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Tang B, Ellis RJ, Vaida F, Umlauf A, Franklin DR, Dastgheyb R, Rubin LH, Riggs PK, Iudicello JE, Clifford DB, Moore DJ, Heaton RK, Letendre SL. Biopsychosocial phenotypes in people with HIV in the CHARTER cohort. Brain Commun 2024; 6:fcae224. [PMID: 39077377 PMCID: PMC11285184 DOI: 10.1093/braincomms/fcae224] [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: 11/17/2023] [Revised: 05/22/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
Neuropsychiatric complications such as neurocognitive impairment and depression are common in people with HIV despite viral suppression on antiretroviral therapy, but these conditions are heterogeneous in their clinical presentations and associated disability. Identifying novel biopsychosocial phenotypes that account for neurocognitive performance and depressive and functional symptoms will better reflect the complexities encountered in clinical practice and may have pathological and therapeutic implications. We classified 1580 people with HIV based on 17 features, including 7 cognitive domains, 4 subscales of the Beck depression inventory-II, 5 components of the patient's assessment of own functioning inventory, and dependence in instrumental and basic activities of daily living. A two-stage clustering procedure consisting of dimension reduction with self-organizing maps and Mahalanobis distance-based k-means clustering algorithms was applied to cross-sectional data. Baseline demographic and clinical characteristics were compared between the phenotypes, and their prediction on the biopsychosocial phenotypes was evaluated using multinomial logistic regression. Four distinct phenotypes were identified. Participants in Phenotype 1 overall did well in all domains. Phenotype 2 had mild-to-moderate depressive symptoms and the most substance use disorders. Phenotype 3 had mild-to-moderate cognitive impairment, moderate depressive symptoms, and the worst daily functioning; they also had the highest proportion of females and non-HIV conditions that could affect cognition. Phenotype 4 had mild-to-moderate cognitive impairment but with relatively good mood, and daily functioning. Multivariable analysis showed that demographic characteristics, medical conditions, lifetime cocaine use disorder, triglycerides, and non-antiretroviral therapy medications were important variables associated with biopsychosocial phenotype. We found complex, multidimensional biopsychosocial profiles in people with HIV that were associated with different risk patterns. Future longitudinal work should determine the stability of these phenotypes, assess factors that influence transitions from one phenotype to another, and characterize their biological associations.
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Affiliation(s)
- Bin Tang
- 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
| | - Florin Vaida
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Patricia K Riggs
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Jennifer E Iudicello
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - David B Clifford
- Department of Neurology, Washington University at St. Louis, St. Louis, MO 63110, USA
| | - David J Moore
- Department of Psychiatry, 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
| | - 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
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Honeycutt JB, Wahl A, Files JK, League AF, Yadav-Samudrala BJ, Garcia JV, Fitting S. In situ analysis of neuronal injury and neuroinflammation during HIV-1 infection. Retrovirology 2024; 21:11. [PMID: 38945996 PMCID: PMC11215835 DOI: 10.1186/s12977-024-00644-z] [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: 01/25/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Since the introduction of combination antiretroviral therapy (cART) the brain has become an important human immunodeficiency virus (HIV) reservoir due to the relatively low penetration of many drugs utilized in cART into the central nervous system (CNS). Given the inherent limitations of directly assessing acute HIV infection in the brains of people living with HIV (PLWH), animal models, such as humanized mouse models, offer the most effective means of studying the effects of different viral strains and their impact on HIV infection in the CNS. To evaluate CNS pathology during HIV-1 infection in the humanized bone marrow/liver/thymus (BLT) mouse model, a histological analysis was conducted on five CNS regions, including the frontal cortex, hippocampus, striatum, cerebellum, and spinal cord, to delineate the neuronal (MAP2ab, NeuN) and neuroinflammatory (GFAP, Iba-1) changes induced by two viral strains after 2 weeks and 8 weeks post-infection. RESULTS Findings reveal HIV-infected human cells in the brain of HIV-infected BLT mice, demonstrating HIV neuroinvasion. Further, both viral strains, HIV-1JR-CSF and HIV-1CH040, induced neuronal injury and astrogliosis across all CNS regions following HIV infection at both time points, as demonstrated by decreases in MAP2ab and increases in GFAP fluorescence signal, respectively. Importantly, infection with HIV-1JR-CSF had more prominent effects on neuronal health in specific CNS regions compared to HIV-1CH040 infection, with decreasing number of NeuN+ neurons, specifically in the frontal cortex. On the other hand, infection with HIV-1CH040 demonstrated more prominent effects on neuroinflammation, assessed by an increase in GFAP signal and/or an increase in number of Iba-1+ microglia, across CNS regions. CONCLUSION These findings demonstrate that CNS pathology is widespread during acute HIV infection. However, neuronal loss and the magnitude of neuroinflammation in the CNS is strain dependent indicating that strains of HIV cause differential CNS pathologies.
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Affiliation(s)
- Jenna B Honeycutt
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Angela Wahl
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, AL, 35294, USA
| | - Jacob K Files
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, AL, 35294, USA
| | - Alexis F League
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Barkha J Yadav-Samudrala
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - J Victor Garcia
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, AL, 35294, USA.
| | - Sylvia Fitting
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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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 Control Trial of Speed of Processing Cognitive Training in Aging Adults with HIV-Associated Neurocognitive Disorder: Results of the Think Fast Study. AIDS Behav 2024:10.1007/s10461-024-04409-9. [PMID: 38954173 DOI: 10.1007/s10461-024-04409-9] [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: 06/03/2024] [Indexed: 07/04/2024]
Abstract
Nearly 40% of people with HIV (PWH) experience HIV-associated Neurocognitive Disorder (HAND). In this 3-group efficacy study, 216 PWH 40 + years with 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 Internet navigation training (n = 73; contact control group). Participants were administered a measure of SOP [i.e., the Useful Field of View Test (UFOV®)] at baseline, at posttest immediately after training, and at year 1 and year 2 follow up. Intent-to-treat linear mixed-effect models with subject-specific intercept and slope were fitted to estimate between-group mean differences at the follow-up time-points. At the post-intervention time-point, small beneficial SOP training effects were observed for the 10-h group in UFOV® total (d = 0.28, p = 0.002). Effects were of larger magnitude for the 20-h group in these same outcomes [UFOV® total (d = 0.43, p < 0.001)]. These results indicated better benefit with more training. No intervention effect was observed at year 1. At year 2, beneficial effects of small magnitude were observed again in the 10-h group [UFOV® total (d = 0.22, p = 0.253)] with larger small-to-moderate magnitude in the 20-h group [UFOV® total (d = 0.32, p = 0.104)]. This study suggests that SOP training can improve a key indicator of this cognitive performance and that treatment gains are small-to-moderate over a two-year period. Prior literature suggests slower SOP is predictive of impairment in everyday functioning in older PWH; such an approach could potentially improve everyday functioning in PWH.
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Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA.
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA
| | - Jennifer S Frank
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA
| | - Virginia G Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James L Raper
- The 1917 (HIV/AIDS) Clinic, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caitlin N Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, KY, USA
| | - Karlene K Ball
- Department of Psychology, UAB, University of Alabama at Birmingham, Birmingham, AL, 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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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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Sundermann EE, Dastgheyb R, Moore DJ, Buchholz AS, Bondi MW, Ellis RJ, Letendre SL, Heaton RK, Rubin LH. Identifying and distinguishing cognitive profiles among virally suppressed people with HIV. Neuropsychology 2024; 38:169-183. [PMID: 37971860 PMCID: PMC11260085 DOI: 10.1037/neu0000935] [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: 11/19/2023] Open
Abstract
OBJECTIVE Cognitive deficits are common among people with HIV (PWH), even when virally suppressed. We identified cognitive profiles among virally suppressed PWH and determined how sociodemographic, clinical/behavioral, and HIV disease characteristics distinguish profile membership. METHOD Participants included 704 virally suppressed PWH (Mage = 43.9 [SD = 10.2], 88% male, 58.9% non-Hispanic White) from the HIV Neurobehavioral Research Program. Demographically adjusted T scores were derived from a neuropsychological evaluation comprised of 13 tests. We implemented a pipeline involving dimension reduction and clustering to identify profiles of cognitive performance. Random forest models on a 70/30 training/testing set with internal cross-validation were used to identify sociodemographic, clinical/behavioral, and HIV disease correlates of profile membership. RESULTS Six cognitive profiles were identified: (a) "unimpaired" (19.9%); (b) weakness in verbal learning and memory (15.5%); (c) weakness in executive function and learning (25.8%); (d) weakness in motor, processing speed, and executive function (8.1%); (e) impaired learning and recall with weak-to-impaired motor, processing speed, and executive function (13.1%); (f) global deficits (17.6%). The most discriminative sociodemographic, clinical/behavioral, and HIV disease characteristics varied by profile with self-reported mood symptoms and cognitive/functional difficulties (e.g., language/communication, memory, and overall everyday function complaints) most consistently associated with profile membership. CONCLUSIONS Cognitive profiles and their associated factors among PWH are heterogeneous, but learning/memory deficits were most common and self-reported mood, and cognitive/functional difficulties were most consistently related to profile membership. This heterogeneity in cognitive profiles and their correlates in PWH suggests that differing mechanisms contribute to cognitive deficits and, thus, underscores the need for personalized risk reduction and therapeutic strategies among PWH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | - David J Moore
- Department of Psychiatry, University of California, San Diego
| | | | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego
| | | | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University
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Mazzitelli M, Trunfio M, Coin A, Sasset L, Farina J, Brundu M, Scaglione V, Devita M, Sergi G, Cattelan AM. Use of different anticholinergic scales and their correlation with anticholinergic symptom burden in a cohort of people living with HIV. J Antimicrob Chemother 2024; 79:66-77. [PMID: 37965917 PMCID: PMC11032244 DOI: 10.1093/jac/dkad348] [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: 06/23/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES How to detect the clinical impact of anticholinergic (AC) burden in people with HIV (PWH) remains poorly investigated. We cross-sectionally described the prevalence and type of AC signs/symptoms and the screening accuracy of three AC scales in detecting their presence in a modern cohort of PWH. METHODS We calculated AC Burden Scale (ABS), AC Risk Score (ARS) and AC Drug Score (ADS) in 721 adult PWH and recorded the presence of AC signs/symptoms over the previous 3 months. High AC risk was defined by ABS score ≥2, and ARS or ADS score ≥3. Comparisons among the scale were based on Cohen's inter-rater agreement, and their screening accuracy was assessed by receiver operating characteristics (ROC) curves and performance measures. RESULTS We enrolled 721 PWH, of whom 72.0% of participants were male; the median age was 53 years, and 164 participants (22.7%) were on at least one AC drug. Among these, 28.6% experienced at least one AC sign/symptom. Agreement in AC risk classification was substantial only between ARS and ADS (k = 0.6). Lower and higher risk of AC signs/symptoms was associated with dual regimens [adjusted OR (aOR) = 0.12 versus three-drug regimens, P = 0.002] and increasing number of AC drugs (aOR = 12.91, P < 0.001). Depression and COPD were also associated with higher risk of AC signs/symptoms in analysis unadjusted for number of AC drugs. ABS and ADS showed the best area under the ROC curve (AUROC) of 0.85 (0.78-0.92) and 0.84 (0.75-0.92; P < 0.001 for both). However, at the cut-off used for the general population, the sensitivity of all three scales was very low (34.0%, 46.8% and 46.8%). CONCLUSIONS Up to one-fourth of participants in our cohort were exposed to at least one AC drug, and among them AC signs/symptoms affected more than one-fourth. Both polypharmacy (as number of antiretrovirals and of co-medications with AC properties) and to a lesser extent specific comorbidities shaped the risk of developing AC signs/symptoms. Sensitive screenings for AC risk in PWH should prefer ABS or ADS based on lower cut-offs than those suggested for the general population.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Turin, Italy
- HIV Neurobehavioral Research Program and Departments of Neurosciences and Psychiatry, School of Medicine, University of California, San Diego, CA, USA
| | - Alessandra Coin
- Geriatric Unit, Padua University Hospital, 35128 Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Jacopo Farina
- Geriatric Unit, Padua University Hospital, 35128 Padua, Italy
| | - Monica Brundu
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Maria Devita
- General Psychology Department, Padua University, 35131 Padua, Italy
| | - Giuseppe Sergi
- Geriatric Unit, Padua University Hospital, 35128 Padua, Italy
| | - Anna M Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
- Department of Molecular Medicine, Padua University, 35128 Padua, Italy
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Doctor J, Winston A, Vera JH, Post FA, Boffito M, Mallon PWG, Anderson J, Prechtl C, Williams I, Johnson M, Bagkeris E, Sachikonye M, Sabin CA. Anticholinergic medications associated with falls and frailty in people with HIV. HIV Med 2023; 24:1198-1209. [PMID: 37644705 DOI: 10.1111/hiv.13532] [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: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Anticholinergic medications (ACMs) are associated with poorer age-related outcomes, including falls and frailty. We investigate associations between ACM use and recurrent falls and frailty among older (aged ≥50 years) people with HIV in the POPPY study. METHODS Anticholinergic potential of co-medications at study entry was coded using the anticholinergic burden score, anticholinergic risk score, and Scottish Intercollegiate Guidelines Network score; drugs scoring ≥1 on any scale were defined as ACM. Associations with recurrent falls (two or more falls in the previous 28 days) and frailty (modified Fried's) were assessed using logistic regression adjusting for (1) possible demographic/lifestyle confounders and (2) clinical factors and depressive symptoms (Patient Health Questionnaire-9). RESULTS ACM use was reported by 193 (28%) of 699 participants, with 64 (9%) receiving two or more ACM; commonly prescribed ACMs were codeine (12%), citalopram (12%), loperamide (9%), and amitriptyline (7%). Falls were reported in 63/673 (9%), and 126/609 (21%) met the frailty criteria. Both recurrent falls and frailty were more common in ACM users than in non-users (recurrent falls: 17% in users vs. 6% in non-users, p < 0.001; frailty: 32% vs. 17%, respectively, p < 0.001). Use of two or more ACMs was associated with increased odds of falls after adjustment for demographic/lifestyle factors (odds ratio [OR] 4.53; 95% confidence interval [CI] 2.06-9.98) and for clinical factors (OR 3.58; 95% CI 1.37-9.38). Similar albeit weaker associations were seen with frailty (OR 2.26; 95% CI 1.09-4.70 and OR 2.12; 95% CI 0.89-5.0, respectively). CONCLUSIONS ACM are commonly prescribed for people living with HIV, and evidence exists for an association with recurrent falls and frailty. Clinicians should be alert to this and reduce ACM exposure where possible.
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Affiliation(s)
| | | | - Jaime H Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Marta Boffito
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | | | | | - Ian Williams
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College, London, UK
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Mukerji SS, Petersen KJ, Pohl KM, Dastgheyb RM, Fox HS, Bilder RM, Brouillette MJ, Gross AL, Scott-Sheldon LAJ, Paul RH, Gabuzda D. Machine Learning Approaches to Understand Cognitive Phenotypes in People With HIV. J Infect Dis 2023; 227:S48-S57. [PMID: 36930638 PMCID: PMC10022709 DOI: 10.1093/infdis/jiac293] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Cognitive disorders are prevalent in people with HIV (PWH) despite antiretroviral therapy. Given the heterogeneity of cognitive disorders in PWH in the current era and evidence that these disorders have different etiologies and risk factors, scientific rationale is growing for using data-driven models to identify biologically defined subtypes (biotypes) of these disorders. Here, we discuss the state of science using machine learning to understand cognitive phenotypes in PWH and their associated comorbidities, biological mechanisms, and risk factors. We also discuss methods, example applications, challenges, and what will be required from the field to successfully incorporate machine learning in research on cognitive disorders in PWH. These topics were discussed at the National Institute of Mental Health meeting on "Biotypes of CNS Complications in People Living with HIV" held in October 2021. These ongoing research initiatives seek to explain the heterogeneity of cognitive phenotypes in PWH and their associated biological mechanisms to facilitate clinical management and tailored interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Dana Gabuzda
- Correspondence: Dana Gabuzda, MD, Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215 ()
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McIntosh RC, Clark US, Cherner M, Cysique LA, Heaton RK, Levin J, Remien RH, Thames A, Moore DJ, Rubin LH. The Evolution of Assessing Central Nervous System Complications in Human Immunodeficiency Virus: Where Do We Go From Here? J Infect Dis 2023; 227:S30-S37. [PMID: 36930636 PMCID: PMC10022716 DOI: 10.1093/infdis/jiac316] [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] [Indexed: 03/18/2023] Open
Abstract
In this fifth decade of the human immunodeficiency virus (HIV) epidemic, central nervous system (CNS) complications including cognitive impairment and mental health remain a burden for people with HIV (PWH) on antiretroviral therapy. Despite the persistence of these complications, which often co-occur, the underlying pathophysiology remains elusive and consequently treatments remain limited. To continue to grow our understanding of the underlying mechanisms of CNS complications among PWH, there is a need to reexamine our current approaches, which are now more than 2 decades old. At the 2021 National Institutes of Health-sponsored meeting on Biotypes of CNS Complications in PWH, the Neurobehavioral Working Group addressed the following: (1) challenges inherent to determining CNS complications; (2) heterogeneity in CNS complications; and (3) problems and solutions for examining integrated biotypes. The review below provides a summary of the main points presented and discussed by the Neurobehavioral Working Group at the meeting.
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Affiliation(s)
- Roger C McIntosh
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Lucette A Cysique
- Department of Psychology, University of New South Wales, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jules Levin
- National AIDS Treatment Advocacy Project, New York, New York, USA
| | - Robert H Remien
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Leah H Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, Epidemiology, and Molecular and Comparative Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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Ossowska A, Kusiak A, Świetlik D. Progression of Selected Parameters of the Clinical Profile of Patients with Periodontitis Using Kohonen's Self-Organizing Maps. J Pers Med 2023; 13:jpm13020346. [PMID: 36836580 PMCID: PMC9958729 DOI: 10.3390/jpm13020346] [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: 01/25/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
(1) Background: Periodontitis is an inflammatory condition that affects the tissues surrounding the tooth and causes clinical attachment loss, which is the loss of periodontal attachment (CAL). Periodontitis can advance in various ways, with some patients experiencing severe periodontitis in a short period of time while others may experience mild periodontitis for the rest of their lives. In this study, we have used an alternative methodology to conventional statistics, self-organizing maps (SOM), to group the clinical profiles of patients with periodontitis. (2) Methods: To predict the periodontitis progression and to choose the best treatment plan, we can use artificial intelligence, more precisely Kohonen's self-organizing maps (SOM). In this study, 110 patients, both genders, between the ages of 30 and 60, were included in this retrospective analysis. (3) Results: To discover the pattern of patients according to the periodontitis grade and stage, we grouped the neurons together to form three clusters: Group 1 was made up of neurons 12 and 16 that represented a percentage of slow progression of almost 75%; Group 2 was made up of neurons 3, 4, 6, 7, 11, and 14 in which the percentage of moderate progression was almost 65%; and Group 3 was made up of neurons 1, 2, 5, 8, 9, 10, 13, and 15 that represented a percentage of rapid progression of almost 60%. There were statistically significant differences in the approximate plaque index (API), and bleeding on probing (BoP) versus groups (p < 0.0001). The post-hoc tests showed that API, BoP, pocket depth (PD), and CAL values were significantly lower in Group 1 relative to Group 2 (p < 0.05) and Group 3 (p < 0.05). A detailed statistical analysis showed that the PD value was significantly lower in Group 1 relative to Group 2 (p = 0.0001). Furthermore, the PD was significantly higher in Group 3 relative to Group 2 (p = 0.0068). There was a statistically significant CAL difference between Group 1 relative to Group 2 (p = 0.0370). (4) Conclusions: Self-organizing maps, in contrast to conventional statistics, allow us to view the issue of periodontitis advancement by illuminating how the variables are organized in one or the other of the various suppositions.
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Affiliation(s)
- Agata Ossowska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-208 Gdańsk, Poland
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-208 Gdańsk, Poland
| | - Dariusz Świetlik
- Division of Biostatistics and Neural Networks, Medical University of Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
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Thompson EC, Muhammad JN, Adimora AA, Chandran A, Cohen MH, Crockett KB, Goparaju L, Henderson E, Kempf MC, Konkle-Parker D, Kwait J, Mimiaga M, Ofotokun I, Rubin L, Sharma A, Teplin LA, Vance DE, Weiser SD, Weiss DJ, Wilson TE, Turan JM, Turan B. Internalized HIV-Related Stigma and Neurocognitive Functioning Among Women Living with HIV. AIDS Patient Care STDS 2022; 36:336-342. [PMID: 36099481 PMCID: PMC9810353 DOI: 10.1089/apc.2022.0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.
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Affiliation(s)
- Emma C. Thompson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Josh N. Muhammad
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adoara A. Adimora
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aruna Chandran
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mardge H. Cohen
- Chicago Women's Interagency HIV Study, Chicago, Illinois, USA
| | - Kaylee B. Crockett
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lakshmi Goparaju
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Emmett Henderson
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mirjam-Colette Kempf
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennafer Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Matthew Mimiaga
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Igho Ofotokun
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Leah Rubin
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anjala Sharma
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda A. Teplin
- School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sheri D. Weiser
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Deborah J. Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tracey E. Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Janet M. Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
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13
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Kamath V, Del Bene VA, Collette C, Jacob A, Fazeli PL, Vance DE. A Pilot Study of Self-Rated and Psychophysical Olfactory Dysfunction in Men Living with HIV. CHEMOSENS PERCEPT 2022; 15:175-184. [PMID: 36406043 PMCID: PMC9648461 DOI: 10.1007/s12078-022-09305-x] [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: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
Abstract
Background Olfactory loss is associated with poor quality of life, malnutrition, and increased risk of depression, yet few studies have examined unawareness of olfactory dysfunction in men living with HIV (MLWH). Method MLWH (n = 51) completed olfaction self-ratings, psychophysical odor identification testing, cognitive measures, and questionnaires assessing smell habits, mood, cognitive failures, and quality of life. The sensitivity and specificity of olfactory self-ratings was calculated, and t-tests were used to examine factors contributing to discordance between self-rated and psychophysical olfaction dysfunction. Results We found that 33.3% (17 of 51 MLWH) of our sample demonstrated discordance between self-reported and psychophysical olfactory scores. Those unaware of olfaction dysfunction reported using less scented products in daily life but showed no other differences across demographic, clinical, or cognitive indices. Conclusions Our results cohere with prior studies of cognitively normal older adults, traumatic brain injury, and Parkinson's disease, which found that olfactory self-ratings may inadequately capture the full range of a person's olfactory status. Our work extends these findings to MLWH, with discordance rates ranging from 35 to 61% for self-rated and psychophysical olfactory dysfunction. Implications Given the differing rates of self-rated and psychophysical olfaction in our sample, psychophysical olfactory measures may be useful to consider in the neuropsychological assessment and clinical care of PLWH. Supplementary Information The online version contains supplementary material available at 10.1007/s12078-022-09305-x.
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Affiliation(s)
- Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Victor A. Del Bene
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, USA
- The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, USA
| | - Christopher Collette
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, USA
| | - Alexandra Jacob
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA
| | - Pariya L. Fazeli
- The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL USA
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL USA
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14
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Rubin LH, Ances BM. Working HAND in HAND: Central nervous system complications in people with HIV. Clin Infect Dis 2021; 74:1314. [PMID: 34415025 DOI: 10.1093/cid/ciab723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leah H Rubin
- Departments of Neurology and Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Beau M Ances
- Departments of Neurology and Radiology, Washington University in Saint Louis, Saint Louis, MO, United States.,Hope Center for Neurological Disorders, Washington University in Saint Louis, Saint Louis, MO, United States
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