Tat. CONCLUSION These results suggest that Tat disrupts the MAM, through the induction of PTPIP51 phosphorylation, leading to ROS accumulation, mitochondrial stress, and altered movement. Hence, we concluded that interfering in the MAM-associated cellular pathways contributes to spatial memory impairment and premature brain aging often observed in HIV-1-infected patients.
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Affiliation(s)
- Sterling P. Arjona
- Molecular Studies of Neurodegenerative Diseases Lab, Fels Cancer Institute for Personalized Medicine, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Charles N. S. Allen
- Molecular Studies of Neurodegenerative Diseases Lab, Fels Cancer Institute for Personalized Medicine, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Maryline Santerre
- Molecular Studies of Neurodegenerative Diseases Lab, Fels Cancer Institute for Personalized Medicine, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Scott Gross
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Jonathan Soboloff
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Rosemarie Booze
- Program of Behavioral Neuroscience, Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Bassel E. Sawaya
- Molecular Studies of Neurodegenerative Diseases Lab, Fels Cancer Institute for Personalized Medicine, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA,Department of Cancer and Cellular BiologyLewis Katz School of Medicine, Temple UniversityPhiladelphiaPennsylvaniaUSA,Department of Neural SciencesLewis Katz School of Medicine, Temple UniversityPhiladelphiaPennsylvaniaUSA
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Mu T, Wei J, Sun J, Jin J, Zhang T, Wu H, Su B. Association of apolipoprotein E epsilon 4 and cognitive impairment in adults living with human immunodeficiency virus: a meta-analysis. Chin Med J (Engl) 2022; 135:2677-2686. [PMID: 36719356 PMCID: PMC9945176 DOI: 10.1097/cm9.0000000000002480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is controversial whether the apolipoprotein E epsilon 4 allele (APOE ε4) is a risk gene for human immunodeficiency virus (HIV)-related neurocognitive impairment. This meta-analysis aimed to summarize evidence of the associations between APOE ε4 and cognitive impairment in people living with HIV (PLWH). METHODS Our study conducted a systematic literature search of PubMed, Web of Science, Embase, Google Scholar, and ProQuest for studies published before April 11, 2022 that evaluated associations between APOE ε4 and cognitive impairment in adult PLWH (aged ≥18 years). We calculated pooled odds ratios (ORs) of global cognitive impairment and 95% confidence intervals (CIs) and standardized mean differences (SMDs) for specific cognitive domains between APOE ε4 carriers and non-carriers. Subgroup meta-analyses were used to evaluate the result profiles across different categorical variables. RESULTS Twenty studies met the inclusion criteria, including 19 that evaluated global cognitive impairment. APOE ε4 was significantly associated with global cognitive impairment in PLWH (OR = 1.36, 95% CI = [1.05, 1.78], number of estimates [k] = 19, P = 0.02, random effects). Subgroup meta-analysis based percentage of females showed evident intergroup differences in global cognitive performance between ε4 carriers and non-carriers (P = 0.015). APOE ε4 carriers had lower cognitive test scores than non-carriers in all seven cognitive domains, including fluency (SMD = -0.51, 95% CI = [-0.76, -0.25], P < 0.001, k = 4, I2 = 0%), learning (SMD = -0.52, 95% CI = [-0.75, -0.28], P < 0.001, k = 5, I2 = 0%), executive function (SMD = -0.41, 95% CI = [-0.59, -0.23], P < 0.001, k = 8, I2 = 0%), memory (SMD = -0.41, 95% CI = [-0.61, -0.20], P < 0.001, k = 10, I2 = 36%), attention/working memory (SMD = -0.34, 95% CI = [-0.54, -0.14], P = 0.001, k = 6, I2 = 0%), speed of information processing (SMD = -0.34, 95% CI = [-0.53, -0.16], P < 0.001, k = 8, I2 = 0%), and motor function (SMD = -0.19, 95% CI = [-0.38, -0.01], P = 0.04, k = 7, I2 = 0%). CONCLUSIONS Our meta-analysis provides significant evidence that APOE ε4 is a risk genotype for HIV-associated cognitive impairment, especially in cognitive domains of fluency, learning, executive function, and memory. Moreover, the impairment is sex specific. META ANALYSIS REGISTRATION PROSPERO, CRD 42021257775.
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Affiliation(s)
- Tingting Mu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Jiaqi Wei
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Jun Sun
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Junyan Jin
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Tong Zhang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
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Trease AJ, Niu M, Morsey B, Guda C, Byrareddy SN, Buch S, Fox HS. Antiretroviral therapy restores the homeostatic state of microglia in SIV-infected rhesus macaques. J Leukoc Biol 2022; 112:969-981. [PMID: 35686500 PMCID: PMC9796061 DOI: 10.1002/jlb.3hi0422-635r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/11/2022] [Indexed: 12/31/2022] Open
Abstract
Microglia and macrophages are essential for homeostatic maintenance and innate immune response in the brain. They are the first line of defense against infections such as HIV/SIV in the brain. However, they are susceptible to infection and function as viral reservoirs even under effective viral suppression. While current antiretroviral regimens successfully suppress viremia and improve quality of life and lifespan, neurologic complications persist and are in part attributed to activated microglia. We sought to test the hypothesis that brain microglia return to a more homeostatic-like state when viremia is suppressed by combination antiretroviral therapy. Using the SIV-rhesus macaque model, we combined single-cell RNA sequencing, bioinformatics, and pathway analysis to compare gene expression profiles of brain myeloid cells under 4 conditions: uninfected, SIV infected, SIV infected with cART suppression, and SIV encephalitis (SIVE). Our study reveals greater myeloid diversity and an elevated proinflammatory state are associated with untreated SIV infection compared with uninfected animals. The development of encephalitis and suppression of viremia both reduced myeloid diversity. However, they had converse effects on the activation state of microglia and inflammation. Notably, suggestive of a restoration of a homeostatic state in microglia, gene expression and activation of pathways related to inflammation and immune response in cART-suppressed monkeys were most similar to that in uninfected monkeys. Untreated SIV infection shared characteristics, especially in brain macrophages to SIVE, with SIVE showing dramatic inflammation. In support of our hypothesis, our study demonstrates that cART indeed restores this key component of the brain's homeostatic state. Summary: ScRNA-seq of rhesus monkey microglia reveals clusters of cells in activated states in the setting of SIV infection, which is primarily reversed by suppressing viremia with combination antiretroviral therapy.
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Affiliation(s)
- Andrew J. Trease
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Meng Niu
- Department of Genetics, Cell Biology and AnatomyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Brenda Morsey
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Chittibabu Guda
- Department of Genetics, Cell Biology and AnatomyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Siddappa N. Byrareddy
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Shilpa Buch
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Howard S. Fox
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Han S, Aili X, Ma J, Liu J, Wang W, Yang X, Wang X, Sun L, Li H. Altered regional homogeneity and functional connectivity of brain activity in young HIV-infected patients with asymptomatic neurocognitive impairment. Front Neurol 2022; 13:982520. [PMID: 36303561 PMCID: PMC9593212 DOI: 10.3389/fneur.2022.982520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 01/10/2023] Open
Abstract
Objective Asymptomatic neurocognitive impairment (ANI) is a predominant form of cognitive impairment in young HIV-infected patients. However, the neurophysiological mechanisms underlying this disorder have not been clarified. We aimed to evaluate the altered patterns of functional brain activity in young HIV-infected patients with ANI by quantifying regional homogeneity (ReHo) and region of interest (ROI)-based functional connectivity (FC). Methods The experiment involved 44 young HIV-infected patients with ANI and 47 well-matched healthy controls (HCs) undergoing resting-state functional magnetic resonance imaging (rs-fMRI) and neurocognitive tests. Reho alterations were first explored between the ANI group and HC groups. Subsequently, regions showing differences in ReHo were defined as ROIs for FC analysis. Finally, the correlation of ReHo and FC with cognitive function and clinical variables was assessed. Results Compared with HCs, ANI patients had a significant ReHo decrease in the right lingual gyrus (LING. R), right superior occipital gyrus (SOG. R), left superior occipital gyrus (SOG. L), left middle occipital gyrus (MOG. L), right middle frontal gyrus (MFG. R), cerebellar vermis, ReHo enhancement in the left middle frontal gyrus (MFG. L), and left insula (INS L). The ANI patients showed increased FC between the LING. R and MOG. L compared to HC. For ANI patients, verbal and language scores were negatively correlated with increased mean ReHo values in the MFG.L. Increased mean ReHo values in the INS. L was positively correlated with disease duration—the mean ReHo values in the LING. R was positively correlated with the abstraction and executive function scores. Increased FC between the LING. R and MOG. L was positively correlated with verbal and language performance. Conclusion The results suggest that the visual network might be the most vulnerable area of brain function in young HIV-infected patients with ANI. The middle frontal gyrus, cerebellar vermis, and insula also play an important role in asymptomatic neurocognitive impairment. The regional homogeneity and functional connectivity of these regions have compound alterations, which may be related to the course of the disease and neurocognitive function. These neuroimaging findings will help us understand the characteristics of brain network modifications in young HIV-infected patients with ANI.
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Affiliation(s)
- Shuai Han
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xire Aili
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Juming Ma
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiaojiao Liu
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xue Yang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xi Wang
- STD & AIDS Clinic, Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lijun Sun
- STD & AIDS Clinic, Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Lijun Sun
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
- *Correspondence: Hongjun Li
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Killingsworth L, Spudich S. Neuropathogenesis of HIV-1: insights from across the spectrum of acute through long-term treated infection. Semin Immunopathol 2022; 44:709-724. [PMID: 35882661 PMCID: PMC10126949 DOI: 10.1007/s00281-022-00953-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/20/2022] [Indexed: 01/16/2023]
Abstract
This review outlines the neuropathogenesis of HIV, from initial HIV entry into the central nervous system (CNS) to chronic infection, focusing on key advancements in the last 5 years. Discoveries regarding acute HIV infection reveal timing and mechanisms of early HIV entry and replication in the CNS, early inflammatory responses, and establishment of genetically distinct viral reservoirs in the brain. Recent studies additionally explore how chronic HIV infection is maintained in the CNS, examining how the virus remains in a latent "hidden" state in diverse cells in the brain, and how this leads to sustained pathological inflammatory responses. Despite viral suppression with antiretroviral therapy, HIV can persist and even replicate in the CNS, and associate with ongoing neuropathology including CD8 + T-lymphocyte mediated encephalitis. Crucial investigation to advance our understanding of the immune mechanisms that both control viral infection and lead to pathological consequences in the brain is necessary to develop treatments to optimize long-term neurologic health in people living with HIV.
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Affiliation(s)
- Lauren Killingsworth
- Department of Neurology, Yale University School of Medicine, 300 George Street, Room 8300c, New Haven, CT, 06520, USA
| | - Serena Spudich
- Department of Neurology, Yale University School of Medicine, 300 George Street, Room 8300c, New Haven, CT, 06520, USA.
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Kaddu-Mulindwa D, Heit M, Wagenpfeil G, Bewarder M, Fassbender K, Behnke S, Yilmaz U, Fousse M. Fewer neurocognitive deficits and less brain atrophy by third ventricle measurement in PLWH treated with modern ART: A prospective analysis. Front Neurol 2022; 13:962535. [PMID: 36081869 PMCID: PMC9447481 DOI: 10.3389/fneur.2022.962535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite antiretroviral therapy, cognitive dysfunction seems to remain a major issue for people living with human immunodeficiency virus (PLWH). Previous studies showed a correlation between the width of the third ventricle (WTV) and neurocognitive disorders in PLWH. Patients and methods We investigated prevalence and correlation of neuropsychological disorders using WTV as a brain atrophy marker examined by transcranial sonography and MRI in PLWH and healthy age- and gender-matched controls. We used Becks Depression Inventory (BDI) for depression screening, the questionnaires Fatigue Severity Scale (FSS) for fatigue and Short-Form-36 (SF36) for quality of life (QoL) evaluation and Consortium to establish a registry for Alzheimer's disease (CERAD-PLUS) as neuropsychological test battery. Results 52 PLWH (47 males) and 28 non-infected controls (23 males) with a median age of 52 years (24–78 years) and 51 years (22–79) were analyzed. WTV correlated significantly with age (p < 0.01) but showed no significantly difference in PLWH (median = 3.4 mm) compared to healthy controls (median = 2.8 mm) (p = 0.085). PLWH had both significantly higher BDI-Scores (p = 0.005) and FSS-Scores (p = 0.012). Controls reported higher QoL (SF-36) with significant differences in most items. However, the overall cognitive performance (CERAD total score) showed no significant difference. The WTV of all subjects correlated with neurocognitive performance measured as CERAD total score (p = 0.009) and trail making tests A (p < 0.001) and B (p = 0.018). There was no correlation between the scores of BDI, FSS, SF-36, and CERAD-PLUS items and WTV. Conclusion WTV is considered as a predictor of cognitive deficits in neurodegenerative diseases. Nevertheless, we found no significant difference in WTV or overall cognitive performance between PLWH and controls. PLWH suffer more often from depression and fatigue and report reduced QoL when compared to healthy controls.
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Affiliation(s)
- Dominic Kaddu-Mulindwa
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Matthias Heit
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometrics, Epidemiology and Medical Computer Science, Saarland University Medical School, Homburg, Germany
| | - Moritz Bewarder
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical School, Homburg, Germany
| | - Stefanie Behnke
- Department of Neurology, Saarland University Medical School, Homburg, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Medical School, Homburg, Germany
| | - Mathias Fousse
- Department of Neurology, Saarland University Medical School, Homburg, Germany
- *Correspondence: Mathias Fousse
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47
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The Role of Pannexin-1 Channels in HIV and NeuroHIV Pathogenesis. Cells 2022; 11:cells11142245. [PMID: 35883688 PMCID: PMC9323506 DOI: 10.3390/cells11142245] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023] Open
Abstract
The human immunodeficiency virus-1 (HIV) enters the brain shortly after infection, leading to long-term neurological complications in half of the HIV-infected population, even in the current anti-retroviral therapy (ART) era. Despite decades of research, no biomarkers can objectively measure and, more importantly, predict the onset of HIV-associated neurocognitive disorders. Several biomarkers have been proposed; however, most of them only reflect late events of neuronal damage. Our laboratory recently identified that ATP and PGE2, inflammatory molecules released through Pannexin-1 channels, are elevated in the serum of HIV-infected individuals compared to uninfected individuals and other inflammatory diseases. More importantly, high circulating ATP levels, but not PGE2, can predict a decline in cognition, suggesting that HIV-infected individuals have impaired ATP metabolism and associated signaling. We identified that Pannexin-1 channel opening contributes to the high serological ATP levels, and ATP in the circulation could be used as a biomarker of HIV-associated cognitive impairment. In addition, we believe that ATP is a major contributor to chronic inflammation in the HIV-infected population, even in the anti-retroviral era. Here, we discuss the mechanisms associated with Pannexin-1 channel opening within the circulation, as well as within the resident viral reservoirs, ATP dysregulation, and cognitive disease observed in the HIV-infected population.
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48
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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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Vance DE, Lee Y, Batey DS, Li W, Chapman Lambert C, Nakkina SR, Anderson JN, Triebel K, Byun JY, Fazeli PL. Emerging directions of cognitive aging with HIV: practice and policy implications for social work. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:476-494. [PMID: 34511048 DOI: 10.1080/01634372.2021.1978028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
Cognitive impairments have been endemic to the HIV epidemic since its beginning and persist to this day. These impairments are attributed to HIV-induced neuroinflammation, the long-term effects of combination antiretroviral therapy, lifestyle factors (e.g., sedentary behavior, substance use), neuro-comorbidities (e.g., depression), age-associated comorbidities (e.g., heart disease, hypertension), and others causes. Normal aging and lifestyle also contribute to the development of cognitive impairment. Regardless of the etiology, such cognitive impairments interfere with HIV care (e.g., medication adherence) and everyday functioning (e.g., driving safely, financial management). With more than half of people with HIV (PWH) 50 years and older, and ~45% of all PWH meeting the criteria for HIV-Associated Neurocognitive Disorder (HAND), those aging PWH are more vulnerable for developing cognitive impairment. This article provides an update to a social work model to identify and monitor PWH for cognitive impairment. Within this update, the state of the science on protecting brain health and cognitive reserve within the context of neuroHIV is also presented. From this, implications for practice and policy to promote successful cognitive functioning in older PWH are provided.
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Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yookyong Lee
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wei Li
- Department of Clinical and Diagnostic Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Sai Rashmi Nakkina
- College of Arts and Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph N Anderson
- School of Medicine, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristen Triebel
- School of Medicine, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jun Y Byun
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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50
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Trunfio M, De Francesco D, Vai D, Medina C, Milesi M, Domini S, Alcantarini C, Imperiale D, Bonora S, Di Perri G, Calcagno A. Screening Accuracy of Mini Addenbrooke's Cognitive Examination Test for HIV-Associated Neurocognitive Disorders in People Ageing with HIV. AIDS Behav 2022; 26:2203-2211. [PMID: 34982319 DOI: 10.1007/s10461-021-03563-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
Aging and increased cardiovascular risk are major drivers for HIV-associated neurocognitive disorders (HAND), for which accurate screenings are lacking. Mini-Addenbrooke's Cognitive Examination (MACE) reliably detects vascular and neurodegenerative cognitive decline among HIV-negative patients. We evaluated MACE diagnostic accuracy in detecting HAND in people living with HIV (PLWH) and we compared it with the International HIV Dementia Scale (IHDS). A single-centre double-blind study of diagnostic accuracy on adult outpatient PLWH without neurocognitive confounding was performed. MACE and IHDS were administered in 5 and 10 min by clinicians, followed by the reference standard battery (14 tests) by neuropsychologists. HAND diagnosis was based on the modified version of Frascati's criteria by Gisslén to reduce false positives. Exploratory cut-offs were evaluated for MACE. Diagnostic accuracy and clinical utility parameters were assessed. 231 patients were enrolled. 75.7% men with a median age, education, and length of infection of 54 (48-59), 10 (8-13) and 16 (5-25) years. HAND prevalence was 48.5% (38.9% asymptomatic impairment). Compared to IHDS, MACE sensitivity (89.3% vs 70.5%), specificity (94.1% vs 63.0%), correct classification rate (86.5% vs 66.7%), J index (0.83 vs 0.34), AUROC (0.97 vs 0.79), agreement with the gold standard (k 0.84 vs 0.33) and effect size in distinguishing HAND vs non-HAND (d 2.11 vs 1.15) were higher. Among PLWH aged 65 years and above (n = 37) MACE performance was consistently better than IHDS. The quick and easy-to-perform MACE could possess an accurate and useful screening performance for HAND in otherwise neurocognitively healthy cohorts of PLWH.
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Affiliation(s)
- Mattia Trunfio
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy.
| | - Davide De Francesco
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Daniela Vai
- Neurology Unit, Maria Vittoria Hospital, ASL Città Di Torino, Torino, Italy
| | - Caterina Medina
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Maurizio Milesi
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Simone Domini
- Neurology Unit, Maria Vittoria Hospital, ASL Città Di Torino, Torino, Italy
| | - Chiara Alcantarini
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Daniele Imperiale
- Neurology Unit, Maria Vittoria Hospital, ASL Città Di Torino, Torino, Italy
| | - Stefano Bonora
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Andrea Calcagno
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
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