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Trunfio M, Tang B, Iudicello JE, Ma Q, Franklin DR, Cookson D, Riggs PK, Cherner M, Moore DJ, Heaton RK, Letendre SL, Ellis RJ. Distinct Effects of Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors on Soluble Biomarkers in Blood and Cerebrospinal Fluid of People With HIV. J Infect Dis 2024; 229:1266-1276. [PMID: 38059529 PMCID: PMC11095536 DOI: 10.1093/infdis/jiad558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Persistent inflammation affects people with HIV (PWH) despite antiretroviral therapy (ART). Selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs, SNRIs), HMG-CoA reductase-inhibitors (statins), and angiotensin-converting enzyme inhibitors (ACEIs) have immunomodulant properties. We evaluated the potential impact of these drugs on inflammation and neurodegeneration in PWH. METHODS Cross-sectional single-center (United States) analysis in 184 PWH on ART with plasma HIV RNA < 200 copies/mL. All participants had 10 biomarkers measured in blood and cerebrospinal fluid (CSF). To reduce dimensionality, hierarchical clustering and principal components (PCs) analysis were employed. The analyses were adjusted for duration of the drugs and clinical conditions. RESULTS Participants were mostly middle-aged men, with median CD4+ T cells of 620/µL. In adjusted models, SSRI use was associated with 3 PCs: higher CSF and plasma Aβ42 and CSF CCL2 (aβ=.14, P = .040); lower CSF 8-oxo-dG, total tau, and sCD14 (aβ=-.12, P = .042); and higher plasma sCD14 with lower sCD40L (aβ=.15, P = .042). SNRI use was associated with higher values of CSF and plasma neopterin and CSF sTNFR-II (aβ=.22, P = .004). Statins and ACEIs showed no association. CONCLUSIONS SSRIs and SNRIs had distinct biomarker signatures. SSRIs were associated with reduced neurodegeneration, immune activation, and oxidative stress in CSF, suggesting a role of SSRIs as adjunctive therapy in PWH.
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Affiliation(s)
- Mattia Trunfio
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Bin Tang
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Jennifer E Iudicello
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Qing Ma
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, New York, USA
| | - Donald R Franklin
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Debra Cookson
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Patricia K Riggs
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Scott L Letendre
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
| | - Ronald J Ellis
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego,San Diego, California, USA
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Tham BZ, Aleman DM, Heaton RK, Nordström H, Coolens C. Physical dose validation of dynamic treatment for Gamma Knife radiosurgery. Med Phys 2024; 51:3635-3647. [PMID: 38517433 DOI: 10.1002/mp.17034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Dynamic treatment in Gamma Knife (GK) radiosurgery systems delivers radiation continuously with couch movement, as opposed to stationary step-and-shoot treatment where radiation is paused when moving between isocenters. Previous studies have shown the potential for dynamic GK treatment to give faster treatment times and improved dose conformity and homogeneity. However, these studies focused only on computational simulations and lack physical validation. PURPOSE This study aims conduct dynamic treatment dosimetric validation with physical experimental measurements. The experiments aim to (1) address assumptions made with computational studies, such as the validity of treating a continuous path as discretised points, (2) investigate uncertainties in translating computed plans to actual treatment, and (3) determine ideal treatment planning parameters, such as interval distance for the path discretization, collimator change limitations, and minimum isocenter treatment times. METHODS This study uses a GK ICON treatment delivery machine, and a motion phantom custom-made to attach to the machine's mask adapter and move in 1D superior-inferior motion. Phantom positioning is first verified through comparisons against couch motion and computed doses. For dynamic treatment experiments, the phantom is moved through a program that first reads the desired treatment plan isocenters' position, time, and collimator sizes, then carries out the motion continuously while the treatment machine delivers radiation. Measurements are done with increasing levels of complexity: varying speed, varying collimator sizes, varying both speed and collimator sizes, then extends the same measurements to simulated 2D motion by combining phantom and couch motion. Dose comparisons between phantom motion radiation measurements and either couch motion measurements or dose calculations are analyzed with 2 mm/2% and 1 mm/2% gamma indices, using both local and global gamma index calculations. RESULTS Phantom positional experiments show a high accuracy, with global gamma indices for all dose comparisons ≥ $\ge $ 99%. Discretization level to approximate continuous path as discrete points show the good dose matches with dose calculations when using 1 and 2-mm gaps. Complex 1D motion, including varying speed, collimator sizes, or both, as well as 2D motion with the same complexities, all show good dose matches with dose calculations: the scores are ≥ $\ge $ 92.0% for the strictest 1 mm/2% local gamma index calculation, ≥ $\ge $ 99.8% for 2 mm/2% local gamma index, and ≥ $\ge $ 97.0% for all global gamma indices. Five simulated 2D treatments with optimized plans scored highly as well, with all gamma index scores ≥ $\ge $ 95.3% when compared to stationary treatment, and scores ≥ $\ge $ 97.9% when compared to plan calculated dose. CONCLUSIONS Dynamic treatment computational studies are validated, with dynamic treatment shown to be physically feasible and deliverable with high accuracy. A 2-mm discretization level in treatment planning is proposed as the best option for shorter dose calculation times while maintaining dose accuracy. Our experimental method enables dynamic treatment measurements using the existing clinical workflow, which may be replicated in other centers, and future studies may include 2D or 3D motion experiments, or planning studies to further quantify potential indication-specific benefits.
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Affiliation(s)
- Benjamin Z Tham
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dionne M Aleman
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Robert K Heaton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Catherine Coolens
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Breton J, Watson CWM, Kamalyan L, Franklin D, Fazeli P, Umlauf A, Moore RC, Ellis R, Grant I, Heaton RK, Cherner M, Moore DJ, Marquine MJ. Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV. Clin Neuropsychol 2024:1-20. [PMID: 38588669 DOI: 10.1080/13854046.2024.2319900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024]
Abstract
Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.
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Affiliation(s)
- Jordana Breton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Caitlin Wei-Ming Watson
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Donald Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Pariya Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Raeanne C Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Trunfio M, Tang B, Okwuegbuna O, Iudicello JE, Bharti A, Moore DJ, Gelman BB, Morgello S, Patel PB, Rubin LH, Ances BM, Gianella S, Heaton RK, Ellis RJ, Letendre SL. Longitudinal analysis of CSF HIV RNA in untreated people with HIV: Identification of CSF controllers. J Med Virol 2024; 96:e29550. [PMID: 38511593 DOI: 10.1002/jmv.29550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
Interindividual variation of human immunodeficiency virus (HIV) RNA setpoint in cerebrospinal fluid (CSF) and its determinants are poorly understood, but relevant for HIV neuropathology, brain reservoirs, viral escape, and reseeding after antiretroviral interruptions. Longitudinal multicentric study on demographic, clinical, and laboratory correlates of CSF HIV RNA in 2000 follow-up visits from 597 people with HIV (PWH) off antiretroviral therapy (ART) and with plasma HIV RNA > the lower limit of quantification (LLQ). Factors associated with CSF control (CSFC; CSF HIV RNA < LLQ while plasma HIV RNA > LLQ) and with CSF/plasma discordance (CSF > plasma HIV RNA > LLQ) were also assessed through mixed-effects models. Posthoc and sensitivity analyses were performed for persistent CSFC and ART-naïve participants, respectively. Over a median follow-up of 2.1 years, CSF HIV RNA was associated with CD4+ and CD8+ T cells, CSF leukocytes, blood-brain barrier (BBB) integrity, biomarkers of iron and lipid metabolism, serum globulins, past exposure to lamivudine, and plasma HIV RNA (model p < 0.0001). CSFC (persistent in 7.7% over 3 years) and CSF/plasma discordance (persistent in <0.01% over 1 year) were variably associated with the same parameters (model p < 0.001). Sensitivity analyses confirmed most of the previous associations in participants never exposed to ART. Persistent CSFC was associated with higher CD4+ T-cell count nadir (p < 0.001), lower serum globulins (p = 0.003), and lower CSF leukocytes (p < 0.001). Without ART, one in 13 PWH had persistently undetectable CSF HIV RNA, while persistent CSF/plasma discordance was extremely rare over years. Immune responses, inflammation, BBB permeability, and iron and lipid metabolism were all associated with HIV replication in CSF.
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Affiliation(s)
- Mattia Trunfio
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Bin Tang
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Oluwakemi Okwuegbuna
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jennifer E Iudicello
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Ajay Bharti
- Division of Infectious Diseases and Global Health, University of California San Diego, San Diego, California, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Payal B Patel
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Leah H Rubin
- Department of Neurology, Psychiatry and Behavioral Sciences, Molecular and Cellular Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Beau M Ances
- Department of Neurology, Washington University, St Louis, Missouri, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Health, University of California San Diego, San Diego, California, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Ronald J Ellis
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Scott L Letendre
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
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5
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Serrano VB, Pasipanodya EC, Montoya JL, Heaton RK, Jeste DV, Moore DJ. Reactivity of Health-Related Quality of Life to Perceived Stress: The Buffering Role of Psychosocial Resources in a Longitudinal Study of Adults with and Without HIV. J Clin Psychol Med Settings 2024; 31:174-185. [PMID: 37204645 PMCID: PMC10924706 DOI: 10.1007/s10880-023-09962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/20/2023]
Abstract
People with HIV now have increased longevity; however, their health-related quality of life (HRQoL) still lags significantly compared to people without HIV. Perceived stress negatively impacts HRQoL, whereas psychosocial resources are linked to better HRQoL. This longitudinal analysis aims to explore the buffering role of psychosocial resources on the relationship between HRQoL and perceived stress. Participants (N = 240) included 142 persons with HIV (PwH) and 98 without HIV, M(SD) = 50.9(8.1) years. Multilevel models over four study years examined longitudinal relationships between HRQoL (outcome) and perceived stress (predictor) and potential moderation by psychosocial resources (personal mastery, social support, and resilience) by HIV serostatus. Among PwH only, personal mastery (p = 0.001), social support (p = 0.015), and resilience (p = 0.029) were associated with an attenuated effect of perceived stress (less negative slopes) for physical HRQoL over time. Bolstering personal mastery, social support, and resilience may have relevance for improving physical well-being among PwH.
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Affiliation(s)
- Vanessa B Serrano
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Elizabeth C Pasipanodya
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
| | - Jessica L Montoya
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA.
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Cysique LA, Brew BJ, Bruning J, Byrd D, Costello J, Daken K, Ellis RJ, Fazeli PL, Goodkin K, Gouse H, Heaton RK, Letendre S, Levin J, Aung HL, Mindt MR, Moore D, Mullens AB, de Almeida SM, Muñoz-Moreno JA, Power C, Robbins RN, Rule J, Rajasuriar R, Savin MJ, Taylor J, Trunfio M, Vance DE, Wong PL, Woods SP, Wright EJ, Rourke SB. Cognitive criteria in HIV: greater consensus is needed. Nat Rev Neurol 2024; 20:127-128. [PMID: 38228906 DOI: 10.1038/s41582-024-00927-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Lucette A Cysique
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada.
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia.
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
- Sydney St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
| | - Bruce J Brew
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Jane Bruning
- Positive Women Inc., Auckland, Aotearoa New Zealand
| | - Desiree Byrd
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Queens College and the Graduate Center, City University of New York, New York, NY, USA
| | - Jane Costello
- Positive Life New South Wales, Sydney, New South Wales, Australia
| | - Kirstie Daken
- School of Psychology & Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Ronald J Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karl Goodkin
- Department of Psychiatry and Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Hetta Gouse
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jules Levin
- National AIDS Treatment Advocacy Project, New York, NY, USA
| | - Htein Linn Aung
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Monica Rivera Mindt
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Latin American Latino Studies, and African and African American Studies, Fordham University, New York, NY, USA
| | - David Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amy B Mullens
- School of Psychology & Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | - Jose A Muñoz-Moreno
- Infectious Diseases Department, Germans Trias Hospital, Spain Open University of Catalonia, Barcalona, Spain
| | - Chrispher Power
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - John Rule
- National Association of People with HIV Australia, Newtown, New South Wales, Australia
| | - Reena Rajasuriar
- Department of Medicine and Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Micah J Savin
- Mailman Department of Public Health, Columbia University, New York, NY, USA
| | - Jeff Taylor
- HIV+Aging Research Project-Palm Springs, Palm Springs, CA, USA
| | - Mattia Trunfio
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Infectious Diseases Unit, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pui Li Wong
- Department of Medicine and Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Steven P Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Edwina J Wright
- Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia
- Burnet Institute, HIV Elimination Program, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
- The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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7
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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 DOI: 10.1037/neu0000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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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8
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Grant I, Krupitsky E, Vetrova M, Umlauf A, Heaton RK, Hauger RL, Toussova O, Franklin DR, Letendre SL, Woody G, Blokhina E, Lioznov D, Zvartau E. Effects of Opioid Withdrawal on Psychobiology in People Living with HIV. Viruses 2024; 16:92. [PMID: 38257791 PMCID: PMC10818595 DOI: 10.3390/v16010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Many persons with opioid use disorders (OUDs) have HIV disease and experience clinically significant stress after they enroll in abstinence-based treatment and undergo medically assisted withdrawal. We examined whether opioid withdrawal affects virologic control, inflammatory markers, cognition, and mood in persons with an OUD and HIV, and explored whether measures of withdrawal stress, such as activation of the HPA axis, contribute to alterations in immune function, cognition, and mood. METHOD AND PARTICIPANTS Study participants were 53 persons with HIV who were admitted for OUD treatment at the City Addiction Hospital in Saint Petersburg, Russian Federation. Participants were examined at admission, at the anticipated peak of withdrawal 3 to 7 days after the last day of a clonidine-based withdrawal process lasting 7 to 14 days, and 3 to 4 weeks after completing withdrawal. At these times, participants received medical exams and were evaluated for symptoms of withdrawal, as well as cognition and mood. Viral load, plasma cortisol, DHEA sulfate ester (DHEA-S), interleukin-6 (IL-6), and soluble CD14 (sCD14) were determined. Multivariable models examined the relationships between markers of HPA activation and the other parameters over time. RESULTS HPA activation as indexed by cortisol/DHEA-S ratio increased during withdrawal, as did markers of immune activation, IL-6 and sCD14. There were no significant associations between viral load and indicators of HPA activation. In longitudinal analyses, higher cortisol/DHEA sulfate was related to worse cognition overall, and more mood disturbance. Increase in IL-6 was associated with worse cognitive performance on a learning task. There were no significant associations with sCD14. CONCLUSIONS Worsening of cognition and measures of mood disturbance during withdrawal were associated with activation of the HPA axis and some measures of inflammation. Whether repeated episodes of opioid withdrawal have a cumulative impact on long-term HIV outcomes and neurocognition is a topic for further investigation.
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Affiliation(s)
- Igor Grant
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Evgeny Krupitsky
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
- Department of Addictions, Bekhterev National Medical Research Center for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
| | - Marina Vetrova
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Richard L. Hauger
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA 92093, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92093, USA
| | - Olga Toussova
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Donald R. Franklin
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Scott L. Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - George Woody
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Elena Blokhina
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Dmitry Lioznov
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Edwin Zvartau
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
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Guarña LA, Kamalyan L, Watson CWM, Karcher K, Umlauf A, Morgan E, Moore D, Ellis R, Grant I, Cherner M, Moore RC, Zlatar ZZ, Heaton RK, Marquine MJ. Emotional health and its association with neurocognition in Hispanic and non-Hispanic White people with HIV. J Int Neuropsychol Soc 2024; 30:56-66. [PMID: 37078464 PMCID: PMC10766342 DOI: 10.1017/s1355617723000188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Emotional functioning is linked to HIV-associated neurocognitive impairment, yet research on this association among diverse people with HIV (PWH) is scant. We examined emotional health and its association with neurocognition in Hispanic and White PWH. METHODS Participants included 107 Hispanic (41% primarily Spanish-speakers; 80% Mexican heritage/origin) and 216 White PWH (Overall age: M = 53.62, SD = 12.19; 86% male; 63% AIDS; 92% on antiretroviral therapy). Emotional health was assessed via the National Institute of Health Toolbox (NIHTB)-Emotion Battery, which yields T-scores for three factor-based summary scores (negative affect, social satisfaction, and psychological well-being) and 13 individual component scales. Neurocognition was measured via demographically adjusted fluid cognition T-scores from the NIHTB-cognition battery. RESULTS 27%-39% of the sample had problematic socioemotional summary scores. Hispanic PWH showed less loneliness, better social satisfaction, higher meaning and purpose, and better psychological well-being than Whites (ps <.05). Within Hispanics, Spanish-speakers showed better meaning and purpose, higher psychological well-being summary score, less anger hostility, but greater fear affect than English speakers. Only in Whites, worse negative affect (fear affect, perceived stress, and sadness) was associated with worse neurocognition (p <.05); and in both groups, worse social satisfaction (emotional support, friendship, and perceived rejection) was linked with worse neurocognition (p <.05). CONCLUSION Adverse emotional health is common among PWH, with subgroups of Hispanics showing relative strengths in some domains. Aspects of emotional health differentially relate to neurocogntition among PWH and cross-culturally. Understanding these varying associations is an important step towards the development of culturally relevant interventions that promote neurocognitive health among Hispanic PWH.
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Affiliation(s)
- Lesley A. Guarña
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0662, USA
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Caitlin Wei-Ming Watson
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Kayle Karcher
- Mentorship for Advancing Diversity in Undergraduate Research on Aging Program, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 920936, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Erin Morgan
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - David Moore
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- Department of Neurosciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0662, USA
| | - Igor Grant
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Raeanne C. Moore
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Zvinka Z. Zlatar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - María J. Marquine
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0662, USA
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- Departments of Medicine (Geriatrics Division) and Psychiatry, Duke University, Durham, NC, USA
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Rogers JM, Grant I, Marcondes MCG, Morgan EE, Cherner M, Ellis RJ, Letendre SL, Heaton RK, Iudicello JE. Cannabis use may attenuate neurocognitive performance deficits resulting from methamphetamine use disorder. J Int Neuropsychol Soc 2024; 30:84-93. [PMID: 37553288 PMCID: PMC10841263 DOI: 10.1017/s1355617723000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Methamphetamine and cannabis are two widely used, and frequently co-used, substances with possibly opposing effects on the central nervous system. Evidence of neurocognitive deficits related to use is robust for methamphetamine and mixed for cannabis. Findings regarding their combined use are inconclusive. We aimed to compare neurocognitive performance in people with lifetime cannabis or methamphetamine use disorder diagnoses, or both, relative to people without substance use disorders. METHOD 423 (71.9% male, aged 44.6 ± 14.2 years) participants, stratified by presence or absence of lifetime methamphetamine (M-/M+) and/or cannabis (C-/C+) DSM-IV abuse/dependence, completed a comprehensive neuropsychological, substance use, and psychiatric assessment. Neurocognitive domain T-scores and impairment rates were examined using multiple linear and binomial regression, respectively, controlling for covariates that may impact cognition. RESULTS Globally, M+C+ performed worse than M-C- but better than M+C-. M+C+ outperformed M+C- on measures of verbal fluency, information processing speed, learning, memory, and working memory. M-C+ did not display lower performance than M-C- globally or on any domain measures, and M-C+ even performed better than M-C- on measures of learning, memory, and working memory. CONCLUSIONS Our findings are consistent with prior work showing that methamphetamine use confers risk for worse neurocognitive outcomes, and that cannabis use does not appear to exacerbate and may even reduce this risk. People with a history of cannabis use disorders performed similarly to our nonsubstance using comparison group and outperformed them in some domains. These findings warrant further investigation as to whether cannabis use may ameliorate methamphetamine neurotoxicity.
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Affiliation(s)
- Jeffrey M. Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Erin E. Morgan
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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11
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Volpe KE, Samuels DC, Elson JL, Steyn JS, Gebretsadik T, Ellis RJ, Heaton RK, Kallianpur AR, Letendre S, Hulgan T. Mitochondrial DNA mutation pathogenicity score and neurocognitive performance in persons with HIV. Mitochondrion 2024; 74:101820. [PMID: 37989461 PMCID: PMC10872545 DOI: 10.1016/j.mito.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/06/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Mitochondrial DNA (mtDNA) genetic variation is associated with neurocognitive (NC) impairment (NCI) in people with HIV (PWH). Other approaches use sequence conservation and protein structure to predict the impact of mtDNA variants on protein function. We examined predicted mtDNA variant pathogenicity in the CHARTER study using MutPred scores, hypothesizing that persons with higher scores (greater predicted pathogenicity) have more NCI. METHODS CHARTER included NC testing in PWH from 2003 to 2007. MutPred scores were assigned to CHARTER participants with mtDNA sequence; any score > 0.5 was considered potentially deleterious. Outcomes at cohort entry were NCI, defined by global and seven NC domain deficit scores, and by mean global and domain NC performance T-scores. Univariate and multivariable regression analyses assessed associations between having a deleterious variant and NCI. Additional models included estimated peripheral blood cell mtDNA copy number. RESULTS Data were available for 744 PWH (357 African ancestry; 317 European; 70 Hispanic). In the overall cohort, PWH having any potentially deleterious variant were less likely to have motor impairment (16 vs. 25 %, p = 0.001). In multivariable analysis, having a deleterious variant remained associated with lower likelihood of motor impairment (adjusted odds ratio 0.59 [95 % CI 0.41-0.88]; p = 0.009), and better motor performance by T-score (β 1.71 [0.31-3.10], p = 0.02). Associations persisted after adjustment for estimated mtDNA quantity. CONCLUSIONS In these PWH, having a potentially deleterious mtDNA variant was associated with less motor impairment. These unexpected findings suggest that potentially deleterious mtDNA variations may confer protection against impaired motor function by as yet unknown mechanisms.
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Affiliation(s)
- Karen E Volpe
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - David C Samuels
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joanna L Elson
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Jannetta S Steyn
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | | | | | | | - Todd Hulgan
- Vanderbilt University Medical Center, Nashville, TN, USA.
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12
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Riggs PK, Anderson AM, Tang B, Rubin LH, Morgello S, Marra CM, Gelman BB, Clifford DB, Franklin D, Heaton RK, Ellis RJ, Fennema-Notestine C, Letendre SL. Elevated Plasma Protein Carbonyl Concentration Is Associated with More Abnormal White Matter in People with HIV. Viruses 2023; 15:2410. [PMID: 38140650 PMCID: PMC10747698 DOI: 10.3390/v15122410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Structural brain abnormalities, including those in white matter (WM), remain common in people with HIV (PWH). Their pathogenesis is uncertain and may reflect multiple etiologies. Oxidative stress is associated with inflammation, HIV, and its comorbidities. The post-translational carbonylation of proteins results from oxidative stress, and circulating protein carbonyls may reflect this. In this cross-sectional analysis, we evaluated the associations between protein carbonyls and a panel of soluble biomarkers of neuronal injury and inflammation in plasma (N = 45) and cerebrospinal fluid (CSF, n = 32) with structural brain MRI. The volume of abnormal WM was normalized for the total WM volume (nAWM). In this multisite project, all regression models were adjusted for the scanner. The candidate covariates included demographics, HIV disease characteristics, and comorbidities. Participants were PWH on virally suppressive antiretroviral therapy (ART) and were mostly white (64.4%) men (88.9%), with a mean age of 56.8 years. In unadjusted analyses, more nAWM was associated with higher plasma protein carbonyls (p = 0.002) and higher CCL2 (p = 0.045). In the adjusted regression models for nAWM, the association with plasma protein carbonyls remained significant (FDR p = 0.018). Protein carbonyls in plasma may be a valuable biomarker of oxidative stress and its associated adverse health effects, including within the central nervous system. If confirmed, these findings would support the hypothesis that reducing oxidative stress could treat or prevent WM injury in PWH.
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Affiliation(s)
- Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Albert M. Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Leah H. Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, and Epidemiology, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Mt Sinai School of Medicine, New York, NY 10029, USA
| | - Christina M. Marra
- Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - Benjamin B. Gelman
- Departments of Pathology, and Neuroscience & Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - David B. Clifford
- Department of Neurology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Donald Franklin
- 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
| | - 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
| | - Christine Fennema-Notestine
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Scott L. Letendre
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
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13
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Umlauf A, Vaida F, Gupta S, Cherner M, Gershon RC, Heaton RK. Automated procedure for demographic adjustments on cognitive test scores. Appl Neuropsychol Adult 2023:1-10. [PMID: 38052056 DOI: 10.1080/23279095.2023.2288231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Performances of normal people on cognitive tests are known to vary by demographic characteristics, such as age, education, and sex. Thus, cognitive test scores should be corrected for demographic influences when they are used to detect below-expected results due to disease or injury involving the central nervous system (CNS). Normative corrections, if estimated from a large, diverse, and well-characterized cohort of controls, help to remove expected differences in cognitive performance associated with normal demographic characteristics and associated socio-economic disadvantages. In this paper, we (1) describe in detail the process of generating regression-based normative standards, and its advantages and limitations, (2) provide recommendations for applying these normative standards to data from individuals and populations at risk for CNS dysfunction, and (3) introduce an R package, test2norm, that contains functions for producing and applying normative formulas to generate demographically corrected scores for measuring deviations from expected, normal cognitive performances.
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Affiliation(s)
- Anya Umlauf
- University of California San Diego, La Jolla, CA, USA
| | - Florin Vaida
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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14
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Wang CX, Hussain MA, Carvalho de LT, Castellanos-Ponce V, Cherner M, Palmer BW, Umlauf A, Heaton RK, Ellis RJ, Marquine MJ. B - 45 Differences in the Association between Social Activity and Neurocognition between Latino and Non-Hispanic White Older Adults with HIV. Arch Clin Neuropsychol 2023; 38:1409. [PMID: 37807444 DOI: 10.1093/arclin/acad067.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Older Hispanics/Latinos/as/x (henceforth Latinos) are disproportionately affected by HIV-associated neurocognitive impairment compared to their non-Hispanic White counterparts. We examined social activity as a possible protective factor against worse neurocognitive outcomes for older people with HIV (PWH). Given cultural values regarding interpersonal relationships, we also examined whether the association between social activity and neurocognition was stronger for Latino than White PWH. METHOD Community-dwelling PWH (N = 114; 50% Latino [53% Spanish-speaking]; Overall group: Age: M = 58.03 SD = 5.75; Education: M = 13.29, SD = 3.39; 82% male; 58% AIDS; 95% on antiretroviral therapy; 4% detectable plasma RNA) completed neuropsychological and neuromedical evaluations. Global neurocognition was derived from demographically adjusted T-scores on a battery of 10 tests with separate norms for English and Spanish-speakers. A questionnaire assessed participants' engagement in 7 social activities over the past year. Covariates included physical activity, depressed mood, and HIV disease characteristics. RESULTS There were no ethnic differences in degree or nature of social activity. A linear regression model revealed a significant interaction between ethnicity and social activity on global neurocognitive T-scores, (β = 0.45, SE = 0.18, p = 0.02), such that increased engagement in social activities was associated with better global neurocognition in White PWH (β = 3.40, SE = 1.13, p < 0.01), but not Latino PWH (β = 0.57, SE = 1.00, p = 0.57). CONCLUSIONS Results indicate a possible protective influence of social activity on neurocognition in older White, but not Latino PWH, highlighting the importance of examining the generalizability of this relationship across ethnic/cultural groups. Future studies might examine the quality of social activities and their link with neurocognition in diverse older PWH.
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15
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Anthes VB, Schwartz M, Cusimano MD, Radovanovic I, Kulkarni AV, Laperriere NJ, Payne D, Heaton RK, van Prooijen M, Das S, Tsang DSC. Effect of Cobalt-60 Calibration Dose-Rate on Arteriovenous Malformation Obliteration after Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2023; 117:e83-e84. [PMID: 37786194 DOI: 10.1016/j.ijrobp.2023.06.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic radiosurgery (SRS) dose rate - how old the cobalt-60 sources are - is known to influence outcomes for some neurologic conditions and benign tumors, but it is not known if SRS dose rate influences arteriovenous malformation (AVM) obliteration. The objective of this study is to determine the association between cobalt-60 calibration dose rate and cerebral AVM obliteration in patients treated with SRS. Our hypothesis is that higher SRS dose rates are associated with increased incidence of cerebral AVM obliteration. MATERIALS/METHODS We performed a retrospective study of 361 patients undergoing 411 AVM-directed SRS treatments between 2005 and 2019 at a single institution. Obliteration was confirmed with digital subtraction angiogram or MRI (if patient refused angiography). Lesion characteristics, SRS treatment details, and post-treatment obliteration and toxicities were recorded. Univariate and multivariate proportional hazards regression models of AVM outcomes with regard to SRS dose rate were performed, controlling for factors such as Spetzler-Martin Grade, maximum AVM extent, prior hemorrhage and prior embolization. RESULTS At 10 years post-SRS, 68% of AVMs were obliterated on follow-up imaging. Dose rates >2.9 Gy/min were found to be significantly associated with AVM obliteration compared to those <2.1 Gy/min (p = 0.034, Gray's test). AVM size or Spetzler-Martin grade were also associated with obliteration, with obliteration more likely for smaller lesions, particularly those <3 cm in maximal diameter, or with lower Spetzler-Martin grade. Higher dose rates were not associated with development of post-SRS radiologic or symptomatic edema, though larger AVM volume was associated with both types of edema. CONCLUSION Patients with cerebral AVMs treated with higher SRS dose rates (from fresh cobalt-60 sources) experience higher incidences of obliteration, without a significant change in the risk of post-treatment edema. These findings suggest that clinics offering SRS for AVMs should regularly renew cobalt-60 radiation sources to maintain high therapeutic dose rates.
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Affiliation(s)
- V B Anthes
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - M Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - I Radovanovic
- Division of Neurosurgery, University Health Network, Toronto, ON, Canada
| | - A V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - N J Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - D Payne
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - R K Heaton
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - M van Prooijen
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - S Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - D S C Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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16
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Hussain MA, Watson CWM, Morgan EE, Heaton RK, Letendre SL, Jeste DV, Moore DJ, Iudicello JE. Combined effects of loneliness and inflammation on depression in people with HIV. J Neurovirol 2023; 29:538-554. [PMID: 37651083 PMCID: PMC10645641 DOI: 10.1007/s13365-023-01145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Loneliness is prevalent in people with HIV (PWH) and associated with adverse health-related consequences, including depression. Chronic inflammation has been linked to depression in PWH, though its association with loneliness is less well established. Simultaneous examination of inflammation, loneliness and depression is needed to clarify these relationships. This study investigated the relationship between loneliness and inflammation, and the effects of loneliness and inflammation on depression in PWH. METHODS 82 PWH who were on suppressive ART (mean age [SD] = 53.2 [9.0]) completed the UCLA Loneliness Scale-Version 3 and the Center for Epidemiologic Studies Depression Scale as part of a comprehensive evaluation. Biomarkers of systemic inflammation (CRP, IL-6, CCL2/MCP-1, sCD14) and coagulation (D-dimer) were measured in blood using commercial immunoassays. RESULTS Multivariable linear regression analyses revealed that higher D-dimer, CCL2/MCP-1, and sCD14 were significant predictors of loneliness (ps < .05) while accounting for relevant covariates. Stepwise multiple linear regression models that included loneliness, biomarkers, and their interactions as predictors of depressive symptoms revealed significant main effects of loneliness and CCL2/MCP-1 levels (ps < .05), and a significant loneliness by D-dimer interaction (p < .05) whereby higher D-dimer was associated with increased depressive symptoms only at higher levels of loneliness. CONCLUSIONS Increased coagulation activity is associated with loneliness, and in the context of loneliness, may increase risk for depression. Increased inflammation was associated with depression suggesting potentially dissociable underlying biological processes. To the extent that these processes are modifiable, such findings could have important implications in the treatment of loneliness and depression in PWH.
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Affiliation(s)
- Mariam A Hussain
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA.
- Department of Psychiatry, University of California San Diego, La Jolla, USA.
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA.
| | - C Wei-Ming Watson
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Erin E Morgan
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- Department of Neurosciences, University of California San Diego, La Jolla, USA
- Sam and Rose Stein Institute for Research On Aging, University of California San Diego, La Jolla, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Jennifer E Iudicello
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
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17
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Watson CWM, Sundermann E, Helm J, Paolillo EW, Hong S, Ellis RJ, Letendre S, Marcotte TD, Heaton RK, Morgan EE, Grant I. A longitudinal study of cannabis use and risk for cognitive and functional decline among older adults with HIV. AIDS Behav 2023; 27:3401-3413. [PMID: 37155086 PMCID: PMC10766343 DOI: 10.1007/s10461-023-04056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/10/2023]
Abstract
Cannabis use is rapidly increasing among older adults in the United States, in part to treat symptoms of common health conditions (e.g., chronic pain, sleep problems). Longitudinal studies of cannabis use and cognitive decline in aging populations living with chronic disease are lacking. We examined different levels of cannabis use and cognitive and everyday function over time among 297 older adults with HIV (ages 50-84 at baseline). Participants were classified based on average cannabis use: frequent (> weekly) (n = 23), occasional (≤ weekly) (n = 83), and non-cannabis users (n=191) and were followed longitudinally for up to 10 years (average years of follow-up = 3.9). Multi-level models examined the effects of average and recent cannabis use on global cognition, global cognitive decline, and functional independence. Occasional cannabis users showed better global cognitive performance overall compared to non-cannabis users. Rates of cognitive decline and functional problems did not vary by average cannabis use. Recent cannabis use was linked to worse cognition at study visits when participants had THC+ urine toxicology-this short-term decrement in cognition was driven by worse memory and did not extend to reports of functional declines. Occasional (≤ weekly) cannabis use was associated with better global cognition over time in older adults with HIV, a group vulnerable to chronic inflammation and cognitive impairment. Recent THC exposure may have a temporary adverse impact on memory. To inform safe and efficacious medical cannabis use, the effects of specific cannabinoid doses on cognition and biological mechanisms must be investigated in older adults.
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Affiliation(s)
- Caitlin Wei-Ming Watson
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States.
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, United States.
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Jonathan Helm
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Emily W Paolillo
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, United States
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
| | - Ronald J Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- Department of Neurosciences, University of California San Diego, San Diego, CA, United States
| | - Scott Letendre
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Thomas D Marcotte
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Erin E Morgan
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
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18
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Rogers JM, Iudicello JE, Marcondes MCG, Morgan EE, Cherner M, Ellis RJ, Letendre SL, Heaton RK, Grant I. Reply to Augello, P.A.; Wu, J. Comment on "Rogers et al. The Combined Effects of Cannabis, Methamphetamine, and HIV on Neurocognition. Viruses 2023, 15, 674". Viruses 2023; 15:1878. [PMID: 37766283 PMCID: PMC10534708 DOI: 10.3390/v15091878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
We thank Augello and Wu [...].
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Affiliation(s)
- Jeffrey M. Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
| | - Jennifer E. Iudicello
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | | | - Erin E. Morgan
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
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19
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Sundermann EE, Tang B, Kim M, Paolillo EW, Heaton RK, Moore RC. Neuropsychiatric predictors of cognitive functioning over a one-year follow-up period in HIV. J Affect Disord 2023; 336:92-96. [PMID: 37211052 PMCID: PMC10766340 DOI: 10.1016/j.jad.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) and cognitive impairment are highly prevalent among persons with HIV (PWH). We examined the effect of the most common NPS, depression and anxiety, on cognitive change among PWH and compared these associations to those among persons without HIV (PWoH). METHODS Participants included 168 PWH and 91 PWoH who completed baseline self-report measures of depression (Beck Depression Inventory-II) and anxiety (Profile of Mood States [POMS] - Tension-anxiety subscale) and completed a comprehensive neurocognitive evaluation at baseline and at 1-year follow-up. Demographically-corrected scores from 15 neurocognitive tests were used to calculate global and domain-specific T-scores. Linear mixed-effects models examined the effect of depression and anxiety and their interaction with HIV-serostatus and time on global T-scores. RESULTS There were significant depression-by-HIV and anxiety-by-HIV interactions on global T-scores such that, among PWH only, greater depressive and anxiety symptoms at baseline related to worse global T-scores across visits. Non-significant interactions with time suggest stability in these relationships across visits. Follow-up analyses examining cognitive domains revealed that both the depression-by-HIV and the anxiety-by-HIV interactions were driven by learning and recall. LIMITATIONS Follow-up was limited to one-year and there were fewer PWoH than PWH, creating a differential in statistical power. CONCLUSION Findings suggest that anxiety and depression have stronger links to worse cognitive functioning in PWH than PWoH, particularly learning and memory, and that these associations seem to persist for at least one-year.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Bin Tang
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Michelle Kim
- Department of Medicine, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Emily W Paolillo
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
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20
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Deist M, Suliman S, Kidd M, Franklin D, Cherner M, Heaton RK, Spies G, Seedat S. Neuropsychological Test Norms for the Assessment of HIV-Associated Neurocognitive Impairment Among South African Adults. AIDS Behav 2023; 27:3080-3097. [PMID: 36918465 PMCID: PMC10386947 DOI: 10.1007/s10461-023-04029-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
Reliable and valid neurocognitive (NC) test batteries that assess multiple domains of cognitive functioning are vital tools in the early detection of HIV-associated NC impairment. The HIV Neurobehavioral Research Center's International Neurobehavioral Battery (HNRC Battery) is one such diagnostic tool and has shown cultural validity in several international neuroHIV studies. However, no published norms are currently available for the full HNRC Battery in South Africa. To accurately interpret NC test results, appropriate reference norms are required. In light of this challenge, data were collected from 500 healthy, HIV-uninfected participants to develop demographically corrected South African norms. When demographically corrected United States of America (U.S.) norms were applied to the performance scores of our neurologically intact, HIV-negative sample, an impairment rate of 62.2% was observed compared to a 15.0% impairment rate when the newly generated South African norms were applied. These results reiterate the findings of other low- and middle-income countries, highlighting the need for localized, country-specific norms when interpreting NC performance.
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Affiliation(s)
- Melanie Deist
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - Donald Franklin
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Mariana Cherner
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Robert K Heaton
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Georgina Spies
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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21
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Okwuegbuna OK, Kaur H, Iudicello J, Bush WS, Bharti A, Umlauf A, Ellis RJ, Franklin DR, Heaton RK, McCutchan JA, Kallianpur AR, Letendre SL. Anemia and Erythrocyte Indices Are Associated With Neurocognitive Performance Across Multiple Ability Domains in Adults With HIV. J Acquir Immune Defic Syndr 2023; 92:414-421. [PMID: 36580636 PMCID: PMC10006328 DOI: 10.1097/qai.0000000000003155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anemia is linked to neurocognitive impairment (NCI) in people with HIV (PWH), but its impact within specific ability domains, and in diverse populations with HIV, is uncertain. METHODS Participants included 1339 PWH enrolled in observational HIV cohort studies with a mean of 3 comprehensive neurocognitive assessments over 30 months. Global and domain-specific neurocognitive function were assessed by the global deficit score and domain deficit score (GDS and DDS, respectively) or as GDS-defined or DDS-defined NCI (GDS ≥ 0.5, DDS > 0.5). Time-dependent associations of anemia or red-cell indices with neurocognitive function were evaluated by multivariable regression. RESULTS The mean age at entry was 43.6 years (85% male, 23.9% Hispanic, 16.7% African ancestry by self-report, and 69.8% virally suppressed). Anemia occurred at entry in 297 (22.2%) and developed subsequently in another 129 (9.6%). Anemia (present in 26.8% of cognitively impaired PWH at entry) and lower hemoglobin were associated with higher (worse) GDS values; the association for anemia persisted after multivariable adjustment and in virally suppressed persons ( P < 0.0001). Anemia was also associated with reduced processing speed, motor function, learning, delayed recall, working memory (all P < 0.01), executive function ( P = 0.021), and verbal fluency ( P = 0.035), and these findings persisted in longitudinal analyses (adjusted P < 0.01 for all domains, except verbal fluency). Higher mean corpuscular volume and mean corpuscular hemoglobin were associated with less impairment in learning and recall (all P < 0.05). CONCLUSIONS Anemia in diverse and virally suppressed PWH associates with reduced neurocognitive performance in multiple domains, cross-sectionally and over time. The impact of identifying and treating anemia to prevent or slow neurocognitive decline in PWH should be prospectively evaluated.
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Affiliation(s)
| | - Harpreet Kaur
- Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic
| | | | - William S. Bush
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ajay Bharti
- Department of Medicine, University of California, San Diego, CA
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, CA
| | - Ronald J. Ellis
- Department of Neuroscience, University of California, San Diego, CA
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Robert K. Heaton
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Asha R. Kallianpur
- Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Scott L. Letendre
- Department of Medicine, University of California, San Diego, CA
- Department of Psychiatry, University of California, San Diego, CA
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22
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Taylor BC, Sheikh Andalibi M, Wandro S, Weldon KC, Sepich-Poore GD, Carpenter CS, Fraraccio S, Franklin D, Iudicello JE, Letendre S, Gianella S, Grant I, Ellis RJ, Heaton RK, Knight R, Swafford AD. Signatures of HIV and Major Depressive Disorder in the Plasma Microbiome. Microorganisms 2023; 11:1022. [PMID: 37110445 PMCID: PMC10146336 DOI: 10.3390/microorganisms11041022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Inter-individual differences in the gut microbiome are linked to alterations in inflammation and blood-brain barrier permeability, which may increase the risk of depression in people with HIV (PWH). The microbiome profile of blood, which is considered by many to be typically sterile, remains largely unexplored. We aimed to characterize the blood plasma microbiome composition and assess its association with major depressive disorder (MDD) in PWH and people without HIV (PWoH). In this cross-sectional, observational cohort, we used shallow-shotgun metagenomic sequencing to characterize the plasma microbiome of 151 participants (84 PWH and 67 PWoH), all of whom underwent a comprehensive neuropsychiatric assessment. The microbial composition did not differ between PWH and PWoH or between participants with MDD and those without it. Using the songbird model, we computed the log ratio of the highest and lowest 30% of the ranked classes associated with HIV and MDD. We found that HIV infection and lifetime MDD were enriched in a set of differentially abundant inflammatory classes, such as Flavobacteria and Nitrospira. Our results suggest that the circulating plasma microbiome may increase the risk of MDD related to dysbiosis-induced inflammation in PWH. If confirmed, these findings may indicate new biological mechanisms that could be targeted to improve treatment of MDD in PWH.
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Affiliation(s)
- Bryn C. Taylor
- Biomedical Sciences Graduate Program, University of California San Diego, San Diego, CA 92093, USA
| | - Mohammadsobhan Sheikh Andalibi
- Departments of Neurosciences and Psychiatry, HIV Neurobehavioral Research Center, University of California, San Diego, CA 92093, USA; (M.S.A.)
| | - Stephen Wandro
- Center for Microbiome Innovation, University of California San Diego, San Diego, CA 92093, USA
| | - Kelly C. Weldon
- Center for Microbiome Innovation, University of California San Diego, San Diego, CA 92093, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA 92093, USA
| | | | - Carolina S. Carpenter
- Center for Microbiome Innovation, University of California San Diego, San Diego, CA 92093, USA
| | - Serena Fraraccio
- Center for Microbiome Innovation, University of California San Diego, San Diego, CA 92093, USA
| | - Donald Franklin
- Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Jennifer E. Iudicello
- Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Scott Letendre
- Departments of Medicine and Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA 92093, USA
| | - Igor Grant
- Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Ronald J. Ellis
- Departments of Neurosciences and Psychiatry, HIV Neurobehavioral Research Center, University of California, San Diego, CA 92093, USA; (M.S.A.)
| | - Robert K. Heaton
- Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Rob Knight
- Center for Microbiome Innovation, University of California San Diego, San Diego, CA 92093, USA
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA 92093, USA
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA 92093, USA
| | - Austin D. Swafford
- Center for Microbiome Innovation, University of California San Diego, San Diego, CA 92093, USA
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23
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Rogers JM, Iudicello JE, Marcondes MCG, Morgan EE, Cherner M, Ellis RJ, Letendre SL, Heaton RK, Grant I. The Combined Effects of Cannabis, Methamphetamine, and HIV on Neurocognition. Viruses 2023; 15:674. [PMID: 36992383 PMCID: PMC10058939 DOI: 10.3390/v15030674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE Methamphetamine and cannabis are two widely used substances among people living with HIV (PLWH). Whereas methamphetamine use has been found to worsen HIV-associated neurocognitive impairment, the effects of combined cannabis and methamphetamine use disorder on neurocognition in PLWH are not understood. In the present study, we aimed to determine the influence of these substance use disorders on neurocognition in PLWH and to explore if methamphetamine-cannabis effects interacted with HIV status. METHOD AND PARTICIPANTS After completing a comprehensive neurobehavioral assessment, PLWH (n = 472) were stratified by lifetime methamphetamine (M-/M+) and cannabis (C-/C+) DSM-IV abuse/dependence disorder into four groups: M-C- (n = 187), M-C+ (n = 68), M+C-, (n = 82), and M+C+ (n = 135). Group differences in global and domain neurocognitive performances and impairment were examined using multiple linear and logistic regression, respectively, while holding constant other covariates that were associated with study groups and/or cognition. Data from participants without HIV (n = 423) were added, and mixed-effect models were used to examine possible interactions between HIV and substance use disorders on neurocognition. RESULTS Compared with M+C+, M+C- performed worse on measures of executive functions, learning, memory, and working memory and were more likely to be classified as impaired in those domains. M-C- performed better than M+C+ on measures of learning and memory but worse than M-C+ on measures of executive functions, learning, memory, and working memory. Detectable plasma HIV RNA and nadir CD4 < 200 were associated with lower overall neurocognitive performance, and these effects were greater for M+C+ compared with M-C-. CONCLUSIONS In PLWH, lifetime methamphetamine use disorder and both current and legacy markers of HIV disease severity are associated with worse neurocognitive outcomes. There was no evidence of an HIV × M+ interaction across groups, but neurocognition was most impacted by HIV among those with polysubstance use disorder (M+C+). Better performance by C+ groups is consistent with findings from preclinical studies that cannabis use may protect against methamphetamine's deleterious effects.
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Affiliation(s)
- Jeffrey M. Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
| | - Jennifer E. Iudicello
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | | | - Erin E. Morgan
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
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Chow FC, Zhao F, He Y, Song X, Zhang J, Ao D, Wu Y, Hou B, Sorond FA, Ances BM, Letendre S, Heaton RK, Shi C, Feng F, Zhu Y, Wang H, Li T. Brief Report: Sex Differences in the Association Between Cerebrovascular Function and Cognitive Health in People Living With HIV in Urban China. J Acquir Immune Defic Syndr 2023; 92:217-222. [PMID: 36318881 DOI: 10.1097/qai.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiometabolic and cerebrovascular disease are strong independent contributors to cognitive impairment in people living with HIV. Data suggest that cardiovascular risk may play a greater role in cognitive health in women than in men with HIV. METHODS We performed a cross-sectional study of 104 participants with virologically suppressed HIV from 2 clinics in urban China. Participants underwent neuropsychological testing from which we calculated T scores globally and in 5 cognitive domains. We assessed cerebral vasoreactivity of the middle cerebral arteries in response to breath holding. We constructed linear regression models to determine associations between cerebrovascular and cognitive function overall and stratified by sex. RESULTS Women were younger than men (48 versus 51 years, P = 0.053), had fewer years of education (9 years versus 12 years, P = 0.004), and fewer cardiometabolic risk factors (0 versus 1 factor, P = 0.008). In a model with all participants, cerebrovascular function was significantly associated with global cognition (2.74 higher T score per 1-point higher cerebral vasoreactivity [SE 1.30], P = 0.037). Cerebrovascular function remained significantly associated with global cognition among women (4.15 higher T score [SE 1.78], P = 0.028) but not men (1.70 higher T score [SE 1.74], P = 0.33). The relationships between cerebrovascular function and specific cognitive domains followed a similar pattern, with significant associations present among women but not men. CONCLUSIONS Women with well-controlled HIV may be more vulnerable to the effect of cerebrovascular injury on cognitive health than men. Studies evaluating strategies to protect against cognitive impairment in people living with HIV should include adequate representation of women and stratification of analyses by sex.
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Affiliation(s)
- Felicia C Chow
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Fang Zhao
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Yun He
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangxia Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Donghui Ao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuchen Wu
- Department of Hematology, Tiantan Hospital, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Beau M Ances
- Department of Neurology and Hope Center for Neurological Disorders, Washington University, St. Louis, MO
| | - Scott Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Chuan Shi
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China; and
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanling Wang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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26
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Heaton RK, Ellis RJ, Tang B, Marra CM, Rubin LH, Clifford DB, McCutchan JA, Gelman BB, Morgello S, Franklin DR, Letendre SL. Twelve-year neurocognitive decline in HIV is associated with comorbidities, not age: a CHARTER study. Brain 2023; 146:1121-1131. [PMID: 36477867 PMCID: PMC10169412 DOI: 10.1093/brain/awac465] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Modern antiretroviral therapy (ART) has increased longevity of people with HIV and shifted the age distribution of the HIV pandemic upward toward that of the general population. This positive development has also led to concerns about premature and/or accelerated neurocognitive and physical ageing due to the combined effects of chronic HIV, accumulating comorbidities, adverse effects or possible toxicities of ART and biological ageing. Here we present results of comprehensive assessments over 12 years of 402 people with HIV in the CNS HIV ART Effects Research (CHARTER) programme, who at follow-up were composed of younger (<60 years) and older (≥60 years) subgroups. Over the 12 years, ART use and viral suppression increased in both subgroups as did systemic and psychiatric comorbidities; participants in both subgroups also evidenced neurocognitive decline beyond what is expected in typical ageing. Contrary to expectations, all these adverse effects were comparable in the younger and older CHARTER subgroups, and unrelated to chronological age. Neurocognitive decline was unrelated to HIV disease or treatment characteristics but was significantly predicted by the presence of comorbid conditions, specifically diabetes, hypertension, chronic pulmonary disease, frailty, neuropathic pain, depression and lifetime history of cannabis use disorder. These results are not consistent with premature or accelerated neurocognitive ageing due to HIV itself but suggest important indirect effects of multiple, potentially treatable comorbidities that are more common among people with HIV than in the general population. Good medical management of HIV disease did not prevent these adverse outcomes, and increased attention to a range of comorbid conditions in people with HIV may be warranted in their care.
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Affiliation(s)
- Robert K Heaton
- 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, CA 92093, USA
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Christina M Marra
- Department of Neurology, University of Washington, Seattle, WA 98104, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - David B Clifford
- Department of Neurology, Washington University at St. Louis, St. Louis, MO 63110, USA
| | - J Allen McCutchan
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Donald R Franklin
- 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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Brody LA, Kamalyan L, Karcher K, Guarena LA, Bender AA, McKenna BS, Umlauf A, Franklin D, Marquine MJ, Heaton RK. NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations. Patient Relat Outcome Meas 2023; 14:15-30. [PMID: 36814680 PMCID: PMC9939807 DOI: 10.2147/prom.s391113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH. Patients and Methods Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests ("problematic" emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH. Results PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen's d=0.71, p<0.001), Psychological Well-Being (Cohen's d=0.49, p<0.001) and Negative Affect (Cohen's d=0.19, p<0.01) summary T-scores, and most component scales. PWH also had higher rates of "problematic" emotional health, particularly in Social Satisfaction (45% vs 17%, p<0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence. Conclusion The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.
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Affiliation(s)
- Lilla A Brody
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Kayle Karcher
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lesley A Guarena
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Benjamin S McKenna
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Donald Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Maria J Marquine
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert K Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
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Kaunda L, Ngoma MS, Menon JA, Heaton RK, Gianella S, Bharti AR, Letendre S, de Oliveira MF, Hestad KA. Effect of coinfections on neurocognitive functioning among people with clade C HIV infection in Zambia. J Neurovirol 2023; 29:45-52. [PMID: 36729300 PMCID: PMC10748732 DOI: 10.1007/s13365-022-01110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/09/2022] [Accepted: 12/19/2022] [Indexed: 02/03/2023]
Abstract
Despite the fact that many coinfections in people with HIV (PWH) are treatable or suppressible, they may still impact neurocognitive (NC) functioning. Here, we aim to evaluate the presence of latent/treated coinfections and their association with NC functioning in a cohort of PWH in Zambia. We carried out a cross-sectional, nested study involving 151 PWH with viral suppression, and a normative sample of 324 adults without HIV. Plasma samples from PWH who underwent a comprehensive NC assessment were evaluated for the presence of treated/latent coinfections that are common in Zambia. Information about treated pulmonary tuberculosis (TB) was obtained from participants' clinical charts. Overall, PWH differed significantly from the HIV seronegatives on all neuropsychological domains except for fine motor control. ANOVA comparisons of all 3 HIV + groups' demographically corrected mean NC T-scores showed that the HIV + /TB + group had the poorest NC functioning in the following domains: executive functioning (F = 4.23, p = 0.02), working memory (F = 5.05, p = 0.002), verbal fluency (F = 4.24, p = 0.006), learning (F = 11.26, p < 0.001), delayed recall (F = 4.56, p = 0.01), and speed of information processing (F = 5.16, p = 0.005); this group also was substantially worse on the total battery (global mean T-scores; F = 8.02, p < 0.001). In conclusion, treated TB coinfection in PWH was associated with worse NC performance compared to both those with antibodies against other coinfections and without. PWH with antibodies for other coinfections (HIV + /CI +) showed somewhat better NC performance compared to those without (HIV + /CI -), which was not expected, although comparisons with the HIV + /CI + group are limited by its lack of specificity regarding type of coinfection being represented.
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Affiliation(s)
- Lumbuka Kaunda
- Department of Physiological Sciences, School of Medicine, University of Zambia, Lusaka, Zambia.
| | - Mary S Ngoma
- Department of Pediatrics, and Child Health, University of Zambia, Lusaka, Zambia
| | - J Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sara Gianella
- Department of Medicine, University of California, San Diego, CA, USA
| | - Ajay R Bharti
- Department of Medicine, University of California, San Diego, CA, USA
| | - Scott Letendre
- Department of Medicine, University of California, San Diego, CA, USA
| | | | - Knut A Hestad
- Department of Research, Innlandet Hospital Trust, Hamar, Norway
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29
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Kohli M, Fisher A, Sun-Suslow N, Heaton A, Dawson MS, Marquie J, Franklin DR, Marquine M, Iudicello JE, Heaton RK, Moore DJ. Concurrent validity and reliability of at-home teleneuropsychological evaluations among people with and without HIV. J Int Neuropsychol Soc 2023; 29:193-204. [PMID: 36510855 PMCID: PMC10205080 DOI: 10.1017/s1355617722000777] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the reliability of teleneuropsychological (TNP) compared to in-person assessments (IPA) in people with HIV (PWH) and without HIV (HIV-). METHODS Participants included 80 PWH (Mage = 58.7, SDage = 11.0) and 23 HIV- (Mage = 61.9, SDage = 16.7). Participants completed two comprehensive neuropsychological IPA before one TNP during the COVID-19 pandemic (March-December 2020). The neuropsychological tests included: Hopkins Verbal Learning Test-Revised (HVLT-R Total and Delayed Recall), Controlled Oral Word Association Test (COWAT; FAS-English or PMR-Spanish), Animal Fluency, Action (Verb) Fluency, Wechsler Adult Intelligence Scale 3rd Edition (WAIS-III) Symbol Search and Letter Number Sequencing, Stroop Color and Word Test, Paced Auditory Serial Addition Test (Channel 1), and Boston Naming Test. Total raw scores and sub-scores were used in analyses. In the total sample and by HIV status, test-retest reliability and performance-level differences were evaluated between the two consecutive IPA (i.e., IPA1 and IPA2), and mean in-person scores (IPA-M), and TNP. RESULTS There were statistically significant test-retest correlations between IPA1 and IPA2 (r or ρ = .603-.883, ps < .001), and between IPA-M and TNP (r or ρ = .622-.958, ps < .001). In the total sample, significantly lower test-retest scores were found between IPA-M and TNP on the COWAT (PMR), Stroop Color and Word Test, WAIS-III Letter Number Sequencing, and HVLT-R Total Recall (ps < .05). Results were similar in PWH only. CONCLUSIONS This study demonstrates reliability of TNP in PWH and HIV-. TNP assessments are a promising way to improve access to traditional neuropsychological services and maintain ongoing clinical research studies during the COVID-19 pandemic.
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Affiliation(s)
- Maulika Kohli
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Arin Fisher
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Ni Sun-Suslow
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Anne Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Matthew S Dawson
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Jennifer Marquie
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Donald R Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Maria Marquine
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jennifer E Iudicello
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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30
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Saloner R, Sun-Suslow N, Morgan EE, Lobo J, Cherner M, Ellis RJ, Heaton RK, Grant I, Letendre SL, Iudicello JE. Plasma biomarkers of vascular dysfunction uniquely relate to a vascular-risk profile of neurocognitive deficits in virally-suppressed adults with HIV. Brain Behav Immun Health 2022; 26:100560. [DOI: 10.1016/j.bbih.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
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Tennant IA, Hull DM, Fagan MA, Casaletto KB, Heaton RK, James Bateman C, Erickson KI, Forrester T, Boyne M. Assessment of cross-cultural measurement invariance of the NIH toolbox fluid cognition measures between Jamaicans and African-Americans. Appl Neuropsychol Adult 2022:1-9. [PMID: 36167328 DOI: 10.1080/23279095.2022.2126939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The NIH Toolbox Cognitive Battery (NIHTB-CB) was developed as a common-metric, computerized cognitive screener for research. Although extensively normed and validated in Americans of different ethnicities, there is little data on how generalizable such results would be when used outside of the United States. The objective of this study was to assess measurement invariance (MI) of the NIHTB-CB across Jamaican and African-American samples and determine appropriateness of comparisons across groups. Multi-group confirmatory factor analyses using a single-factor model were conducted using five tests of fluid cognitive abilities from the NIHTB-CB, which assess working memory, episodic memory, processing speed, and executive function. MI was tested sequentially for configural, metric and scalar invariance. 125 Jamaican and 154 American adults of African descent were included. The Jamaican mean age was 31.6 ± 8.6 years (57% males) compared to 43.5 ± 15.5 years (25% males) for the African-American group. The Jamaicans had on average 11.3 ± 2.7 years of education compared to 13.9 ± 2.6 years for the African-Americans. We found metric and configural invariance across both samples but not scalar invariance. These findings suggest that the single factor emerging from the NIHTB-CB measures the same construct, i.e. fluid cognitive ability, in both groups and hence the battery is appropriate for assessments within cultures. However, lack of scalar invariance indicates that direct cross-cultural comparisons of performance levels should be interpreted with caution, also suggesting that U.S. normative standards are not generalizable to the Jamaican population.
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Affiliation(s)
- Ingrid A Tennant
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Mona, Jamaica
| | - Darrell M Hull
- Department of Educational Psychology, University of North Texas, Denton, TX, USA
| | - Marcus A Fagan
- Center for Research Design and Analysis, Texas Women's University, Denton, TX, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California at San Diego, La Jolla, CA, USA
| | - Caryl James Bateman
- Department of Sociology, Psychology and Social Work, The University of the West Indies, Mona, Jamaica
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Australia
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Terrence Forrester
- Solutions for Developing Countries, The University of the West Indies, Mona, Jamaica
| | - Michael Boyne
- Department of Medicine, The University of the West Indies, Mona, Jamaica
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Kamalyan L, Guareña LA, Díaz-Santos M, Suarez P, Cherner M, García Alcorn MY, Umlauf A, Franklin DR, Mindt MR, Fortuny LAI, Heaton RK, Marquine MJ. Influence of Educational Background, Childhood Socioeconomic Environment, and Language Use on Cognition among Spanish-Speaking Latinos Living Near the US-Mexico Border. J Int Neuropsychol Soc 2022; 28:876-890. [PMID: 34486514 PMCID: PMC8898321 DOI: 10.1017/s1355617721001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We investigated the impact of culturally relevant social, educational, and language factors on cognitive test performance among Spanish speakers living near the US-Mexico border. METHODS Participants included 254 healthy native Spanish speakers from the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project (Age: M = 37.3, SD = 10.4; Education: M = 10.7, SD = 4.3; 59% Female). A comprehensive neuropsychological battery was administered in Spanish. Individual test scaled scores and T-scores (based on region-specific norms adjusted for age, education, and sex) were averaged to create Global Mean Scaled and T-scores. Measures of culturally relevant factors included a self-reported indicator of educational quality/access (proportion of education in Spanish-speaking country, quality of school/classroom setting, stopped attending school to work), childhood socioeconomic environment (parental education, proportion of time living in Spanish-speaking country, childhood socioeconomic and health status, access to basic resources, work as a child), and Spanish/English language use and fluency. RESULTS Several culturally relevant variables were significantly associated with unadjusted Global Scaled Scores in univariable analyses. When using demographically adjusted T-scores, fewer culturally relevant characteristics were significant. In multivariable analyses, being bilingual (p = .04) and working as a child for one's own benefit compared to not working as a child (p = .006) were significantly associated with higher Global Mean T-score, accounting for 9% of variance. CONCLUSIONS Demographically adjusted normative data provide a useful tool for the identification of brain dysfunction, as these account for much of the variance of sociocultural factors on cognitive test performance. Yet, certain culturally relevant variables still contributed to cognitive test performance above and beyond basic demographics, warranting further investigation.
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Affiliation(s)
- Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Lesley A. Guareña
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- Department of Medicine, Division of Geriatrics and Gerontology, University of California, San Diego
| | - Mirella Díaz-Santos
- Department of Psychiatry and Biobehavioral Sciences, Hispanic Neuropsychiatric Center of Excellence, University of California, Los Angeles
| | - Paola Suarez
- Department of Psychiatry and Biobehavioral Sciences, Hispanic Neuropsychiatric Center of Excellence, University of California, Los Angeles
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | | | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Donald R. Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Monica Rivera Mindt
- Department of Psychology & Latino American and Latino Studies Institute, Fordham University
| | | | - Robert K. Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - María J. Marquine
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- Department of Medicine, Division of Geriatrics and Gerontology, University of California, San Diego
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Campbell LM, Kohli M, Lee EE, Kaufmann CN, Higgins M, Delgadillo JD, Heaton RK, Cherner M, Ellis RJ, Moore DJ, Moore RC. Objective and subjective sleep measures are associated with neurocognition in aging adults with and without HIV. Clin Neuropsychol 2022; 36:1352-1371. [PMID: 32993422 PMCID: PMC8007669 DOI: 10.1080/13854046.2020.1824280] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 02/01/2023]
Abstract
Objective: Poor sleep quality is related to worse neurocognition in older adults and in people with HIV (PWH); however, many previous studies have relied only on self-report sleep questionnaires, which are inconsistently correlated with objective sleep measures. We examined relationships between objective and subjective sleep quality and neurocognition in persons with and without HIV, aged 50 and older. Method: Eighty-five adults (PWH n = 52, HIV-negative n = 32) completed comprehensive neuropsychological testing to assess global and domain-specific neurocognition. Objective sleep quality was assessed with wrist actigraphy (total sleep time, efficiency, sleep fragmentation) for five to 14 nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Results: Objective and subjective sleep measures were unrelated (p's > 0.30). Compared to HIV-negative participants, PWH had greater sleep efficiency (80% vs. 75%, p = 0.05) and were more likely to be using prescription and/or over the counter sleep medication (p = 0.04). In the whole sample, better sleep efficiency (p < 0.01) and greater total sleep time (p = 0.05) were associated with better learning. Less sleep fragmentation was associated with better learning (p < 0.01) and recall (p = 0.04). While PWH had slightly stronger relationships between total sleep time and sleep fragmentation, it is not clear if these differences are clinically meaningful. Better subjective sleep quality was associated with better executive function (p < 0.01) and working memory (p = 0.05); this relationship was primarily driven by the HIV-negative group. Conclusions: Objective sleep quality was associated with learning and recall whereas subjective sleep quality was associated with executive function and working memory. Therefore, assessing objective and subjective sleep quality could be clinically useful, as they are both related to important domains of cognition frequently impacted in HIV-associated neurocognitive disorders as well as neurodegenerative disorders associated with aging. Future studies should evaluate if behavioral sleep interventions can improve neurocognition.
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Affiliation(s)
- Laura M. Campbell
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Maulika Kohli
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Ellen E. Lee
- Department of Psychiatry, University of California San
Diego, San Diego, CA
- VA San Diego Healthcare System, San Diego, California,
U.S.A
- Sam and Rose Stein Institute for Research on Aging,
University of California San Diego, La Jolla, California, U.S.A
| | - Christopher N. Kaufmann
- VA San Diego Healthcare System, San Diego, California,
U.S.A
- Division of Geriatrics and Gerontology, Department of
Medicine, University of California San Diego, La Jolla, California, U.S.A
| | - Michael Higgins
- Department of Family Medicine and Public Health, University
of California San Diego, San Diego, CA
| | - Jeremy D. Delgadillo
- Advancing Diversity in Aging Research (ADAR) Program, San
Diego State University, San Diego, CA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Mariana Cherner
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San
Diego, San Diego, CA
- Department of Neurosciences, University of California San
Diego, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San
Diego, San Diego, CA
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Saloner R, Lobo JD, Paolillo EW, Campbell LM, Letendre SL, Cherner M, Grant I, Heaton RK, Ellis RJ. Cognitive and Physiologic Reserve Independently Relate to Superior Neurocognitive Abilities in Adults Aging With HIV. J Acquir Immune Defic Syndr 2022; 90:440-448. [PMID: 35364601 PMCID: PMC9246889 DOI: 10.1097/qai.0000000000002988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate joint contributions of cognitive and physiologic reserve to neurocognitive SuperAging in older persons with HIV (PWH). METHODS Participants included 396 older PWH (age range: 50-69 years) who completed cross-sectional neuropsychological and neuromedical evaluations. Using published criteria, participants exhibiting global neurocognition within normative expectations of healthy 25-year-olds were classified as SuperAgers (SA; n = 57). Cognitively normal (CN; n = 172) and impaired (n = 167) participants were classified with chronological age-based norms. Cognitive reserve was operationalized with an estimate of premorbid verbal intelligence, and physiologic reserve was operationalized with a cumulative index of 39 general and HIV-specific health variables. Analysis of variance with confirmatory multinomial logistic regression examined linear and quadratic effects of cognitive and physiologic reserve on SA status, adjusting for chronological age, depression, and race/ethnicity. RESULTS Univariably, SA exhibited significantly higher cognitive and physiologic reserve compared with CN and cognitively impaired ( d s ≥ 0.38, p s < 0.05). Both reserve factors independently predicted SA status in multinomial logistic regression; higher physiologic reserve predicted linear increases in odds of SA, and higher cognitive reserve predicted a quadratic "J-shaped" change in odds of SA compared with CN (ie, odds of SA > CN only above 35th percentile of cognitive reserve). CONCLUSIONS Each reserve factor uniquely related to SA status, which supports the construct validity of our SA criteria and suggests cognitive and physiologic reserve reflect nonoverlapping pathways of neuroprotection in HIV. Incorporation of proxy markers of reserve in clinical practice may improve characterization of age-related cognitive risk and resilience among older PWH, even among PWH without overt neurocognitive impairment.
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Affiliation(s)
- Rowan Saloner
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Judith D. Lobo
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Emily W. Paolillo
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Laura M. Campbell
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Scott L. Letendre
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Robert K. Heaton
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
- Department of Neurosciences, University of California, San Diego, San Diego, CA
| | - CHARTER Study Group
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA
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Ellis RJ, Sacktor N, Clifford DB, Marra CM, Collier AC, Gelman B, Robinson-Papp J, Letendre SL, Heaton RK. Neuropathic pain correlates with worsening cognition in people with human immunodeficiency virus. Brain 2022; 145:2206-2213. [PMID: 35773234 DOI: 10.1093/brain/awab462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/21/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
Neuropathic pain and cognitive impairment are among the HIV-related conditions that have most stubbornly resisted amelioration by virally suppressive antiretroviral therapy. Overlaps between the regional brain substrates and mechanisms of neuropathic pain and cognitive disorders are increasingly recognized, yet no studies have examined the longitudinal relationship between these two disorders. Participants in the prospective, observational CNS HIV AntiRetroviral Therapy Effects Research (CHARTER) cohort underwent standardized clinical evaluations for clinical examination findings of distal sensory polyneuropathy, reporting distal neuropathic pain and neurocognitive performance at study entry (baseline) and an average of 12 years later. Change in neuropathic pain and neuropathy status from baseline to follow-up was by self-report and repeat examination, and change in neurocognitive performance was assessed using a previously published summary regression-based change score. Relationships between incident or worsened neuropathic pain and neurocognitive change were evaluated using uni- and multivariable regressions, including age at baseline and other relevant covariates. Participants were 385 people with HIV, 91 (23.6%) females, mean ± standard deviation (SD) age at baseline 43.5 (7.81) years, ethnicity 44.9% African American, 10.6% Hispanic, 42.6% non-Hispanic white and 1.82% other. Baseline median (interquartile range) nadir CD4 was 175 (34 309) cells/µl and current CD4 was 454 (279 639). Incident or worsened distal neuropathic pain occurred in 98 (25.5%) over the follow-up period. People with HIV with incident or worsened distal neuropathic pain had significantly worsened neurocognitive performance at follow-up compared to those without incident or worsened distal neuropathic pain (summary regression-based change score mean ± SD -0.408 ± 0.700 versus -0.228 ± 0.613; P = 0.0158). This effect remained significant when considering viral suppression on antiretroviral therapy, incident diabetes and other covariates as predictors. Overall neurocognitive change related to neuropathic pain was driven primarily by changes in the domains of executive function and speed of information processing. Those with incident distal neuropathy signs did not have neurocognitive worsening, nor did individuals who used opioid analgesics or other pain-modulating drugs such as amitriptyline. Worsened neurocognitive performance in people with HIV was associated with worsened neuropathic pain but not with changes in physical signs of neuropathy, and this was not attributable to therapies for pain or depression or to differences in viral suppression. This finding implies that incident or worsened pain may signal increased risk for neurocognitive impairment, and deserves more investigation, particularly if better pain management might stabilize or improve neurocognitive performance.
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Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, CA 92103-8231, USA.,Department of Psychiatry, University of California, San Diego, CA 92103-8231, USA
| | - Ned Sacktor
- Department of Neurology, Johns-Hopkins University, Baltimore, MD 21224, USA
| | - David B Clifford
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Christina M Marra
- Department of Neurology, University of Washington, Seattle, WA 98104, USA
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, WA 98104, USA
| | - Benjamin Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | | | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, CA 92103, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, CA 92103-8231, USA.,Department of Medicine, University of California, San Diego, CA 92103, USA
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Saloner R, Lobo JD, Paolillo EW, Campbell LM, Letendre SL, Cherner M, Grant I, Heaton RK, Ellis RJ, Roesch SC, Moore DJ, Grant I, Letendre SL, Ellis RJ, Marcotte TD, Franklin D, McCutchan JA, Smith DM, Heaton RK, Atkinson JH, Dawson M, Fennema-Notestine C, Taylor MJ, Theilmann R, Gamst AC, Cushman C, Abramson I, Vaida F, Sacktor N, Rogalski V, Morgello S, Simpson D, Mintz L, McCutchan JA, Collier A, Marra C, Storey S, Gelman B, Head E, Clifford D, Al-Lozi M, Teshome M. Identification of Youthful Neurocognitive Trajectories in Adults Aging with HIV: A Latent Growth Mixture Model. AIDS Behav 2022; 26:1966-1979. [PMID: 34878634 PMCID: PMC9046348 DOI: 10.1007/s10461-021-03546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/12/2022]
Abstract
Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1–5 years of follow-up. Classes were defined using ‘peak-age’ global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1Stable Elite (n = 31 [16.8%], high baseline peak-age T-scores with flat trajectory); Class 2Quadratic Average (n = 100 [54.3%], intermediate baseline peak-age T-scores with u-shaped trajectory); Class 3Quadratic Low (n = 53 [28.8%], low baseline peak-age T-scores with u-shaped trajectory). Baseline predictors of Class 1Stable Elite included SA status, younger age, higher cognitive and physiologic reserve, and fewer subjective cognitive difficulties. This GMM analysis supports the construct validity of SuperAging in older PWH through identification of a subgroup with longitudinally-stable, youthful neurocognition and robust biopsychosocial health.
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Ellis RJ, Heaton RK, Tang B, Collier A, Marra CM, Gelman BB, Morgello S, Clifford DB, Sacktor N, Cookson D, Letendre S. Peripheral inflammation and depressed mood independently predict neurocognitive worsening over 12 years. Brain Behav Immun Health 2022; 21:100437. [PMID: 35308084 PMCID: PMC8928134 DOI: 10.1016/j.bbih.2022.100437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/09/2022] [Accepted: 02/26/2022] [Indexed: 10/25/2022] Open
Abstract
Background Neurocognitive (NC) impairment in people with HIV (PWH) is associated with important adverse outcomes, but no markers exist to predict long-term NC decline. We evaluated depressed mood and markers of persistent inflammation, oxidative stress and altered amyloid processing (all common in PWH) as predictors of NC worsening over 12 years. Methods PWH were enrolled and followed longitudinally in the CNS HIV Antiretroviral Effects Research (CHARTER) study at six US sites. At entry we quantified biomarkers in blood of inflammation: (interleukin-6 [IL-6], C-reactive protein [CRP], monocyte chemoattractant protein type 1 [MCP-1], D-dimer, soluble sCD14 (sCD14), soluble tumor necrosis factor receptor - type II [sTNFR-II], neopterin, and soluble CD40 ligand [sCD40L], oxidative stress (protein carbonyls, 8-oxo-2'-deoxyguanosine [8-oxo-dG]) and altered amyloid processing [amyloid beta (Aβ)-42, soluble amyloid precursor protein-α (sAPPα)] using commercial immunoassays. The Beck Depression Inventory-II (BDI-II) assessed depressed mood at entry. NC decline over 12 years was evaluated using the published and validated summary (global) regression-based change score (sRBCS). A factor analysis reduced dimensionality of the biomarkers. Univariable and multiple regression models tested the relationship between baseline predictors and the outcome of neurocognitive decline. Results Participants were 191 PWH, 37 (19.4%) women, 46.6% African American, 43.5% non-Hispanic white, 8.83% Hispanic, 15.7% white, 1.6% other; at study entry mean (SD) age 43.6 (8.06) years, estimated duration of HIV infection (median, IQR) 9.82 [4.44, 14.5] years, nadir CD4 104/μL (19,205), current CD4 568/μL (356, 817), and 80.1% had plasma HIV RNA <50 c/mL. Participants were enrolled between 2003 and 2007; median (IQR) duration of follow-up 12.4 [9.69, 16.2] years. Three biomarker factors were identified: Factor (F)1 (IL-6, CRP), F2 (sTNFR-II, neopterin) and F3 (sCD40L, sAPPα). Participants with higher F1, reflecting worse systemic inflammation at baseline, and higher F3, had greater decline in global neurocognition (r = -0.168, p = 0.0205 and r = -0.156, p = 0.0309, respectively). Of the F1 components, higher CRP levels were associated with worse decline (r = -0.154, p = 0.0332), while IL-6 did not (r = -0.109, p = 0.135). NC change was not significantly related to F2, nor to demographics, nadir and current CD4, viral suppression or baseline NC comorbidity ratings. Individuals with worse depressed mood at entry also experienced more NC decline (r = -0.1734, p = 0.0006). Together BDI-II (p = 0.0290), F1 (p = 0.0484) and F3 (p = 0.0309) contributed independently to NC decline (p = 0.0028); their interactions were not significant. Neither CRP nor IL-6 correlated significantly with depression. Conclusions PWH with greater systemic inflammation and more depression at entry had greater NC decline over 12 years. Understanding the basis of this inflammatory state might be particularly important. These findings raise the possibility that targeted anti-inflammatory or antidepressant therapies may help prevent NC worsening in PWH with depression and inflammation.
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Affiliation(s)
- Ronald J. Ellis
- University of California San Diego, San Diego, CA, United States
| | - Robert K. Heaton
- University of California San Diego, San Diego, CA, United States
| | - Bin Tang
- University of California San Diego, San Diego, CA, United States
| | - A.C. Collier
- University of Washington, Seattle, WA, United States
| | | | | | - S. Morgello
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - N. Sacktor
- Johns-Hopkins University, Baltimore, MD, United States
| | - D. Cookson
- University of California San Diego, San Diego, CA, United States
| | - Scott Letendre
- University of California San Diego, San Diego, CA, United States
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Watson CWM, Kamalyan L, Tang B, Hussain MA, Cherner M, Mindt MR, Byrd DA, Franklin DR, Collier AC, Clifford DB, Gelman B, Morgello S, McCutchan JA, Ellis RJ, Grant I, Heaton RK, Marquine MJ. Ethnic/Racial Disparities in Longitudinal Neurocognitive Decline in People With HIV. J Acquir Immune Defic Syndr 2022; 90:97-105. [PMID: 35081558 PMCID: PMC8986565 DOI: 10.1097/qai.0000000000002922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To examine longitudinal neurocognitive decline among Latino, non-Latino Black, and non-Latino White people with HIV (PWH) and factors that may explain ethnic/racial disparities in neurocognitive decline. METHODS Four hundred ninety nine PWH (13.8% Latino, 42.7% Black, 43.5% White; baseline age: M = 43.5) from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study completed neurocognitive, neuromedical, and laboratory assessments every 6-12 months with up to 5 years of follow-up. Longitudinal neurocognitive change was determined via published regression-based norms. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and baseline and time-dependent variables that may explain ethnic/racial disparities in neurocognitive decline, including socio-demographic, HIV-disease, medical, psychiatric, and substance use characteristics. RESULTS In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latino compared with White PWH (HR = 2.25, 95% CI = 1.35 to 3.73, P = 0.002), and Latino compared with Black PWH (HR = 1.86, 95% CI = 1.14 to 3.04, P = 0.013), with no significant differences between Black and White PWH (P = 0.40). Comorbidities, including cardiometabolic factors and more severe neurocognitive comorbidity classification, accounted for 33.6% of the excess hazard for Latino compared with White PWH, decreasing the hazard ratio associated with Latino ethnicity (HR = 1.83, 95% CI = 1.06 to 3.16, P = 0.03), but did not fully account for elevated risk of decline. CONCLUSIONS Latino PWH may be at higher risk of early neurocognitive decline compared with Black and White PWH. Comorbidities accounted for some, but not all, of this increased risk among Latino PWH. Future research examining institutional, sociocultural, and biomedical factors, including structural discrimination and age-related biomarkers, may further explain the observed disparities.
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Affiliation(s)
| | | | - Bin Tang
- University of California, San Diego, San Diego, CA
| | | | | | | | | | | | - Ann C. Collier
- University of Washington School of Medicine, Seattle, WA
| | | | | | | | | | | | - Igor Grant
- University of California, San Diego, San Diego, CA
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Campbell LM, Sun-Suslow N, Heaton A, Heaton RK, Ellis RJ, Moore DJ, Moore RC. Fatigue is associated with worse cognitive and everyday functioning in older persons with HIV. AIDS 2022; 36:763-772. [PMID: 34999606 PMCID: PMC9081180 DOI: 10.1097/qad.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether there are relationships between fatigue, cognition, and everyday functioning in older persons with and without HIV and to examine if associations remain after accounting for depression, anxiety, and sleep quality. METHODS Sixty-nine persons with HIV (PWH) and 36 persons without HIV, aged 50-74 years, were recruited from ongoing studies at UC San Diego's HIV Neurobehavioral Research Program and from the community. Participants completed neuropsychological testing, a performance-based measure of everyday functioning, and self-report questionnaires of fatigue, depression, anxiety, sleep quality, and everyday functioning. Multivariable linear regressions and logistic regressions stratified by HIV serostatus were used to examine relationships between fatigue, cognition, and everyday functioning. Psychiatric symptoms and sleep quality were examined as covariates. RESULTS In this cross-sectional study, PWH had significantly greater fatigue than the HIV-negative group (g = 0.83; P < 0.01). When stratifying by HIV serostatus, greater fatigue was significantly associated with worse global cognition (β = -0.56;P < 0.01) in PWH even when controlling for covariates;however, fatigue was not significantly associated with global cognition in persons without HIV. In PWH and when accounting for covariates, fatigue was also associated with greater risk of self-reported everyday functioning impairment [odds ratio (OR) = 1.66 for 10-point increase in fatigue, P = 0.04] but not performance-based everyday functioning (P = 0.95). CONCLUSION Fatigue is associated with cognition, particularly measures with a speeded component, and self-reported everyday functioning in older PWH. Findings suggest that fatigue is important to assess and consider in the context of aging with HIV.
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Affiliation(s)
- Laura M Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ni Sun-Suslow
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Hussain MA, Sun-Suslow N, Montoya JL, Iudicello JE, Heaton RK, Grant I, Morgan EE. Loneliness, Risky Beliefs and Intentions about Practicing Safer Sex among Methamphetamine Dependent Individuals. Subst Use Misuse 2022; 57:295-307. [PMID: 34889707 PMCID: PMC8922988 DOI: 10.1080/10826084.2021.2003404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Methamphetamine use is a known predictor of riskier sexual behaviors, which can have important public health implications (e.g., HIV-transmission risk). Loneliness also is associated with riskier sexual behaviors, though the relationship between loneliness and beliefs and/or intentions to practice safer sex has not been examined among people dependent on methamphetamine. MATERIALS AND METHODS Individuals who met DSM-IV criteria for lifetime methamphetamine dependence and current (≤ 18-months) methamphetamine abuse or dependence (METH+ n = 56) were compared to those without severity and recency of methamphetamine use (METH- n = 59). These groups did not differ on social network size or proportion of people with HIV (∼58% HIV+). Participants completed the NIH Toolbox Loneliness Scale and the Sexual Risks Scale's "Norms" and "Intentions" subscales. RESULTS METH+ individuals were significantly lonelier than METH- controls (t(113) = 2.45, p = .02). Methamphetamine dependence remained significantly associated with greater loneliness, after controlling for HIV status and other relevant covariates (e.g., neurocognitive impairment, history of mood disorder, social network size; F = 3.70, Adjusted R2 = 0.18, p = .0009). Loneliness, above and beyond the aforementioned covariates, was significantly associated with riskier beliefs and intentions to practice safer sex among METH+, but not METH-, individuals (β = 2.92, p = .02). CONCLUSIONS Loneliness is prevalent among individuals dependent on methamphetamine, and is uniquely associated with riskier beliefs and intentions regarding practicing safer sex. Findings may aid in identifying individuals at-risk of engaging in riskier sexual behaviors and guide risk prevention strategies.
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Affiliation(s)
- Mariam A Hussain
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA.,Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Ni Sun-Suslow
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Jessica L Montoya
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Jennifer E Iudicello
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Robert K Heaton
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Igor Grant
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Erin E Morgan
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
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- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
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Serrano VB, Montoya JL, Campbell LM, Sundermann EE, Iudicello J, Letendre S, Heaton RK, Moore DJ. The relationship between vascular endothelial growth factor (VEGF) and amnestic mild cognitive impairment among older adults living with HIV. J Neurovirol 2021; 27:885-894. [PMID: 34735690 PMCID: PMC8901513 DOI: 10.1007/s13365-021-01001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/03/2021] [Accepted: 07/13/2021] [Indexed: 10/27/2022]
Abstract
Older people with HIV (PWH) experience increased risk of age-related neurodegenerative disorders and cognitive decline, such as amnestic mild cognitive impairment (aMCI). The objective of this study was to examine the relationship between aMCI and plasma VEGF biomarkers among older PWH. Data were collected at a university-based research center from 2011 to 2013. Participants were 67 antiretroviral therapy-treated, virally suppressed PWH. Participants completed comprehensive neurobehavioral and neuromedical evaluations. aMCI status was determined using adapted Jak/Bondi criteria, classifying participants as aMCI + if their performance was > 1 SD below the normative mean on at least two of four memory assessments. VEGF family plasma biomarkers (i.e., VEGF, VEGF-C, VEGF-D, and PIGF) were measured by immunoassay. Logistic regression models were conducted to determine whether VEGF biomarkers were associated with aMCI status. Participants were mostly non-Hispanic white (79%) men (85%) with a mean age of 57.7 years. Eighteen (26.9%) participants met criteria for aMCI. Among potential covariates, only antidepressant drug use differed by aMCI status, and was included as a covariate. VEGF-D was significantly lower in the aMCI + group compared to the aMCI - group. No other VEGF levels (VEGF, VEGF-C, PIGF) differed by aMCI classification (ps > .05). In a sample of antiretroviral therapy-treated, virally suppressed PWH, lower levels of VEGF-D were associated with aMCI status. Longitudinal analyses in a larger and more diverse sample are needed to support VEGF-D as a putative biological marker of aMCI in HIV.
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Affiliation(s)
- Vanessa B Serrano
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, La Jolla, CA, USA
| | - Jessica L Montoya
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Laura M Campbell
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, La Jolla, CA, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer Iudicello
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Scott Letendre
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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Ellis RJ, Iudicello JE, Heaton RK, Isnard S, Lin J, Routy JP, Gianella S, Hoenigl M, Knight R. Markers of Gut Barrier Function and Microbial Translocation Associate with Lower Gut Microbial Diversity in People with HIV. Viruses 2021; 13:1891. [PMID: 34696320 PMCID: PMC8537977 DOI: 10.3390/v13101891] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022] Open
Abstract
People with human immunodeficiency virus (HIV) (PWH) have reduced gut barrier integrity ("leaky gut") that permits diffusion of microbial antigens (microbial translocation) such as lipopolysaccharide (LPS) into the circulation, stimulating inflammation. A potential source of this disturbance, in addition to gut lymphoid tissue CD4+ T-cell depletion, is the interaction between the gut barrier and gut microbes themselves. We evaluated the relationship of gut barrier integrity, as indexed by plasma occludin levels (higher levels corresponding to greater loss of occludin from the gut barrier), to gut microbial diversity. PWH and people without HIV (PWoH) participants were recruited from community sources and provided stool, and 16S rRNA amplicon sequencing was used to characterize the gut microbiome. Microbial diversity was indexed by Faith's phylogenetic diversity (PD). Participants were 50 PWH and 52 PWoH individuals, mean ± SD age 45.6 ± 14.5 years, 28 (27.5%) women, 50 (49.0%) non-white race/ethnicity. PWH had higher gut microbial diversity (Faith's PD 14.2 ± 4.06 versus 11.7 ± 3.27; p = 0.0007), but occludin levels were not different (1.84 ± 0.311 versus 1.85 ± 0.274; p = 0.843). Lower gut microbial diversity was associated with higher plasma occludin levels in PWH (r = -0.251; p = 0.0111), but not in PWoH. A multivariable model demonstrated an interaction (p = 0.0459) such that the correlation between Faith's PD and plasma occludin held only for PWH (r = -0.434; p = 0.0017), but not for PWoH individuals (r = -0.0227; p = 0.873). The pattern was similar for Shannon alpha diversity. Antiretroviral treatment and viral suppression status were not associated with gut microbial diversity (ps > 0.10). Plasma occludin levels were not significantly related to age, sex or ethnicity, nor to current or nadir CD4 or plasma viral load. Higher occludin levels were associated with higher plasma sCD14 and LPS, both markers of microbial translocation. Together, the findings suggest that damage to the gut epithelial barrier is an important mediator of microbial translocation and inflammation in PWH, and that reduced gut microbiome diversity may have an important role.
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Affiliation(s)
- Ronald J. Ellis
- Departments of Neurosciences and Psychiatry, University of California, San Diego, CA 92093, USA
| | - Jennifer E. Iudicello
- Department of Psychiatry, University of California, San Diego, CA 92093, USA; (J.E.I.); (R.K.H.)
| | - Robert K. Heaton
- Department of Psychiatry, University of California, San Diego, CA 92093, USA; (J.E.I.); (R.K.H.)
| | - Stéphane Isnard
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (S.I.); (J.L.); (J.-P.R.)
| | - John Lin
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (S.I.); (J.L.); (J.-P.R.)
| | - Jean-Pierre Routy
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (S.I.); (J.L.); (J.-P.R.)
| | - Sara Gianella
- Department of Medicine, University of California, San Diego, CA 92093, USA; (S.G.); (M.H.)
| | - Martin Hoenigl
- Department of Medicine, University of California, San Diego, CA 92093, USA; (S.G.); (M.H.)
| | - Rob Knight
- Department of Pediatrics, University of California, San Diego, CA 92093, USA;
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Sun-Suslow N, Watson CWM, Iudicello J, Heaton RK, Morgan EE. A-20 Frailty Is Associated with Decreased Social–Emotional Functioning in People with HIV: A National Institutes of Health Toolbox Emotion Battery Study. Arch Clin Neuropsychol 2021. [DOI: 10.1093/arclin/acab062.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
People with HIV (PWH) are more likely to experience problematic emotions and are at increased risk for frailty. In the general population, frailty is broadly associated with worse social–emotional functioning. However, the extent of this dysfunction has largely been isolated to depression and these relationships have yet to be examined among PWH. Thus, this study examined associations between frailty and summary factor scores developed from the National Institutes of Health Toolbox Emotion Battery (NIH-TB-EB) among PWH.
Method
Participants were 320 PWH (mean age = 52.3, SD = 12.7). Three previously validated composite scores from the NIH-TB-EB were used to assess social–emotional functioning: negative affect, social satisfaction, and psychological well-being. Using the Fried Phenotype, the sample was dichotomized into non-frail (n = 155) and prefrail/frail (n = 165) groups. Multiple regression was used to examine the association between frailty and social–emotional functioning. Covariates included age, estimated duration of HIV infection, antiretroviral therapy (ART) status, and antidepressant medication count.
Results
Being prefrail/frail was associated with increased negative affect (B = 0.26, p < 0.001), decreased social satisfaction (B = -0.18, p = 0.002), and decreased psychological well-being (B = -0.25, p < 0.001). Increased age was associated with decreased negative affect (B = -0.17, p = 0.002), and was unrelated to social satisfaction and psychological well-being. Estimated duration of infection, ART status, and antidepressant use were not associated with social–emotional functioning.
Conclusions
Pre-frail/frail PWH have worse social–emotional functioning, above and beyond age, duration of HIV disease, ART status, and antidepressant use. This suggests both frailty and poor social–emotional functioning may be important targets to screen and treat in order to improve prognosis and quality of life for PWH.
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Volpe K, Samuels D, Kallianpur A, Ellis R, Franklin D, Letendre S, Heaton RK, Hulgan T. Mitochondrial DNA haplogroups and domain-specific neurocognitive performance in adults with HIV. J Neurovirol 2021; 27:557-567. [PMID: 34101088 PMCID: PMC8527871 DOI: 10.1007/s13365-021-00989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/14/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
Neurocognitive (NC) impairment (NCI) is an important cause of morbidity in persons with HIV (PWH). In the high-energy environment of the central nervous system, mitochondria contribute to neuroinflammation and aging, which may ultimately drive the pathogenesis of neurodegenerative diseases. Mitochondrial DNA (mtDNA) haplogroups are associated with health outcomes in PWH. For example, we previously observed less global NCI in Hispanic ancestry PWH having mtDNA haplogroup B. Another study reported increased NCI among PWH having African subhaplogroup L2a. We therefore analyzed NC domains in relation to these haplogroups in CNS HIV Antiretroviral Therapy Effects Research (CHARTER), a multi-site observational neuro-HIV study. Haplogroups were assigned using mtDNA sequence in 1016 PWH. Outcomes were NCI, defined by domain deficit score and mean T-scores (TS) for seven NC domains. Ancestry-stratified analyses of NC performance included Wilcoxon rank sum, χ2, and Fisher's exact tests. Multivariable regression adjusted for NC comorbidity, antiretroviral therapy use, and nadir CD4+ T cells. Among 98 Hispanic ancestry PWH, executive function, learning, and recall performance were better with haplogroup B (N = 17) than other haplogroups. With adjustment for covariates, haplogroup B remained associated with better executive function (p = 0.04) and recall TS (p = 0.03). PWH with haplogroup B had fewer impaired domains than other haplogroups (p < 0.01). Subhaplogroup L2a (N = 89) was associated with greater NCI in learning, recall, and working memory among 478 PWH of African ancestry, and had more impaired domains than other subhaplogroups (p < 0.01). These findings may inform risk stratification for NCI and studies to define mechanisms by which mtDNA variation may influence NCI in PWH.
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Affiliation(s)
- Karen Volpe
- Vanderbilt University Medical Center, Nashville, TN, USA.
| | - David Samuels
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Asha Kallianpur
- Cleveland Clinic/Lerner Research Institute, Cleveland, OH, USA
| | - Ronald Ellis
- Univ. of California San Diego, San Diego, CA, USA
| | | | | | | | - Todd Hulgan
- Vanderbilt University Medical Center, Nashville, TN, USA
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45
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Ellis RJ, Paolillo E, Saloner R, Heaton RK. Higher comorbidity burden predicts worsening neurocognitive trajectories in people with HIV. Clin Infect Dis 2021; 74:1323-1328. [PMID: 34329400 DOI: 10.1093/cid/ciab655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Age-related comorbidities accumulate faster in people with HIV (PWH) than in those without (PWoH). We evaluated whether a validated multimorbidity scale, the Charlson Index, predicted neurocognitive trajectories in PWH. METHODS Scaled scores a comprehensive neuropsychological battery were averaged across all visits. Multilevel modeling examined between- and within-person predictors of global neurocognition. At the between-person level, averaged Charlson scores were examined as a predictor of neurocognitive change rate, covarying for HIV disease characteristics. Within-persons, visit-specific Charlson Index was used to predict fluctuations in global neurocognition at the same and next visit, covarying for disease measures. RESULTS Participants were 1195 PWH (mean baseline age 43·0; SD 9·7 years) followed for a mean of 7·1 years (range 0·5-20·5). At the between-person level, more rapid neurocognitive worsening correlated with higher (worse) average Charlson scores (standardized β -0·062, SE 0·015; p=0·001) and lower CD4 nadir (standardized β 0·055, SE 0·021; p=0·011), but not viral suppression or average CD4+ lymphocytes (ps > 0·05). At the within-person level, poorer visit-specific neurocognition was related to worse concurrent, but not preceding, Charlson scores (standardized β-0·046, SE 0·015; p = 0·003), detectable HIV viral load (standardized β0·018, SE 0·006; p = 0·001) and higher CD4+ (standardized β0·043, SE 0·009; p < 0·001). CONCLUSION The impact of comorbidities on neurocognitive decline exceeded that of HIV disease factors. Although correlative, the temporal relationships suggested that treatment of comorbidities might improve neurocognitive prognosis for PWH.
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Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Emily Paolillo
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Rowan Saloner
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
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Walter TJ, Iudicello J, Cookson DR, Franklin D, Tang B, Young JW, Perry W, Ellis R, Heaton RK, Grant I, Minassian A, Letendre S. The Relationships between HIV-1 Infection, History of Methamphetamine Use Disorder, and Soluble Biomarkers in Blood and Cerebrospinal Fluid. Viruses 2021; 13:1287. [PMID: 34372493 PMCID: PMC8310127 DOI: 10.3390/v13071287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/13/2023] Open
Abstract
Methamphetamine (METH) use disorder is highly prevalent among people with HIV (PWH) and is a significant public health problem. HIV and METH use are each associated with immune system dysfunction; however, the combined effects on the immune system are poorly understood. This cross-sectional project measured soluble immune biomarkers in plasma and cerebrospinal fluid (CSF) collected from a control group, people with a history of a METH use disorder (METH+), PWH with no history of METH use disorder (HIV+), and PWH with a history of METH use disorder (HIV+/METH+). HIV, METH, and immune dysfunction can also be associated with affective and cognitive deficits, so we characterized mood and cognition in our participants. Two factor analyses were performed for the plasma and CSF biomarkers. Plasma IL-8, Ccl2, VEGF, and 8-isoprostane loaded onto one factor that was highest in the HIV+/METH+ group (p < 0.047) reflecting worse inflammation, vascular injury, and oxidative stress. This plasma factor was also negatively correlated with delayed recall (R = -0.49, p = 0.010), which was worst in the HIV+/METH+ group (p = 0.030 compared to the control group). Overall, these data implicate that combined HIV-1 infection and METH use may exacerbate inflammation, leading to worse cognition.
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Affiliation(s)
- T. Jordan Walter
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Jennifer Iudicello
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Debra Rosario Cookson
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Donald Franklin
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Jared W. Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - William Perry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Ronald Ellis
- Department of Neurosciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA;
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (J.I.); (D.R.C.); (D.F.); (B.T.); (J.W.Y.); (W.P.); (R.K.H.); (I.G.); (A.M.)
- VA Center of Excellence for Stress and Mental Health, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Scott Letendre
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Kaur H, Bush WS, Letendre SL, Ellis RJ, Heaton RK, Patton SM, Connor JR, Samuels DC, Franklin DR, Hulgan T, Kallianpur AR. Higher CSF Ferritin Heavy-Chain (Fth1) and Transferrin Predict Better Neurocognitive Performance in People with HIV. Mol Neurobiol 2021; 58:4842-4855. [PMID: 34195939 DOI: 10.1007/s12035-021-02433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
HIV-associated neurocognitive disorder (HAND) remains prevalent despite antiretroviral therapy and involves white matter damage in the brain. Although iron is essential for myelination and myelin maintenance/repair, its role in HAND is largely unexplored. We tested the hypotheses that cerebrospinal fluid (CSF) heavy-chain ferritin (Fth1) and transferrin, proteins integral to iron delivery and myelination, are associated with neurocognitive performance in people with HIV (PWH). Fth1, transferrin, and the pro-inflammatory cytokines TNF-α and IL-6 were quantified in CSF at baseline (entry) in 403 PWH from a prospective observational study who underwent serial, comprehensive neurocognitive assessments. Associations of Fth1 and transferrin with Global Deficit Score (GDS)-defined neurocognitive performance at baseline and 30-42 months of follow-up were evaluated by multivariable regression. While not associated with neurocognitive performance at baseline, higher baseline CSF Fth1 predicted significantly better neurocognitive performance over 30 months in all PWH (p < 0.05), in PWH aged < 50 at 30, 36, and 42 months (all p < 0.05), and in virally suppressed PWH at all three visit time-points (all p < 0.01). Higher CSF transferrin was associated with superior neurocognitive performance at all visits, primarily in viremic individuals (all p < 0.05). All associations persisted after adjustment for neuro-inflammation. In summary, higher CSF Fth1 is neuroprotective over prolonged follow-up in all and virally suppressed PWH, while higher CSF transferrin may be most neuroprotective during viremia. We speculate that higher CSF levels of these critical iron-delivery proteins support improved myelination and consequently, neurocognitive performance in PWH, providing a rationale for investigating their role in interventions to prevent and/or treat HAND.
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Affiliation(s)
- Harpreet Kaur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, 9500 Euclid Ave/Mail Code R4-008, Cleveland, OH, 44195, USA
| | - William S Bush
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Scott L Letendre
- Departments of Medicine and Psychiatry, University of California-San Diego, San Diego, CA, USA
| | - Ronald J Ellis
- Departments of Neurology and Psychiatry, University of California-San Diego, San Diego, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California-San Diego, San Diego, CA, USA
| | - Stephanie M Patton
- Department of Neurosurgery, Pennsylvania State/Hershey College of Medicine, Hershey, PA, USA
| | - James R Connor
- Department of Neurosurgery, Pennsylvania State/Hershey College of Medicine, Hershey, PA, USA
| | - David C Samuels
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California-San Diego, San Diego, CA, USA
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Asha R Kallianpur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, 9500 Euclid Ave/Mail Code R4-008, Cleveland, OH, 44195, USA. .,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA. .,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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Ellis RJ, Iudicello J, Sun-Suslow N, Grelotti D, Cherner M, Morgan E, Letendre SL, Heaton RK. Social Isolation Is Linked to Inflammation in Aging People With HIV and Uninfected Individuals. J Acquir Immune Defic Syndr 2021; 86:600-606. [PMID: 33298794 PMCID: PMC7933098 DOI: 10.1097/qai.0000000000002596] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Even in the era of suppressive antiretroviral therapy, people with HIV (PWH) suffer greater exposure to inflammation than their uninfected peers. Although poor social support and social isolation have been linked to systemic inflammation in the general population, it is not known whether this is true also among PWH. METHODS People with and without HIV infection were enrolled in a community-based, single-center study. Primary predictors were the Medical Outcomes Study Social Support Survey, and outcomes were a panel of inflammatory biomarkers (ICAM-1, MCP-1, IL-6, IL-8, IP-10, C-reactive protein, D-dimer, VEGF, sCD14, and uPAR) in blood plasma and cerebrospinal fluid (CSF). RESULTS PWH had worse positive social support (P = 0.0138) and affectionate support (P = 0.0078) than did HIV- individuals. A factor analysis was used to group the biomarkers into related categories separately for each fluid. Levels of 3 of the 4 plasma factors were significantly higher in PWH than HIV- (ps = 0.007, 0.001, and 0.0005, respectively). Levels of 1 of the 3 CSF factors also were significantly higher in PWH than HIV- (P = 0.0194). In the combined PWH and HIV- cohort, poorer social support was associated with higher levels of a factor in plasma loading on MCP-1, IL-8, and VEGF (P = 0.020) and with a CSF factor loading on MCP-1 and IL-6 (P = 0.006). CONCLUSION These results suggest that enhancing social support might be an intervention to reduce inflammation and its associated adverse outcomes among PWH.
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Affiliation(s)
- Ronald J. Ellis
- Department of Neurosciences, University of California, San Diego
| | - Jenny Iudicello
- Department of Psychiatry, University of California, San Diego
| | - Ni Sun-Suslow
- Department of Psychiatry, University of California, San Diego
| | - David Grelotti
- Department of Psychiatry, University of California, San Diego
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego
| | - Erin Morgan
- Department of Psychiatry, University of California, San Diego
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Walter TJ, Young JW, Milienne-Petiot M, Deben DS, Heaton RK, Letendre S, Grelotti DJ, Perry W, Grant I, Minassian A. Both HIV and Tat expression decrease prepulse inhibition with further impairment by methamphetamine. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110089. [PMID: 32891668 PMCID: PMC7750302 DOI: 10.1016/j.pnpbp.2020.110089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
HIV infection and methamphetamine (METH) use are highly comorbid and represent a significant public health problem. Both conditions are known to negatively impact a variety of brain functions. One brain function that may be affected by HIV and METH use is sensorimotor gating, an automatic, pre-conscious filtering of sensory information that is thought to contribute to higher order cognitive processes. Sensorimotor gating is often measured using prepulse inhibition (PPI), a paradigm that can be conducted in both humans and animals, thereby enabling cross-species translational studies. While previous studies suggest HIV and METH may individually impair PPI, little research has been conducted on the effects of combined HIV and METH on PPI. The goal of this cross-species study was to determine the effects of METH on PPI in the inducible Tat (iTat) mouse model of HIV and in people with HIV. PPI was measured in the iTat mouse model before, during, and after chronic METH treatment and after Tat induction. Chronic METH treatment decreased PPI in male but not female mice. PPI normalized with cessation of METH. Inducing Tat expression decreased PPI in male but not in female mice. No interactions between chronic METH treatment and Tat expression were observed in mice. In humans, HIV was associated with decreased PPI in both men and women. Furthermore, PPI was lowest in people with HIV who also had a history of METH dependence. Overall, these results suggest HIV and METH may additively impair early information processing in humans, potentially affecting downstream cognitive function.
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Affiliation(s)
- T. Jordan Walter
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA,Corresponding Author at: 410 Dickinson St, Office 6, San Diego CA, 92103, Telephone: 619-543-3098,
| | - Jared W. Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA,Research Services, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego CA, 92161, USA
| | - Morgane Milienne-Petiot
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - D. S. Deben
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - David J. Grelotti
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - William Perry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; VA Center of Excellence for Stress and Mental Health, Veterans Administration San Diego HealthCare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Pérez-Santiago J, Marquine MJ, Cookson D, Giraud-Colón R, Heaton RK, Grant I, Ellis RJ, Letendre SL, Peterson SN. Gut microbiota dysbiosis is associated with worse emotional states in HIV infection. J Neurovirol 2021; 27:228-238. [PMID: 33651324 DOI: 10.1007/s13365-020-00933-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 12/31/2022]
Abstract
The biological mechanisms underlying emotional distress in HIV infection are likely to be complex but remain understudied. We investigated whether dysbiotic signatures in the gut microbiome of persons living with HIV (PLWH) are associated with their emotional status. We retrospectively examined the gut microbiome and clinical evaluation of 129 adults (94 PLWH and 35 HIV-) enrolled at UC San Diego's HIV Neurobehavioral Research Program. A subset of participants (32 PLWH vs. 13 HIV-) underwent an emotional assessment using the NIH Toolbox Emotion Battery summarized by three composite scores (negative affect, social satisfaction, and psychological well-being). We then sequenced the 16S rDNA V3-V4 regions from stool and performed taxonomic assignment using CLC Microbial Genomics Module. The gut microbiota profiles were evaluated in relation to participants' emotional assessment. All analyses were done in R statistical software. We found that the relative abundance of aerotolerant bacteria was significantly higher in PLWH (p < 0.01) and was associated with a lifetime major depression diagnosis independently of HIV status (p = 0.05). Moreover, PLWH experienced significantly worse psychological well-being (p = 0.02), less social satisfaction (p = 0.03), and more negative affect (p = 0.02). Higher levels of aerotolerant bacteria were associated with worse psychological well-being (rho = -0.35, p = 0.02), less social satisfaction (r = - 0.42, p < 0.01), and more negative affect (rho = 0.46, p < 0.01). The association of aerotolerant bacteria with social satisfaction and negative affect was independent of HIV status (p < 0.05, for both). The over-representation of aerotolerant bacteria in the gut may reflect worse oxidative stress and barrier defects and may contribute to emotional distress during HIV infection.
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Affiliation(s)
- Josué Pérez-Santiago
- University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA. .,University of California San Diego, La Jolla, CA, USA.
| | | | | | | | | | - Igor Grant
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Scott N Peterson
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
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