1
|
Maboso Ekolo E, Masaya Mupuala A, Mabiala Bodi J, Nkuadiolandu A, Manyanga Tshibasu P. HIV-related cognitive disorders in children in Kinshasa (Democratic Republic of Congo). BMC Public Health 2024; 24:2033. [PMID: 39075395 PMCID: PMC11287852 DOI: 10.1186/s12889-024-19398-6] [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: 09/23/2023] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES HIV-infected individuals are at increased risk of neurocognitive disorders compared with the general population. Studies suggest that, despite the combination of antiretroviral drugs, HIV infection causes immune activation leading to significant neural damage; however, there is little data on HIV-infected young people in our country. METHODOLOGY This is a comparative cross-sectional study conducted between November 2020 and March 2021 on two hundred and sixteen children aged 6-15 years, including 106 HIV-positive children and 108 healthy children. Cognitive performance was assessed using the Differential Ability Scale Second Edition (DAS-II). RESULTS HIV-infected children showed lower cognitive scores than control children in the subtest group of verbal ability (82.1% vs. 43.5%); non-verbal ability (84.9% vs. 45.4%); spatial ability (79.2% vs. 21.3%) and generall conceptual ability (GCA) (88.7% vs. 43.5%). The children in the control group had significantly higher ability scores in the diagnostic tests and in school achievement, and the difference was statistically significant. CONCLUSION Cognitive impairment remains a significant complication in HIV-positive children, as suggested by low cognitive scores in more than half of our participants. This is an unresolved issue with implications for survival, quality of life and daily functioning in these children. It is important that clinicians are able to identify and manage these cognitive deficits.
Collapse
Affiliation(s)
- Esther Maboso Ekolo
- Department of Paediatrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Paediatric Neurology Unit, CUK, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Department of Gastroenterology, Nutritional Rehabilitation and Neurology, CUK, University of Kinshasa, Avenue Mangamanga 9A, Joli parc, commune de Ngaliema-Kinshasa, Kinshasa, Democratic Republic of Congo.
- Paediatrician Department of Gastroenterology, Nutritional Rehabilitation and Paediatric Neurology, CUK, University of Kinshasa, Avenue Mangamanga 9A, Joli parc, commune de Ngaliema-Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Aimée Masaya Mupuala
- Department of Paediatrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Paediatric Neurology Unit, CUK, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Department of Gastroenterology, Nutritional Rehabilitation and Neurology, CUK, University of Kinshasa, Avenue Mangamanga 9A, Joli parc, commune de Ngaliema-Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Joseph Mabiala Bodi
- Department of Paediatrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Paediatric Emergency Department, CUK, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Adolphine Nkuadiolandu
- Department of Paediatrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Department of Gastroenterology, Nutritional Rehabilitation and Neurology, CUK, University of Kinshasa, Avenue Mangamanga 9A, Joli parc, commune de Ngaliema-Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pierre Manyanga Tshibasu
- Department of Paediatrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Department of Gastroenterology, Nutritional Rehabilitation and Neurology, CUK, University of Kinshasa, Avenue Mangamanga 9A, Joli parc, commune de Ngaliema-Kinshasa, Kinshasa, Democratic Republic of Congo
| |
Collapse
|
2
|
Rachel M, Jia H, Amina A, Perez-Garcia M, Kumar M, Wicherts JM. Psychometric evaluation of the computerized battery for neuropsychological evaluation of children (BENCI) among school aged children in the context of HIV in an urban Kenyan setting. BMC Psychiatry 2023; 23:373. [PMID: 37248481 DOI: 10.1186/s12888-023-04880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Culturally validated neurocognitive measures for children in Low- and Middle-Income Countries are important in the timely and correct identification of neurocognitive impairments. Such measures can inform development of interventions for children exposed to additional vulnerabilities like HIV infection. The Battery for Neuropsychological Evaluation of Children (BENCI) is an openly available, computerized neuropsychological battery specifically developed to evaluate neurocognitive impairment. This study adapted the BENCI and evaluated its reliability and validity in Kenya. METHODOLOGY The BENCI was adapted using translation and back-translation from Spanish to English. The psychometric properties were evaluated in a case-control study of 328 children (aged 6 - 14 years) living with HIV and 260 children not living with HIV in Kenya. We assessed reliability, factor structure, and measurement invariance with respect to HIV. Additionally, we examined convergent validity of the BENCI using tests from the Kilifi Toolkit. RESULTS Internal consistencies (0.49 < α < 0.97) and test-retest reliabilities (-.34 to .81) were sufficient-to-good for most of the subtests. Convergent validity was supported by significant correlations between the BENCI's Verbal memory and Kilifi's Verbal List Learning (r = .41), the BENCI's Visual memory and Kilifi's Verbal List Learning (r = .32) and the BENCI's Planning total time test and Kilifi's Tower Test (r = -.21) and the BENCI's Abstract Reasoning test and Kilifi's Raven's Progressive Matrix (r = .21). The BENCI subtests highlighted meaningful differences between children living with HIV and those not living with HIV. After some minor adaptions, a confirmatory four-factor model consisting of flexibility, fluency, reasoning and working memory fitted well (χ2 = 135.57, DF = 51, N = 604, p < .001, RMSEA = .052, CFI = .944, TLI = .914) and was partially scalar invariant between HIV positive and negative groups. CONCLUSION The English version of the BENCI formally translated for use in Kenya can be further adapted and integrated in clinical and research settings as a valid and reliable cognitive test battery.
Collapse
Affiliation(s)
- Maina Rachel
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands.
- Brain and Mind Institute, Aga Khan University, Nairobi, 10834-00400, Kenya.
| | - He Jia
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
| | - Abubakar Amina
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Miguel Perez-Garcia
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi, 10834-00400, Kenya
| | - Jelte M Wicherts
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
| |
Collapse
|
3
|
Mouchati C, El Kamari V, Sattar A, Yu J, McComsey GA. Comprehensive assessment of neurocognitive function, inflammation markers, and adiposity in treated HIV and control. Medicine (Baltimore) 2022; 101:e31125. [PMID: 36281153 PMCID: PMC9592384 DOI: 10.1097/md.0000000000031125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
To compare the neurocognitive scores between persons living with human immunodeficiency virus (PLWH) and persons without human immunodeficiency virus (HIV) and assess the relationship between neurocognition, HIV status and variables, inflammation, and body composition measures. Cross-sectional study involving 225 participants (126 PLWH on antiretroviral therapy [ART] and 99 persons without HIV). For the first time in HIV, we used Cognivue®, an food and drug administration (FDA)-approved computer-based test to assess cognitive function. The test was calibrated to individuals' unique cognitive ability and measured 6 cognitive domains and 2 performance parameters. Markers of inflammation, immune activation, insulin resistance, and body fat composition (using dual-energy X-ray absorptiometry scan) were collected. Classical t tests, chi-square tests, and spearman correlations were used to compare and explore relationships between variables. Inverse probability weighting adjusted average treatment effect models were performed to evaluate the differences between PLWH and persons without HIV, adjusting for age, race, sex, and heroin use. Overall, 64% were male, 46% were Black, with a mean age of 43 years. Among PLWH, 83% had an undetectable HIV-1 RNA level (≤20 copies/mL). Compared persons without HIV, PLWH performed poorer across 4 domains: visuospatial (P = .035), executive function (P = .029), naming/language (P = .027), and abstraction (P = .018). In addition, PLWH had a significantly longer processing speed time compared to controls (1686.0 ms vs 1606.0 ms [P = .007]). In PLWH, lower cognitive testing domain scores were associated with higher inflammatory markers (high sensitivity C-reactive protein [hsCRP]) and with higher total fat and visceral adipose tissue (P < .05). Neurocognitive impairment (NCI) in HIV is associated with inflammation and total and central adiposity.
Collapse
Affiliation(s)
- Christian Mouchati
- Case Western Reserve University, School of Medicine, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vanessa El Kamari
- Case Western Reserve University, School of Medicine, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Abdus Sattar
- Case Western Reserve University, School of Medicine, OH, USA
| | - Jiao Yu
- Case Western Reserve University, School of Medicine, OH, USA
| | - Grace A McComsey
- Case Western Reserve University, School of Medicine, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
- Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| |
Collapse
|
4
|
Teunissen CE, Rohlwink U, Pajkrt D, Naudé PJW. Biomarkers of Tuberculous Meningitis and Pediatric Human Immunodeficiency Virus on the African Continent. Front Neurol 2022; 13:793080. [PMID: 35665032 PMCID: PMC9160376 DOI: 10.3389/fneur.2022.793080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Biomarkers in body fluids are helpful objective tools in diagnosis, prognosis and monitoring of (therapeutic) responses of many neurological diseases. Cerebrospinal fluid (CSF) biomarkers are part of the diagnostic toolbox for infectious neurological diseases. Tuberculous meningitis (TBM) and Human immunodeficiency virus (HIV), are important burdens of disease in Africa and can negatively affect brain health. Two thirds of the world's population of people living with HIV reside in sub-Saharan Africa and 25% of the global burden of tuberculosis (TB) is carried by the African continent. Neuroinflammation and damage of specific neuronal cell types are key constituents in the pathophysiology of these central nervous system (CNS) diseases, and important potential sources of circulating biomarkers. In this review, we summarize current research in the use of biomarkers in TBM and pediatric HIV as case demonstrations for high prevalence neurological diseases in Africa. Inflammatory molecules, primarily when detected in CSF, appear to have diagnostic value in these diseases, especially when measured as profiles. Brain injury molecules, such as S100, Neuron specific enolase and glial fibrillary acidic protein may have prognostic value in TBM, but more studies are needed. There is a need for more cost-economic and high sensitivity technologies to drive further biomarker discoveries and translate into healthcare improvements for these important healthcare problems in a globally fair way.
Collapse
Affiliation(s)
- Charlotte Elisabeth Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Ursula Rohlwink
- Division of Neurosurgery, Neuroscience Institute, Department of Surgery, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, United Kingdom
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
| | - Petrus J. W. Naudé
- Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
van der Post J, van Genderen JG, Heijst JA, Blokhuis C, Teunissen CE, Pajkrt D. Plasma Neurofilament Light Is Not Associated with Ongoing Neuroaxonal Injury or Cognitive Decline in Perinatally HIV Infected Adolescents: A Brief Report. Viruses 2022; 14:v14040671. [PMID: 35458401 PMCID: PMC9030750 DOI: 10.3390/v14040671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 12/01/2022] Open
Abstract
Despite combination antiretroviral therapy (cART), adolescents with perinatally acquired human immunodeficiency virus (PHIV) exhibit cerebral injury and cognitive impairment. Plasma neurofilament light (pNfL) is a biomarker identified as a promising marker associated with neuroaxonal injury and cognitive impairment. To investigate whether cerebral injury in cART-treated PHIV adolescents is persistent, we longitudinally measured pNfL. We included 21 PHIV adolescents and 23 controls, matched for age, sex, ethnic origin and socio-economic status. We measured pNfL in both groups and CSF NfL in PHIV adolescents using a highly sensitive Single Molecule Array (Simoa) immunoassay. We compared pNfL between groups over time with a mean follow-up time of 4.6 years and assessed its association with MRI outcomes, cognitive function and HIV-related characteristics using linear mixed models. The median age was 17.5 years (15.5–20.7) and 16.4 years (15.8–19.6) at the second assessment for PHIV adolescents and controls, respectively. We found comparable pNfL (PHIV vs. controls) at the first (2.9 pg/mL (IQR 2.0–3.8) and 3.0 pg/mL (IQR 2.3–3.5), p = 0.499) and second assessment (3.3 pg/mL (IQR 2.5–4.1) and 3.0 pg/mL (IQR 2.5–3.7), p = 0.658) and observed no longitudinal change (coefficient; −0.19, 95% −0.5 to 0.1, p = 0.244). No significant associations were found between pNfL and HIV- or cART-related variables, MRI outcomes or cognitive function. We observed low CSF NfL concentrations at the baseline in PHIV adolescents (100.8 pg/mL, SD = 47.5). Our results suggest that there is no ongoing neuroaxonal injury in cART-treated PHIV adolescents and that the neuroaxonal injury is acquired in the past, emphasizing the importance of early cART to mitigate HIV-related neuroaxonal damage.
Collapse
Affiliation(s)
- Julie van der Post
- Pediatric Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, 1105 Amsterdam, The Netherlands; (J.G.v.G.); (C.B.); (D.P.)
- Correspondence: ; Tel.: +31-630-595-488
| | - Jason G. van Genderen
- Pediatric Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, 1105 Amsterdam, The Netherlands; (J.G.v.G.); (C.B.); (D.P.)
| | - Johannes A. Heijst
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1117 Amsterdam, The Netherlands; (J.A.H.); (C.E.T.)
| | - Charlotte Blokhuis
- Pediatric Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, 1105 Amsterdam, The Netherlands; (J.G.v.G.); (C.B.); (D.P.)
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1117 Amsterdam, The Netherlands; (J.A.H.); (C.E.T.)
| | - Dasja Pajkrt
- Pediatric Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, 1105 Amsterdam, The Netherlands; (J.G.v.G.); (C.B.); (D.P.)
| |
Collapse
|
6
|
Williams ME, Janse Van Rensburg A, Loots DT, Naudé PJW, Mason S. Immune Dysregulation Is Associated with Neurodevelopment and Neurocognitive Performance in HIV Pediatric Populations-A Scoping Review. Viruses 2021; 13:2543. [PMID: 34960812 PMCID: PMC8706807 DOI: 10.3390/v13122543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022] Open
Abstract
HIV-1 is known for its complex interaction with the dysregulated immune system and is responsible for the development of neurocognitive deficits and neurodevelopmental delays in pediatric HIV populations. Considering that HIV-1-induced immune dysregulation and its association with neurodevelopmental and neurocognitive impairments in pediatric populations are not well understood, we conducted a scoping review on this topic. The study aimed to systematically review the association of blood and cerebrospinal fluid (CSF) immune markers with neurocognitive deficits and neurodevelopmental delays in pediatric HIV populations. PubMed, Scopus, and Web of Science databases were searched using a search protocol designed specifically for this study. Studies were selected based on a set eligibility criterion. Titles, abstracts, and full texts were assessed by two independent reviewers. Data from the selected studies were extracted and analyzed by two independent reviewers. Seven studies were considered eligible for use in this context, which included four cross-sectional and three longitudinal studies. An average of 130 (±70.61) children living with HIV, 138 (±65.37) children exposed to HIV but uninfected and 90 (±86.66) HIV-negative participants were included across the seven studies. Results indicate that blood and CSF immune markers are associated with neurocognitive development/performance in pediatric HIV populations. Only seven studies met the inclusion criteria, therefore, these limited the number of significant conclusions which could have been made by using such an approach. All considered, the evidence suggests that immune dysregulation, as in the case of adult HIV populations, also has a significant association with neurocognitive performance in pediatric HIV populations.
Collapse
Affiliation(s)
- Monray E. Williams
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom 2531, South Africa; (A.J.V.R.); (D.T.L.); (S.M.)
| | - Anicia Janse Van Rensburg
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom 2531, South Africa; (A.J.V.R.); (D.T.L.); (S.M.)
| | - Du Toit Loots
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom 2531, South Africa; (A.J.V.R.); (D.T.L.); (S.M.)
| | - Petrus J. W. Naudé
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa;
- Neuroscience Institute, University of Cape Town, Cape Town 7701, South Africa
| | - Shayne Mason
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom 2531, South Africa; (A.J.V.R.); (D.T.L.); (S.M.)
| |
Collapse
|
7
|
McLaurin KA, Li H, Booze RM, Mactutus CF. Neurodevelopmental Processes in the Prefrontal Cortex Derailed by Chronic HIV-1 Viral Protein Exposure. Cells 2021; 10:3037. [PMID: 34831259 PMCID: PMC8616332 DOI: 10.3390/cells10113037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 12/27/2022] Open
Abstract
Due to the widespread access to, and implementation of, combination antiretroviral therapy, individuals perinatally infected with human immunodeficiency virus type 1 (HIV-1) are living into adolescence and adulthood. Perinatally infected adolescents living with HIV-1 (pALHIV) are plagued by progressive, chronic neurocognitive impairments; the pathophysiological mechanisms underlying these deficits, however, remain understudied. A longitudinal experimental design from postnatal day (PD) 30 to PD 180 was utilized to establish the development of pyramidal neurons, and associated dendritic spines, from layers II-III of the medial prefrontal cortex (mPFC) in HIV-1 transgenic (Tg) and control animals. Three putative neuroinflammatory markers (i.e., IL-1β, IL-6, and TNF-α) were evaluated early in development (i.e., PD 30) as a potential mechanism underlying synaptic dysfunction in the mPFC. Constitutive expression of HIV-1 viral proteins induced prominent neurodevelopmental alterations and progressive synaptodendritic dysfunction, independent of biological sex, in pyramidal neurons from layers II-III of the mPFC. From a neurodevelopmental perspective, HIV-1 Tg rats exhibited prominent deficits in dendritic and synaptic pruning. With regards to progressive synaptodendritic dysfunction, HIV-1 Tg animals exhibited an age-related population shift towards dendritic spines with decreased volume, increased backbone length, and decreased head diameter; parameters associated with a more immature dendritic spine phenotype. There was no compelling evidence for neuroinflammation in the mPFC during early development. Collectively, progressive neuronal and dendritic spine dysmorphology herald synaptodendritic dysfunction as a key neural mechanism underlying chronic neurocognitive impairments in pALHIV.
Collapse
Affiliation(s)
| | | | | | - Charles F. Mactutus
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA; (K.A.M.); (H.L.); (R.M.B.)
| |
Collapse
|
8
|
Payne H, Chan MK, Watters SA, Otwombe K, Hsiao NY, Babiker A, Violari A, Cotton MF, Gibb DM, Klein NJ. Early ART-initiation and longer ART duration reduces HIV-1 proviral DNA levels in children from the CHER trial. AIDS Res Ther 2021; 18:63. [PMID: 34587974 PMCID: PMC8482761 DOI: 10.1186/s12981-021-00389-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background Reduction of the reservoir of latent HIV-infected cells might increase the possibility of long-term remission in individuals living with HIV. We investigated factors associated with HIV-1 proviral DNA levels in children receiving different antiretroviral therapy (ART) strategies in the children with HIV early antiretroviral therapy (CHER) trial. Methods Infants with HIV < 12 weeks old with CD4% ≥ 25% were randomized in the CHER trial to early limited ART for 40 or 96 weeks (ART-40 W, ART-96 W), or deferred ART (ART-Def). For ART-Def infants or following ART interruption in ART-40 W/ART-96 W, ART was started/re-started for clinical progression or CD4% < 25%. In 229 participants, HIV-1 proviral DNA was quantified by PCR from stored peripheral blood mononuclear cells from children who had received ≥ 24 weeks ART and two consecutive undetectable HIV-1 RNA 12–24 weeks apart. HIV-1 proviral DNA was compared between ART-Def and ART-96 W at week 96, and in all arms at week 248. Factors associated with HIV-1 proviral DNA levels were evaluated using linear regression. Findings Longer duration of ART was significantly associated with lower HIV-1 proviral DNA at both 96 (p = 0.0003) and 248 weeks (p = 0.0011). Higher total CD8 count at ART initiation was associated with lower HIV-1 proviral DNA at both 96 (p = 0.0225) and 248 weeks (p = 0.0398). Week 248 HIV-1 proviral DNA was significantly higher in those with positive HIV-1 serology at week 84 than those with negative serology (p = 0.0042). Intepretation Longer ART duration is key to HIV-1 proviral DNA reduction. Further understanding is needed of the effects of “immune-attenuation” through early HIV-1 exposure. Funding Wellcome Trust, National Institutes of Health, Medical Research Council.
Collapse
|
9
|
Hileman CO, Kalayjian RC, Azzam S, Schlatzer D, Wu K, Tassiopoulos K, Bedimo R, Ellis RJ, Erlandson KM, Kallianpur A, Koletar SL, Landay AL, Palella FJ, Taiwo B, Pallaki M, Hoppel CL. Plasma Citrate and Succinate Are Associated With Neurocognitive Impairment in Older People With HIV. Clin Infect Dis 2021; 73:e765-e772. [PMID: 33564870 DOI: 10.1093/cid/ciab107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) is associated with monocyte activation in people with HIV (PWH). Activated monocytes increase glycolysis, reduce oxidative phosphorylation, and accumulate citrate and succinate, tricarboxylic acid (TCA) cycle metabolites that promote inflammation-this metabolic shift may contribute to NCI and slowed gait speed in PWH. METHODS Plasma citrate and succinate were assayed by liquid chromatography-mass spectrometry from 957 participants upon entry to a multicenter, prospective cohort of older PWH. Logistic, linear, and mixed-effects linear regression models were used to examine associations between entry/baseline TCA cycle metabolites and cross-sectional and longitudinal NCI, neuropsychological test scores (NPZ-4), and gait speed. RESULTS Median age was 51 (range 40-78) years. Each 1 standard deviation (SD) citrate increment was associated with 1.18 higher odds of prevalent NCI at baseline (P = .03), 0.07 SD lower time-updated NPZ-4 score (P = .01), and 0.02 m/s slower time-updated gait speed (P < .0001). Age accentuated these effects. In the oldest age-quartile, higher citrate was associated with 1.64 higher odds of prevalent NCI, 0.17 SD lower NPZ-4, and 0.04 m/s slower gait speed (P ≤ .01 for each). Similar associations were apparent with succinate in the oldest age-quintile, but not with gait speed. In participants without NCI at entry, higher citrate predicted a faster rate of neurocognitive decline. CONCLUSIONS Higher plasma citrate and succinate are associated with worse cross-sectional and longitudinal measures of neurocognitive function and gait speed that are age-dependent, supporting the importance of altered bioenergetic metabolism in the pathogenesis of NCI in older PWH.
Collapse
Affiliation(s)
- Corrilynn O Hileman
- Department of Medicine, Division of Infectious Diseases, MetroHealth Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Robert C Kalayjian
- Department of Medicine, Division of Infectious Diseases, MetroHealth Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Sausan Azzam
- Department of Nutrition, Proteomics and Small Molecule Mass Spectrometry, Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Daniela Schlatzer
- Department of Nutrition, Proteomics and Small Molecule Mass Spectrometry, Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Kunling Wu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachussets, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachussets, USA
| | - Roger Bedimo
- Infectious Diseases Section, VA North Texas Health Care System, Dallas, Texas, USA
| | - Ronald J Ellis
- Department of Neurosciences, Psychiatry and Medicine, University of California, San Diego, California, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Columbus, USA
| | - Asha Kallianpur
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Susan L Koletar
- Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Frank J Palella
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Babafemi Taiwo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muralidhar Pallaki
- Department of Medicine Louis Stokes Cleveland VA Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Charles L Hoppel
- Center for Mitochondrial Disease and Department of Pharmacology, Case Western Reserve University and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
10
|
Rowe K, Buivydaite R, Heinsohn T, Rahimzadeh M, Wagner RG, Scerif G, Stein A. Executive function in HIV-affected children and adolescents: a systematic review and meta-analyses. AIDS Care 2021; 33:833-857. [PMID: 33764813 DOI: 10.1080/09540121.2021.1873232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This review aimed to determine: whether EF is affected in children and adolescents (2-24-years-old) with perinatal HIV infection, perinatal HIV exposure without infection, and behaviourally acquired HIV. A systematic review (PROSPERO number: CRD42017067813) was conducted using 11 electronic databases (01.01.1981-09.07.2019) and 8 conference websites. Primary quantitative studies with EF scores on cognitive tasks and/or behavioural report measures were included. Meta-analyses were performed by EF subtype and subpopulations compared. 1789 records were found. Sixty-one studies were included in the narrative synthesis; 32 (N = 7884 participants) were included in meta-analyses. There was a distinct pattern of reduced EF in those with perinatal HIV infection on antiretroviral therapy compared to controls: pooled effect sizes were largest for verbal and visuospatial working memory, with smaller effects on planning, inhibitory control and set-shifting. Data were limited for other HIV-affected subpopulations. Perinatal HIV infection is associated with reduced EF with varying effect sizes for the different EF subtypes.
Collapse
Affiliation(s)
- Kirsten Rowe
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Ruta Buivydaite
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Torben Heinsohn
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Mana Rahimzadeh
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Gaia Scerif
- Developmental Cognitive Neuroscience, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alan Stein
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
11
|
Increased monocyte and T-cell activation in treated HIV+ Ugandan children: associations with gut alteration and HIV factors. AIDS 2020; 34:1009-1018. [PMID: 32073452 DOI: 10.1097/qad.0000000000002505] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The pathophysiology of immune activation and its mechanisms in children living with perinatally acquired HIV (PHIV) in sub-Saharan Africa has been understudied. METHODS We enrolled 101 children living with PHIV and 96 HIV-negative controls (HIV-). All participants were between 10 and 18 years of age with no known active infections. PHIVs were on ART with HIV-1 RNA level 400 copies/ml or less. We measured plasma and cellular markers of monocyte activation, T-cell activation (expression of CD38 and HLA-DR on CD4 and CD8), oxidized lipids, markers of gut integrity and fungal translocation. Spearman correlations and linear regression models were used. RESULTS Overall median (Q1; Q3) age was 13 years (11; 15) and 52% were girls. Groups were similar by age, sex and BMI. Median ART duration was 10 years (8; 11). PHIVs had higher monocyte and T-cell activation; higher sCD14 (P = 0.01) and elevated frequencies of nonclassical monocytes (P < 0.001 for both). Markers of systemic inflammation (hsCRP), fungal translocation (BDG), intestinal permeability (zonulin) and oxidized lipids (ox LDL) correlated with monocyte and T-cell activation in PHIV (≤0.05). After adjusting for age, sex, ART duration, protease inhibitor and nonnucleoside reverse transcriptase inhibitor use, a modest association between BDG and activated CD4 T cells was observed (β=0.65, P < 0.01). Oxidized LDL was inversely associated with activated T cells, inflammatory and nonclassical monocytes (P < 0.01). CONCLUSION Ugandan children with perinatally acquired HIV with viral suppression have evidence of ongoing immune activation. Intestinal barrier dysfunction and fungal translocation may be involved in chronic immune dysfunction.
Collapse
|
12
|
Higher soluble CD14 levels are associated with lower visuospatial memory performance in youth with HIV. AIDS 2019; 33:2363-2374. [PMID: 31764101 DOI: 10.1097/qad.0000000000002371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE HIV-associated neurocognitive disorders persist despite early antiretroviral therapy (ART) and optimal viral suppression. We examined the relationship between immunopathogenesis driven by various pathways of immune activation and discrete neurocognitive performance domains in youth with HIV (YWH). DESIGN Observational cross-sectional study. METHODS YWH, ages 20-28 years, enrolled in Adolescent Medicine Trials Network 071/101 were assessed for biomarkers of macrophage, lymphocyte activation, and vascular inflammation using ELISA/multiplex assays. Standardized neurocognitive tests were performed, and demographically adjusted z-scores were combined to form indices of attention, motor, executive function, verbal, and visuospatial memory. Cross-sectional analysis of the relationship between 18 plasma inflammatory biomarkers and each neurocognitive domain was performed. Linear regression models were fit for each combination of log-transformed biomarker value and neurocognitive domain score, and were adjusted for demographics, socioeconomic status, substance use, depression, CD4 T-cell count, HIV viral load, and ART status. RESULTS Study included 128 YWH [mean age 23.8 (SD 1.7) years, 86% men, 68% African American]. Verbal and visuospatial memory domains were most significantly impaired in the cohort (z = -1.59 and -1.0, respectively). Higher sCD14 was associated with impaired visuospatial memory, which remained robust after adjusting for other biomarkers, demographics, and HIV-associated covariates. Among biomarkers of vascular inflammation, sICAM-1 was negatively associated with verbal memory and attention, whereas sVCAM-1 was positively associated with executive function and visuospatial memory. Specific neurocognitive domains were not associated with sCD163, LPS, or CCL2 levels. CONCLUSION Impaired visuospatial memory in YWH is associated with immune activation, as reflected by higher sCD14.
Collapse
|
13
|
Moran LM, McLaurin KA, Booze RM, Mactutus CF. Neurorestoration of Sustained Attention in a Model of HIV-1 Associated Neurocognitive Disorders. Front Behav Neurosci 2019; 13:169. [PMID: 31447657 PMCID: PMC6691343 DOI: 10.3389/fnbeh.2019.00169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/12/2019] [Indexed: 12/26/2022] Open
Abstract
Due to the sustained prevalence of human immunodeficiency virus (HIV)-1 associated neurocognitive disorders (HAND) in the post-combination antiretroviral therapy (cART) era, as well as the increased prevalence of older HIV-1 seropositive individuals, there is a critical need to develop adjunctive therapeutics targeted at preserving and/or restoring neurocognitive function. To address this knowledge gap, the present study examined the utility of S-Equol (SE), a phytoestrogen produced by gut microbiota, as an innovative therapeutic strategy. A signal detection operant task with varying signal durations (1,000, 500, 100 ms) was utilized to assess sustained attention in HIV-1 transgenic (Tg) and control animals. During the signal detection pretest assessment, HIV-1 Tg animals displayed profound deficits in stimulus-response learning and sustained attention relative to control animals. Subsequently, between 6 and 8 months of age, HIV-1 Tg and control animals were treated with a daily oral dose of either placebo or SE (0.05, 0.1, 0.2 mg) and a posttest assessment was conducted in the signal detection operant task with varying signal durations. In HIV-1 Tg animals, a linear decrease in the number of misses at 100 ms was observed as SE dose increased, suggesting a dose response with the most effective dose at 0.2 mg SE, approximating controls. Comparison of the number of misses across signal durations at the pretest and posttest revealed a preservation of neurocognitive function in HIV-1 Tg animals treated with 0.2 mg SE; an effect that was in sharp contrast to the neurocognitive decline observed in HIV-1 Tg animals treated with placebo. The results support the utility of 0.2 mg SE as a potential efficacious neuroprotective and/or neurorestorative therapeutic for sustained attention, in the absence of any adverse peripheral effects, in the HIV-1 Tg rat. Thus, the present study highlights the critical need for further in vivo studies to elucidate the full potential and generalizability of phytoestrogen treatment for HAND.
Collapse
Affiliation(s)
- Landhing M Moran
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Kristen A McLaurin
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Rosemarie M Booze
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Charles F Mactutus
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, Columbia, SC, United States
| |
Collapse
|
14
|
Chahroudi A, Wagner TA, Persaud D. CNS Persistence of HIV-1 in Children: the Untapped Reservoir. Curr HIV/AIDS Rep 2019; 15:382-387. [PMID: 30159813 DOI: 10.1007/s11904-018-0412-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The central nervous system (CNS) represents a potential HIV-1 reservoir that may need to be specifically targeted by remission strategies. Perinatally HIV-1-infected children and youth are exposed to HIV-1 at a critical period of brain development. This review summarizes the current literature regarding HIV-1 and the CNS in perinatal infection. RECENT FINDINGS HIV-1-associated encephalopathy is prevalent with perinatal infection and neurocognitive impairment persists even following antiretroviral treatment (ART)-mediated suppression of viremia. Compartmentalization of HIV-1 between plasma and CSF of ART-naïve, perinatally infected children suggests the presence of a CNS reservoir; however, similar studies have not yet been conducted with ART suppression. CSF viral escape where CSF and plasma virus concentrations are discordant has been reported in this population, but larger studies with well-defined virologic and immunologic parameters are needed. A better understanding of HIV-1 persistence in the CNS with perinatal infection is essential for improving long-term neurocognitive outcomes and for designing strategies to induce HIV-1 remission in this population.
Collapse
Affiliation(s)
- Ann Chahroudi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Thor A Wagner
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Deborah Persaud
- Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building 1170, Baltimore, MD, 21205, USA.
| |
Collapse
|
15
|
Systemic and intrathecal immune activation in association with cerebral and cognitive outcomes in paediatric HIV. Sci Rep 2019; 9:8004. [PMID: 31142789 PMCID: PMC6541601 DOI: 10.1038/s41598-019-44198-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/24/2019] [Indexed: 01/23/2023] Open
Abstract
Despite treatment, immune activation is thought to contribute to cerebral injury in children perinatally infected with human immunodeficiency virus (HIV). We aimed to characterize immune activation in relation to neuroimaging and cognitive outcomes. We therefore measured immunological, coagulation, and neuronal biomarkers in plasma and cerebrospinal fluid (CSF) samples of 34 perinatally HIV-infected children aged 8–18 years, and in plasma samples of 37 controls of comparable age, sex, ethnicity, and socio-economic status. We then compared plasma biomarker levels between groups, and explored associations between plasma/CSF biomarkers and neuroimaging and cognitive outcomes using network analysis. HIV-infected children showed higher plasma levels of C-reactive protein, interferon-gamma, interferon-gamma-inducible protein-10, and monocyte chemoattractant protein-1 than controls. In HIV-infected participants, plasma soluble CD14 was positively associated with microstructural white matter (WM) damage, and plasma D-dimer was negatively associated with WM blood flow. In CSF, IL-6 was negatively associated with WM volume, and neurofilament heavy-chain (NFH) was negatively associated with intelligence quotient and working memory. These markers of ongoing inflammation, immune activation, coagulation, and neuronal damage could be used to further evaluate the pathophysiology and clinical course of cerebral and cognitive deficits in perinatally acquired HIV.
Collapse
|
16
|
Eckard AR, O'Riordan MA, Rosebush JC, Lee ST, Habib JG, Ruff JH, Labbato D, Daniels JE, Uribe-Leitz M, Tangpricha V, Chahroudi A, McComsey GA. Vitamin D supplementation decreases immune activation and exhaustion in HIV-1-infected youth. Antivir Ther 2018; 23:315-324. [PMID: 28994661 PMCID: PMC6070412 DOI: 10.3851/imp3199] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Heightened immune activation and exhaustion drive HIV disease progression and comorbidities. Vitamin D has pleiotropic immunomodulatory effects, but little is known about the effects of supplementation in HIV. Our study investigates changes in immune activation and exhaustion markers after 12 months of supplementation in virologically suppressed HIV-infected youth with vitamin D insufficiency. METHODS This is a randomized, active-control, double-blind trial investigating with three different vitamin D3 doses (18,000 [standard/active-control dose], 60,000 [moderate dose] and 120,000 IU/month [high dose]) in 8-25-year-old HIV-infected youth on combination antiretroviral therapy with baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations ≤30 ng/ml. Only subjects (n=51) who maintained an undetectable HIV-1 RNA over the 12-month study period were included in this analysis. RESULTS Baseline serum 25(OH)D concentrations and immune activation/exhaustion markers were not different between groups. By 12 months, 25(OH)D increased significantly within each dosing group with the greatest increase and most sustained concentrations ≥30 ng/ml in the high-dose group. Overall, all measured markers decreased with CD4 activation (CD4+CD38+HLA-DR+), CD8 activation (CD8+CD38+HLA-DR+), CD4 exhaustion (CD4+CD38+HLA-DR+PD1+) and inflammatory monocytes (CD14+CD16+) reaching statistical significance. When analysed separately, there were no significant decreases in the moderate- or standard-dose groups, but CD4 and CD8 activation and inflammatory monocytes decreased significantly in the high-dose group. CONCLUSIONS Vitamin D supplementation decreased markers of T-cell activation/exhaustion and monocyte activation in HIV-infected youth, with subjects given the highest dose (120,000 IU/month) showing the greatest decreases. These data suggest that high-dose vitamin D supplementation may attenuate immune activation and exhaustion, and serve as adjuvant therapy to antiretroviral therapy in HIV. ClinicalTrials.gov identifier: NCT01523496.
Collapse
Affiliation(s)
- Allison Ross Eckard
- Medical University of South Carolina, Charleston, SC, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Mary Ann O'Riordan
- Rainbow Babies & Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Jakob G Habib
- Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua H Ruff
- Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle Labbato
- Rainbow Babies & Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | | | - Ann Chahroudi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Grace A McComsey
- Rainbow Babies & Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|