151
|
Robertson KR, Miyahara S, Lee A, Brown TT, Chan ES, Berzins B, Rusin D, Eron JJ, Taiwo BO. Neurocognition with maraviroc compared with tenofovir in HIV. AIDS 2016; 30:2315-21. [PMID: 27333088 PMCID: PMC5014739 DOI: 10.1097/qad.0000000000001189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective was to determine whether maraviroc (MVC) has unique neurocognitive benefits in the context of initial antiretroviral therapy (ART). DESIGN Randomized, double-blind, placebo-controlled, 48-week trial. SETTING Participants were enrolled in US AIDS Clinical Trials Group clinical trial sites. PARTICIPANTS Total 262 ART-naive, chemokine coreceptor 5 tropic HIV, and HIV RNA greater than 1000 copies/ml participants were randomized, 230 participants completed the study. INTERVENTION Participants received MVC 150 mg or tenofovir disoproxil fumarate (TDF) 300 mg on a background of ritonavir-boosted darunavir and emtricitabine. MAIN OUTCOME MEASURE(S) The neuropsychological battery of 15 tests done at baseline, week 24 and week 48 assessed seven domains, and were standardized into z-scores then converted into deficit scores and a global deficit score. The 48-week changes from baseline in the neuropsychological scores and the global deficit score were compared by Wilcoxon or Kruskal-Wallis test between arms, and among baseline impairment groups [classified as normal, mild (2 deficit scores ≥1) and moderate (2 deficit scores ≥2)]. It was hypothesized that the MVC arm would have improved neuropsychological performance over TDF. RESULTS In this double-blind, randomized, placebo-controlled trial, there were no differences in neuropsychological performance between MVC and TDF. Those with moderate neuropsychological impairment at baseline experienced greater ART-mediated neuropsychological improvement than those with mild or no neuropsychological impairment. CONCLUSION Improvement in neurocognitive functioning was greater with more baseline impairment but was comparable with MVC or TDF.
Collapse
Affiliation(s)
- Kevin R Robertson
- aUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina bHarvard University, Boston, Massachusetts cJohns Hopkins Hospital, Baltimore, Maryland dNorthwestern University, Chicago, Illinois eFrontier Science & Technology, Amherst, New York, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
152
|
Measuring cognitive complaints in breast cancer survivors: psychometric properties of the patient's assessment of own functioning inventory. Support Care Cancer 2016; 24:4939-4949. [PMID: 27432402 DOI: 10.1007/s00520-016-3352-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Cognitive complaints are a concern for breast cancer survivors. Among various published measures for cognitive complaints, the Patient's Assessment of Own Functioning Inventory (PAOFI) is one of the few assessing a spectrum of cognitive abilities, including those most commonly reported by breast cancer survivors. This study aimed to examine the psychometric properties of the PAOFI in breast cancer survivors. METHODS An exploratory factor analysis was conducted with a sample of breast cancer survivors (n = 189) who had completed all primary cancer treatments. Construct validity was examined by correlating factor scores with valid measures of cognitive complaints, fatigue, and quality of life. Reliability was measured by internal consistency of the items in each factor within this sample, a separate sample of breast cancer survivors with high persistent cognitive complaints (n = 72), and healthy controls (n = 63). Factor scores were compared across the three samples. RESULTS A five-factor structure similar to the PAOFI standardization study was found, with factors related to executive functioning (accounting for most of the variance), two aspects of memory functioning, language, and motor/sensory-perceptual abilities. Factor scores highly correlated with measures of cognitive complaints, fatigue, and quality of life. Executive functioning and memory-related factors achieved adequate reliability across samples. Scores were significantly different across the three samples as expected. CONCLUSIONS The PAOFI is a reliable and valid tool for measuring cognitive complaints in breast cancer survivors.
Collapse
|
153
|
Dampier W, Antell GC, Aiamkitsumrit B, Nonnemacher MR, Jacobson JM, Pirrone V, Zhong W, Kercher K, Passic S, Williams JW, James T, Devlin KN, Giovannetti T, Libon DJ, Szep Z, Ehrlich GD, Wigdahl B, Krebs FC. Specific amino acids in HIV-1 Vpr are significantly associated with differences in patient neurocognitive status. J Neurovirol 2016; 23:113-124. [PMID: 27400931 DOI: 10.1007/s13365-016-0462-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/05/2016] [Accepted: 06/09/2016] [Indexed: 11/26/2022]
Abstract
Even in the era of combination antiretroviral therapies used to combat human immunodeficiency virus type 1 (HIV-1) infection, up to 50 % of well-suppressed HIV-1-infected patients are still diagnosed with mild neurological deficits referred to as HIV-associated neurocognitive disorders (HAND). The multifactorial nature of HAND likely involves the HIV-1 accessory protein viral protein R (Vpr) as an agent of neuropathogenesis. To investigate the effect of naturally occurring variations in Vpr on HAND in well-suppressed HIV-1-infected patients, bioinformatic analyses were used to correlate peripheral blood-derived Vpr sequences with patient neurocognitive performance, as measured by comprehensive neuropsychological assessment and the resulting Global Deficit Score (GDS). Our studies revealed unique associations between GDS and the presence of specific amino acid changes in peripheral blood-derived Vpr sequences [neuropsychological impairment Vpr (niVpr) variants]. Amino acids N41 and A55 in the Vpr sequence were associated with more pronounced neurocognitive deficits (higher GDS). In contrast, amino acids I37 and S41 were connected to measurably lower GDS. All niVpr variants were also detected in DNA isolated from HIV-1-infected brain tissues. The implication of these results is that niVpr variants alter the genesis and/or progression of HAND through differences in Vpr-mediated effects in the peripheral blood and/or the brain.
Collapse
Affiliation(s)
- Will Dampier
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Gregory C Antell
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Benjamas Aiamkitsumrit
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Michael R Nonnemacher
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jeffrey M Jacobson
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Clinical and Translational Medicine, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Medicine, Section of Infectious Disease, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Vanessa Pirrone
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Wen Zhong
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Katherine Kercher
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Shendra Passic
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jean W Williams
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tony James
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Kathryn N Devlin
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | | | - David J Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Zsofia Szep
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Garth D Ehrlich
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Genomic Sciences, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Advanced Microbial Processing, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Brian Wigdahl
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Fred C Krebs
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA.
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA.
| |
Collapse
|
154
|
Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis 2016; 63:687-693. [PMID: 27325690 DOI: 10.1093/cid/ciw399] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are not routinely assessed due to the lack of an adequate screening strategy. We aimed to develop a clinically relevant screening procedure for symptomatic HAND, validated against a gold standard neuropsychological (NP) test battery. METHODS Representative HIV-infected (HIV+) and demographically matched HIV-uninfected (HIV-) participants in an observational study completed a standard evaluation for mood, drug and/or alcohol use, and activities of daily living and a newly designed 20-minute computerized CogState battery that assessed 5 cognitive domains. A subset completed standard NP assessment for 8 cognitive domains. HAND definition on screening and gold standard NP was determined using demographically corrected z scores and the global deficit score (≥ 0.5), applying the Frascati criteria. Participants were blinded to screening results, and the NP examiner was blinded to screening and HIV status. RESULTS A total of 254 HIV+ participants were enrolled-mean age, 48.9 ± 10.2 years; median nadir CD4, 270 cells/mL; tertiary educated, 54%; and HIV- controls, 72. HIV+ HAND screening prevalence was 30.7% (HIV-associated dementia, 3.2%; mild neurocognitive disorder, 12.6%; and asymptomatic neurocognitive disorder, 15.0%; HIV- group: 13.9%; P = .004). Of the 75 participants who completed the NP battery, the HAND rate in the HIV+ group was 50.9% vs 43.4% by screening (P > .50). HAND screening vs gold standard NP sensitivity was 76% and specificity was 71%. Clinically relevant HIV-associated dementia and mild neurocognitive disorder sensitivity was 100% and specificity was 98% (positive predictive value 0.92). CONCLUSIONS Symptomatic HAND warranting neurological review was accurately predicted using a CogState-based screening procedure.
Collapse
Affiliation(s)
- Mark Bloch
- Holdsworth House Medical Practice.,Faculty of Medicine, University of New South Wales
| | | | - Avindra Jayewardene
- Holdsworth House Medical Practice.,Charles Perkins Centre, University of Sydney, New South Wales
| | | | - Angela Carberry
- Holdsworth House Medical Practice.,Charles Perkins Centre, University of Sydney, New South Wales
| | | | | | - Paul Maruff
- Psychology Department Melbourne University, Victoria
| | - Bruce Brew
- Faculty of Medicine, University of New South Wales.,St Vincent's Hospital.,St Vincent's Applied Medical Research Centre
| | - Lucette A Cysique
- Faculty of Medicine, University of New South Wales.,St Vincent's Hospital.,St Vincent's Applied Medical Research Centre.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| |
Collapse
|
155
|
Increased Intrathecal Immune Activation in Virally Suppressed HIV-1 Infected Patients with Neurocognitive Impairment. PLoS One 2016; 11:e0157160. [PMID: 27295036 PMCID: PMC4905676 DOI: 10.1371/journal.pone.0157160] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/25/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Although milder forms of HIV-associated neurocognitive disorder (HAND) remain prevalent, a correlation to neuronal injury has not been established in patients on antiretroviral therapy (ART). We examined the relationship between mild HAND and CSF neurofilament light protein (NFL), a biomarker of neuronal injury; and CSF neopterin, a biomarker of CNS immunoactivation, in virally suppressed patients on antiretroviral therapy (ART). Design and Methods We selected 99 subjects on suppressive ART followed longitudinally from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study. Based on standardized comprehensive neurocognitive performance (NP) testing, subjects were classified as neurocognitively normal (NCN; n = 29) or impaired (NCI; n = 70). The NCI group included subjects with asymptomatic (ANI; n = 37) or mild (MND; n = 33) HAND. CSF biomarkers were analyzed on two occasions. Results Geometric mean CSF neopterin was 25% higher in the NCI group (p = 0.04) and NFL and neopterin were significantly correlated within the NCI group (r = 0.30; p<0.001) but not in the NCN group (r = -0.13; p = 0.3). Additionally, a trend towards higher NFL was seen in the NCI group (p = 0.06). Conclusions Mild HAND was associated with increased intrathecal immune activation, and the correlation between neopterin and NFL found in NCI subjects indicates an association between neurocognitive impairment, CNS inflammation and neuronal damage. Together these findings suggest that NCI despite ART may represent an active pathological process within the CNS that needs further characterization in prospective studies.
Collapse
|
156
|
Yechoor N, Towe SL, Robertson KR, Westreich D, Nakasujja N, Meade CS. Utility of a brief computerized battery to assess HIV-associated neurocognitive impairment in a resource-limited setting. J Neurovirol 2016; 22:808-815. [PMID: 27245592 DOI: 10.1007/s13365-016-0456-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Abstract
Despite the persistently high prevalence of neurocognitive impairment in HIV-positive patients, routine HIV care in many resource-limited settings does not include neuropsychological assessment. The objective of this study was to examine the utility of a brief computerized battery for identifying neurocognitive impairment in a busy HIV clinic in Uganda. Specifically, we compared performance on a gold standard neuropsychological exam to that on the CogState Brief Battery. In this cross-sectional study, 181 HIV-positive patients completed both assessment batteries in a randomized order. The primary outcome measures were neurocognitive impairment on the standard exam defined by the global deficit score and cumulative performance on the CogState Brief Battery. Sixty-nine participants (38 %) were classified as impaired on the standard neuropsychological exam, and participants who were classified as impaired performed significantly worse on CogState compared to those who were unimpaired (p < 0.001). CogState had adequate specificity but low sensitivity, suggesting that it may not be a clinically useful screening tool to identify patients who likely have neurocognitive impairment in Uganda. This study supports the feasibility of using a computerized battery for assessing neurocognitive impairment in HIV-positive patients in resource-limited settings, but additional research is needed to identify screening tools with higher sensitivity for use in HIV clinics.
Collapse
Affiliation(s)
- Nirupama Yechoor
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.,The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Sheri L Towe
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Kevin R Robertson
- Department of Neurology, Physicians Office Building, 170 Manning Drive, UNC-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Daniel Westreich
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.,Department of Epidemiology, CB 7435 McGavran-Greenberg Hall, UNC-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christina S Meade
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA. .,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27708, USA.
| |
Collapse
|
157
|
Saylor D, Sacktor N. Cognitive Impairment Among Older Individuals with HIV Infection. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0165-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
158
|
Abstract
OBJECTIVE In this work, we evaluated the association of human immunodeficiency virus (HIV) infection and methamphetamine (METH) use with mitochondrial injury in the brain and its implication on neurocognitive impairment. DESIGN Mitochondria carry their genome (mtDNA) and play a critical role in cellular processes in the central nervous system. METH is commonly used in HIV-infected populations. HIV infection and METH use can cause damage to mtDNA and lead to neurocognitive morbidity. We evaluated HIV infection and METH use with mitochondrial injury in the brain. METHODS We obtained white and gray matter from Brodmann areas 7, 8, 9, 46 of the following: HIV-infected individuals with history of past METH use (HIV+METH+, n = 16), HIV-infected individuals with no history of past METH use (HIV+METH-, n = 11), and HIV-negative controls (HIV-METH-, n = 30). We used the 'common deletion', a 4977 bp mutation, as a measurement of mitochondrial injury, and quantified levels of mtDNA and 'common deletion' by droplet digital PCR, and evaluated in relation to neurocognitive functioning [Global Deficit Score (GDS)]. RESULTS Levels of mtDNA and mitochondrial injury were highest in white matter of Brodmann area 46. A higher relative proportion of mtDNA carrying the 'common deletion' was associated with lower GDS (P < 0.01) in HIV+METH+ but higher GDS (P < 0.01) in HIV+METH-. CONCLUSIONS Increased mitochondrial injury was associated with worse neurocognitive function in HIV+METH- individuals. Among HIV+METH+ individuals, an opposite effect was seen.
Collapse
|
159
|
Hoenigl M, de Oliveira MF, Pérez-Santiago J, Zhang Y, Morris S, McCutchan AJ, Finkelman M, Marcotte TD, Ellis RJ, Gianella S. (1→3)-β-D-Glucan Levels Correlate With Neurocognitive Functioning in HIV-Infected Persons on Suppressive Antiretroviral Therapy: A Cohort Study. Medicine (Baltimore) 2016; 95:e3162. [PMID: 26986173 PMCID: PMC4839954 DOI: 10.1097/md.0000000000003162] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Microbial translocation from the gut is associated with immune dysfunction, persistent inflammation, and likely plays a role in the pathogenesis of neurocognitive dysfunction during HIV infection. (1→3)-β-D-Glucan (BDG) is a component of most fungal cell walls and might be a useful indicator of gut mucosal barrier impairment. The objective of this study was to evaluate whether higher blood BDG levels correlate with impaired neurocognitive functioning in a cohort of HIV-infected adults with suppressed levels of HIV RNA in blood plasma. In this cross-sectional cohort study, we measured levels of BDG in blood plasma and cerebrospinal fluid (CSF) supernatant samples in a cohort of adults with acute/early HIV infection, who initiated antiretroviral therapy (ART) during the earliest phase of infection and achieved suppressed levels of HIV RNA in blood plasma (<50 copies/mL) thereafter. We compared BDG with established biomarkers of microbial translocation, immune activation, and cognitive dysfunction (evaluated by global deficit score). We found that higher blood BDG levels were significantly related to higher global deficit scores, reflecting worse neurocognitive performance (Spearman r = 0.47; P = 0.042) among HIV-infected adults with suppressed viral loads who initiated ART early in infection. Two CSF samples presented elevated BDG levels. Interestingly, these 2 samples originated from the 2 subjects with the highest global deficit scores of the cohort. BDG may be a promising independent biomarker associated with neurocognitive functioning in virologically suppressed HIV-infected individuals.
Collapse
Affiliation(s)
- Martin Hoenigl
- From the Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA (MH, MFDO, JP-S, SM, SG), Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine (MH), Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria (MH), Research Laboratory, Associates of Cape Cod, Inc, Falmouth, MA (YZ, MF), Department of Psychiatry (AJM, TDM), and Department of Neurosciences, HIV Neurobehavioral Research Center, University of California, San Diego, CA (RJE)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
160
|
Preliminary Findings Describing Participant Experience With iSTEP, an mHealth Intervention to Increase Physical Activity and Improve Neurocognitive Function in People Living With HIV. J Assoc Nurses AIDS Care 2016; 27:495-511. [PMID: 26847379 DOI: 10.1016/j.jana.2016.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
We assessed the feasibility and acceptability of using text messages to monitor and encourage physical activity in the first 21 participants enrolled in an ongoing randomized controlled trial evaluating a 16-week Short Message Service/Multimedia Message Service (SMS/MMS) intervention (iSTEP) designed to increase moderate physical activity and improve neurocognition in persons with HIV-associated neurocognitive disorders (HAND; iSTEP, n = 11; control group, n = 10). Data were collected during the intervention and from interviews conducted at the 16-week postintervention visits. Text message response rates for both iSTEP and control participants were high (89% and 85%, respectively). Pedometer self-monitoring, step count goals, and milestone achievement texts were reported to facilitate physical activity. All iSTEP participants (100%) and 70% of control participants indicated that they would recommend the study to other people living with HIV. The results indicate that it is feasible to administer an SMS/MMS physical activity intervention to persons with HAND.
Collapse
|
161
|
Kabuba N, Menon JA, Franklin DR, Heaton RK, Hestad KA. HIV- and AIDS-associated neurocognitive functioning in Zambia - a perspective based on differences between the genders. Neuropsychiatr Dis Treat 2016; 12:2021-8. [PMID: 27570456 PMCID: PMC4986908 DOI: 10.2147/ndt.s105481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) are frequently associated with neurocognitive impairment (NCI). However, few studies have examined the interrelationship between gender and NCI in the HIV and AIDS population. This cross-sectional study examined the neurocognitive (NC) functioning of HIV-infected male and female adults from urban Zambia. The participants included 266 HIV seropositive (HIV+) adults (males [n=107] and females [n=159]). Participants completed NC assessment by means of a comprehensive test battery using normative data from 324 HIV-seronegative (HIV-) controls. The norms corrected for effects of age, education, and gender in the general population, and the test battery measures domains of attention/working memory (learning and delayed recall), executive function, verbal fluency, processing speed, verbal and visual episodic memory, and fine motor skills. An overall comparison of the HIV+ male and female participants yielded no statistically significant differences. Analysis of covariance results controlling for disease characteristics showed that HIV+ female participants had worse delayed recall scores than males, F(1,117) =9.70, P=0.002, partial η(2)=0.077. The females also evidenced a trend toward greater impairment on learning efficiency (P=0.015). The findings suggest that there are gender-related differences in NCI after controlling for disease characteristics. It was observed that although the HIV+ females enjoyed better health compared to their HIV+ male counterparts, they still had worse performance on the neuropsychological tests. This implies that HIV may have more NC consequences for Zambian females than males.
Collapse
Affiliation(s)
- Norma Kabuba
- Department of Psychology, The University of Zambia, Lusaka, Zambia; Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - J Anitha Menon
- Department of Psychology, The University of Zambia, Lusaka, Zambia
| | - Donald R Franklin
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Knut A Hestad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research, Innlandet Hospital Trust, Hamar, Norway; Department of Public Health, Hedmark University of Applied Sciences, Elverum, Norway
| |
Collapse
|
162
|
Gates TM, Cysique LA. The Chronicity of HIV Infection Should Drive the Research Strategy of NeuroHIV Treatment Studies: A Critical Review. CNS Drugs 2016; 30:53-69. [PMID: 26749584 PMCID: PMC4733144 DOI: 10.1007/s40263-015-0302-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
HIV infection has become a chronic illness when successfully treated with combined antiretroviral therapy (cART). The long-term health prognosis of aging with controlled HIV infection and HIV-associated neurocognitive disorder (HAND) remains unclear. In this review, we propose that, almost 20 years after the introduction of cART, a change in research focus is needed, with a greater emphasis on chronicity effects driving our research strategy. We argue that pre-emptive documentation of episodes of mild neurocognitive dysfunction is needed to determine their long-term prognosis. This strategy would also seek to optimally represent the entire HAND spectrum in therapeutic trials to assess positive and/or negative treatment effects on brain functions. In the first part of the paper, to improve the standard implementation of the Frascati HAND diagnostic criteria, we provide a brief review of relevant quantitative neuropsychology concepts to clarify their appropriate application for a non-neuropsychological audience working in HIV research and wanting to conduct randomized clinical trials on brain functions. The second part comprises a review of various antiretroviral drug classes and individual agents with respect to their effects on HAND, while also addressing the question of when cART should be initiated to potentially reduce HAND incidence. In each section, we use recent observational studies and randomized controlled trials to illustrate our perspective while also providing relevant statistical comments. We conclude with a discussion of the neuroimaging methods that could be combined with neuropsychological approaches to enhance the validity of HIV neurology (neuroHIV) treatment effect studies.
Collapse
Affiliation(s)
- Thomas M Gates
- St. Vincent's Hospital Department of Neurology, Sydney, Australia
- St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Lucette A Cysique
- Neuroscience Research Australia, 139 Barker Street, Randwick, PO Box 1165, Sydney, NSW, 2031, Australia.
- The University of New South Wales, Sydney, Australia.
| |
Collapse
|
163
|
de Oliveira MF, Murrell B, Murrel B, Pérez-Santiago J, Vargas M, Ellis RJ, Letendre S, Grant I, Smith DM, Woods SP, Gianella S. Circulating HIV DNA Correlates With Neurocognitive Impairment in Older HIV-infected Adults on Suppressive ART. Sci Rep 2015; 5:17094. [PMID: 26603568 PMCID: PMC4658529 DOI: 10.1038/srep17094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/20/2015] [Indexed: 11/09/2022] Open
Abstract
Older HIV-infected adults have a higher risk of neurocognitive impairment, but the underlying mechanisms are poorly understood. Here, we investigated the associations between levels of HIV DNA in peripheral blood, soluble markers of inflammation and cellular trafficking in blood and cerebrospinal fluid (CSF) and neurocognitive functioning among 18 younger (22–40 years) and 26 older (50–71 years) HIV-infected subjects, who were administered a comprehensive neurocognitive battery. Older HIV-infected individuals presented higher levels of inflammation in CSF and blood compared to younger individuals, but no difference was observed in HIV DNA levels. Among older participants, higher HIV DNA levels were significantly associated with more severe neurocognitive impairment (p = 0.005), particularly in the Executive Functions domain (p = 0.004). No association was observed between HIV DNA and neurocognition among younger individuals. Despite significantly increased inflammation observed in the older group, none of the inflammatory markers were associated with neurocognitive impairment among older HIV+ individuals (p > 0.05). Our study supports the involvement of peripheral HIV DNA reservoir in the pathogenesis of neurocognitive disorder during suppressive ART. Correlates of neurocognitive impairment might differ between younger and older adults, suggesting that future treatment and prevention strategies for HIV-associated neurocognitive disorders likely need to be tailored based on age.
Collapse
Affiliation(s)
| | | | - Ben Murrel
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | - Igor Grant
- HIV Neurobehavioral Research Center, San Diego, CA, USA
| | - Davey M Smith
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | - Sara Gianella
- University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
164
|
Pérez-Santiago J, Schrier RD, de Oliveira MF, Gianella S, Var SR, Day TRC, Ramirez-Gaona M, Suben JD, Murrell B, Massanella M, Cherner M, Smith DM, Ellis RJ, Letendre SL, Mehta SR. Cell-free mitochondrial DNA in CSF is associated with early viral rebound, inflammation, and severity of neurocognitive deficits in HIV infection. J Neurovirol 2015; 22:191-200. [PMID: 26428514 DOI: 10.1007/s13365-015-0384-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/02/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
Cell-free mitochondiral DNA (mtDNA) is an immunogenic molecule associated with many inflammatory conditions. We evaluated the relationship between cell-free mtDNA in cerebrospinal fluid (CSF) and neurocognitive performance and inflammation during HIV infection. In a cross-sectional analysis, we evaluated the association of mtDNA levels with clinical assessments, inflammatory markers, and neurocognitive performance in 28 HIV-infected individuals. In CSF, we measured mtDNA levels by droplet digital PCR, and soluble CD14 and CD163, neurofilament light, and neopterin by ELISA. In blood and CSF, we measured soluble IP-10, MCP-1, TNF-α, and IL-6 by ELISA, and intracellular expression of IL-2, IFN-γ, and TNF-α in CD4(+) and CD8(+) T cells by flow cytometry. We also evaluated the relationship between CSF pleocytosis and mtDNA longitudinally in another set of five individuals participating in an antiretroviral treatment (ART) interruption study. Cell-free CSF mtDNA levels strongly correlated with neurocognitive performance among individuals with neurocognitive impairment (NCI) (r = 0.77, p = 0.001). CSF mtDNA also correlated with levels of IP-10 in CSF (r = 0.70, p = 0.007) and MCP-1 in blood plasma (r = 0.66, p = 0.01) in individuals with NCI. There were no significant associations between inflammatory markers and mtDNA in subjects without NCI, and levels of mtDNA did not differ between subjects with and without NCI. MtDNA levels preceded pleocytosis and HIV RNA following ART interruption. Cell-free mtDNA in CSF was strongly associated with the severity of neurocognitive dysfunction and inflammation only in individuals with NCI. Our findings suggest that within a subset of subjects cell-free CSF mtDNA is associated with inflammation and degree of NCI.
Collapse
Affiliation(s)
- Josué Pérez-Santiago
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA.
| | - Rachel D Schrier
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Michelli F de Oliveira
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Sara Gianella
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Susanna R Var
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Tyler R C Day
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | | | - Jesse D Suben
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Ben Murrell
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Marta Massanella
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Mariana Cherner
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Davey M Smith
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA.,Veterans Administration San Diego Healthcare System, San Diego, CA, USA
| | - Ronald J Ellis
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Scott L Letendre
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Sanjay R Mehta
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA.,Veterans Administration San Diego Healthcare System, San Diego, CA, USA
| |
Collapse
|
165
|
Kupprat SA, Halkitis PN, Pérez-Figueroa R, Solomon TM, Ashman T, Kingdon MJ, Levy MD. Age- and education-matched comparison of aging HIV+ men who have sex with men to general population on common neuropsychological assessments. J Health Psychol 2015; 20:1175-85. [PMID: 24265296 PMCID: PMC4451431 DOI: 10.1177/1359105313509844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Little is known about the impact of HIV and aging on cognitive functioning. This New York City cross-sectional study of aging HIV-positive gay and bisexual men assessed their neuropsychological state. Working memory and verbal abstract reasoning were relatively intact. After 55 years of age, attention abilities were impaired. Executive function impairment was present regardless of age and education. Results suggest the need for HIV-specific norms, and the use of neuropsychological assessments (i.e. baseline and over time) as a cost-effective way to assess HIV-related cognitive decline in developed and under-developed countries.
Collapse
|
166
|
Intellectual Impairment in Patients with Newly Diagnosed HIV Infection in Southwestern Nigeria. BIOMED RESEARCH INTERNATIONAL 2015; 2015:185891. [PMID: 26295033 PMCID: PMC4532809 DOI: 10.1155/2015/185891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/17/2015] [Indexed: 12/01/2022]
Abstract
Neurocognitive impairment is a detrimental complication of HIV infection. Here, we characterized the intellectual performance of patients with newly diagnosed HIV infection in southwestern Nigeria. We conducted a prospective study at Owo Federal Medical Center by using the adapted Wechsler Adult Intelligence Scale (WAIS). The raw scores were converted to standardized scores (z-scores) and correlated with clinical and laboratory findings. Fifty-eight HIV positive patients were recruited; 72% were in WHO stages 3 and 4. We detected a high rate of intellectual impairment in HIV positive patients and controls (63.8% and 10%, resp.; P < 0.001). HIV positive patients performed worse throughout the subtests of both verbal and performance intelligence quotients. Presence of opportunistic infections was associated with worse performance in the similarities and digit symbol tests and performance and full scale scores. Lower body weight correlated with poor performance in different WAIS subtests. The high rate of advanced disease stage warrants measures aimed at earlier diagnosis and treatment. Assessment of neurocognitive performance at diagnosis may offer the opportunity to improve functioning in daily life and counteract disease progression.
Collapse
|
167
|
Vance DE, Humphrey SC, Yoo-Jeong M, Jones G"LD, Nicholson WC. The Role of Employment on Neurocognitive Reserve in Adults With HIV: A Review of the Literature. J Assoc Nurses AIDS Care 2015; 26:316-29. [PMID: 26066688 PMCID: PMC4552356 DOI: 10.1016/j.jana.2015.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 04/03/2015] [Indexed: 01/25/2023]
Abstract
The benefits of employment are enormous; when employed, people naturally: (a) engage socially with the public and colleagues/co-workers, (b) learn new skills to increase job productivity and competence, (c) establish routines that can prevent lethargy and boredom and may regulate sleep and healthy behaviors, (d) are provided purposeful and meaningful activity that may prevent depression, and (e) gain income to pursue cognitively stimulating interests. All of these and other employment influences can provide an enriched personal and social environment that stimulates positive neuroplasticity and promotes neurocognitive reserve, which are particularly relevant to adults with HIV because (a) approximately 50% of adults with HIV experience observable cognitive impairments that can adversely affect everyday functioning such as medication adherence, and (b) approximately 45% of adults with HIV are unemployed and do not receive the neurocognitive benefits of employment. From these considerations, implications for health care research and nursing practice are provided.
Collapse
Affiliation(s)
- David E. Vance
- The University of Alabama School of Nursing, Room 2M026, 1701 University Boulevard, University of Alabama at Birmingham (UAB), Birmingham, AL 35294-1210, Office: 205-934-7589, Fax: 205-996-7183,
| | - Shameka C. Humphrey
- University of Alabama at Birmingham School of Nursing, Room 1020P, 1701 University Boulevard, University of Alabama at Birmingham (UAB), Birmingham, AL 35294-1210, Office: 205-996-9457, Fax: 205-975-6194,
| | - Moka Yoo-Jeong
- 1520 Clifton Rd NE, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322,
| | - Gwendolyn "Lynn" D. Jones
- Department of Psychology and Sociology, JKH Rm. 44 - 300, Tuskegee University, Tuskegee, AL, 36083, Office: 334-727-8830, Fax: 334-724-4196,
| | - William C. Nicholson
- University of Alabama at Birmingham-School of Nursing, Room 343, 1701 University Boulevard, University of Alabama at Birmingham (UAB), Birmingham, AL 35249-1210, Office: 205-996-9821,
| |
Collapse
|
168
|
Hulgan T, Samuels DC, Bush W, Ellis RJ, Letendre SL, Heaton RK, Franklin DR, Straub P, Murdock DG, Clifford DB, Collier AC, Gelman BB, Marra CM, McArthur JC, McCutchan JA, Morgello S, Simpson DM, Grant I, Kallianpur AR. Mitochondrial DNA Haplogroups and Neurocognitive Impairment During HIV Infection. Clin Infect Dis 2015; 61:1476-84. [PMID: 26129753 DOI: 10.1093/cid/civ527] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/22/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) remains an important complication in persons infected with human immunodeficiency virus (HIV). Ancestry-related mitochondrial DNA (mtDNA) haplogroups have been associated with outcomes of HIV infection and combination antiretroviral therapy (CART), and with neurodegenerative diseases. We hypothesize that mtDNA haplogroups are associated with NCI in HIV-infected adults and performed a genetic association study in the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) cohort. METHODS CHARTER is an observational study of ambulatory HIV-infected adults. Haplogroups were assigned using mtDNA sequence, and principal components were derived from ancestry-informative nuclear DNA variants. Outcomes were cross-sectional global deficit score (GDS) as a continuous measure, GDS impairment (GDS ≥ 0.50), and HIV-associated neurocognitive disorder (HAND) using international criteria. Multivariable models were adjusted for comorbidity status (incidental vs contributing), current CART, plasma HIV RNA, reading ability, and CD4 cell nadir. RESULTS Haplogroups were available from 1027 persons; median age 43 years, median CD4 nadir 178 cells/mm(3), 72% on CART, and 46% with HAND. The 102 (9.9%) persons of genetically determined admixed Hispanic ancestry had more impairment by GDS or HAND than persons of European or African ancestry (P < .001 for all). In multivariate models including persons of admixed Hispanic ancestry, those with haplogroup B had lower GDS (β = -0.34; P = .008) and less GDS impairment (odds ratio = 0.16; 95% confidence interval, .04, .63; P = .009) than other haplogroups. There were no significant haplogroup associations among persons of European or African ancestry. CONCLUSIONS In these mostly CART-treated persons, mtDNA haplogroup B was associated with less NCI among persons of genetically determined Hispanic ancestry. mtDNA variation may represent an ancestry-specific factor influencing NCI in HIV-infected persons.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Susan Morgello
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Igor Grant
- University of California-San Diego, California
| | - Asha R Kallianpur
- Cleveland Clinic Foundation/Lerner Research Institute and Cleveland Clinic Lerner College of Medicine, Ohio
| | | |
Collapse
|
169
|
Abstract
Objective: Existing screening tools for HIV-Associated Neurocognitive Disorders (HAND) may lack the accuracy required for clinical use. We hypothesized that the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) as a screening tool for HAND might be improved with a stronger scoring methodology. Design: Two hundred HIV-positive participants aged 18–65 years completed the MoCA and a battery of neuropsychological tests. Methods: HAND diagnosis was established according to the Frascati criteria, and an NPZ-8 score was also calculated. Rasch analysis was applied to the MoCA items to create a quantitative score. Results: The optimal cut-off on the quantitative MoCA for detecting impairment as per Frascati criteria yielded a sensitivity of 0.74 and a specificity of 0.68. Overall accuracy was 0.79 (95% CI: 0.73–0.85), an improvement over standard scoring methods. However, whether cognition was quantified with the quantitative MoCA or with NPZ-8, there was substantial overlap between diagnostic categories; several individuals categorized as impaired had better overall cognitive function as assessed by NPZ-8 or quantitative MoCA than those classified as normal using standard criteria. Conclusion: Quantifying performance on MoCA items through Rasch analysis improves its accuracy as a screening tool for HAND, and demonstrates that cognition can be measured as a unidimensional construct in HIV, at least at the level of precision of bedside testing. However, the current categorical diagnostic approach to HAND is poorly aligned with summary measures of cognitive ability. Measuring cognition as a quasi-continuous construct may be more relevant than conventional HAND diagnostic categories for many clinical purposes.
Collapse
|
170
|
Abdominal obesity contributes to neurocognitive impairment in HIV-infected patients with increased inflammation and immune activation. J Acquir Immune Defic Syndr 2015; 68:281-8. [PMID: 25469522 DOI: 10.1097/qai.0000000000000458] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We tested our hypothesis that abdominal obesity when associated with increased levels of systemic and central nervous system immunoinflammatory mediators contributes to neurocognitive impairment (NCI). DESIGN Cross-sectional. SETTING Six Academic Centers. PARTICIPANTS One hundred fifty-two patients with plasma HIV RNA <1000 copies per milliliter had clinical evaluations and cognitive function quantified by global deficit scores (GDS). OUTCOME MEASURES GDS, waist circumference (WC) and plasma IL-6, sCD163, and sCD14 and CSF sCD40L, sTNFrII, MCP-1, sICAM, and MMP-9. RESULTS WC and plasma IL-6 levels positively correlated with GDS; the WC correlation was strongest in the high tertile of IL-6 (ρ = 0.39, P = 0.005). IL-6 correlated with GDS only if WC was ≥99 cm. In the high tertile of CSF sCD40L, a biomarker of macrophage and microglial activation, the correlation of IL-6 to GDS was strongest (ρ = 0.60, P < 0.0001). Across 3-5 visits within ±1 year of the index visit, GDS remained worse in patients with IL-6 levels in the high versus low tertile (P = 0.02). Path analysis to explore potential mediators of NCI produced a strong integrated model for patients in the high CSF sCD40L tertile. In this model, WC affected GDS both directly and through a second path that was mediated by IL-6. Inclusion of plasma sCD14 levels strengthened the model. NCI was more common in men and for individuals with components of the metabolic syndrome. CONCLUSIONS Neurocognitive function was significantly linked to abdominal obesity, systemic inflammation (high IL-6), and immune activation in plasma (high sCD14) and CSF (high sCD40L). Abdominal obesity, inflammation, and central nervous system immune activation are potential therapeutic targets for NCI in HIV-positive patients.
Collapse
|
171
|
Cysique LA, Hewitt T, Croitoru-Lamoury J, Taddei K, Martins RN, Chew CSN, Davies NNWS, Price P, Brew BJ. APOE ε4 moderates abnormal CSF-abeta-42 levels, while neurocognitive impairment is associated with abnormal CSF tau levels in HIV+ individuals - a cross-sectional observational study. BMC Neurol 2015; 15:51. [PMID: 25880550 PMCID: PMC4386081 DOI: 10.1186/s12883-015-0298-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) biomarkers Aβ1-42, t-tau and p-tau have a characteristic pattern in Alzheimer’s Disease (AD). Their roles in HIV-associated neurocognitive disorder (HAND) remains unclear. Methods Adults with chronic treated HIV disease were recruited (n = 43, aged 56.7 ± 7.9; 32% aged 60+; median HIV duration 20 years, >95% plasma and CSF HIV RNA <50 cp/mL, on cART for a median 24 months). All underwent standard neuropsychological testing (61% had HAND), APOE genotyping (30.9% carried APOE ε4 and 7.1% were ε4 homozygotes) and a lumbar puncture. Concentrations of Aβ1-42, t-tau and p-tau were assessed in the CSF using commercial ELISAs. Current neurocognitive status was defined using the continuous Global Deficit Score, which grades impairment in clinically relevant categories. History of HAND was recorded. Univariate correlations informed multivariate models, which were corrected for nadir CD4-T cell counts and HIV duration. Results Carriage of APOE ε4 predicted markedly lower levels of CSF Aβ1-42 in univariate (r = -.50; p = .001) and multivariate analyses (R2 = .25; p < .0003). Greater levels of neurocognitive impairment were associated with higher CSF levels of p-tau in univariate analyses (r = .32; p = .03) and multivariate analyses (R2 = .10; p = .03). AD risk prediction cut-offs incorporating all three CSF biomarkers suggested that 12.5% of participants had a high risk for AD. Having a CSF-AD like profile was more frequent in those with current (p = .05) and past HIV-associated dementia (p = .03). Conclusions Similarly to larger studies, APOE ε4 genotype was not directly associated with HAND, but moderated CSF levels of Aβ1-42 in a minority of participants. In the majority of participants, increased CSF p-tau levels were associated with current neurocognitive impairment. Combined CSF biomarker risk for AD in the current HIV+ sample is more than 10 times greater than in the Australian population of the same age. Larger prospective studies are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0298-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lucette A Cysique
- University of New South Wales, St. Vincent's Hospital Clinical School, Sydney, Australia. .,Neuroscience Research Australia, Sydney, Australia. .,Department of Neurology St. Vincent's Hospital, Sydney, Australia. .,St. Vincent's Centre for Applied Medical Research, Sydney, Australia.
| | - Timothy Hewitt
- St. Vincent's Centre for Applied Medical Research, Sydney, Australia. .,University of Notre Dame, Sydney, Australia.
| | - Juliana Croitoru-Lamoury
- University of New South Wales, St. Vincent's Hospital Clinical School, Sydney, Australia. .,St. Vincent's Centre for Applied Medical Research, Sydney, Australia.
| | - Kevin Taddei
- Centre of Excellence for Alzheimer's disease Research & Care, School of Medical Sciences, Edith Cowan University, Mount Lawley, Australia. .,Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Nedlands, Australia.
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's disease Research & Care, School of Medical Sciences, Edith Cowan University, Mount Lawley, Australia. .,Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Nedlands, Australia. .,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
| | - Constance S N Chew
- School of Biomedical Science, Curtin University of Technology, Bentley, Australia.
| | | | - Patricia Price
- School of Biomedical Science, Curtin University of Technology, Bentley, Australia.
| | - Bruce J Brew
- University of New South Wales, St. Vincent's Hospital Clinical School, Sydney, Australia. .,Department of Neurology St. Vincent's Hospital, Sydney, Australia. .,St. Vincent's Centre for Applied Medical Research, Sydney, Australia.
| |
Collapse
|
172
|
Abstract
The ability to accurately perceive the passage of time relies on several neurocognitive abilities, including attention, memory, and executive functions, which are domains commonly affected in persons living with HIV disease. The current study examined time estimation and production and their neurocognitive correlates in a sample of 53 HIV+ individuals with HIV-associated neurocognitive disorders (HAND), 120 HIV+ individuals without HAND, and 113 HIV- individuals. Results revealed a moderate main effect of HAND on time estimation and a trend-level effect on time production, but no interaction between HAND and time interval duration. Correlational analyses revealed that time estimation in the HIV+ group was associated with attention, episodic memory and time-based prospective memory. Findings indicate that individuals with HAND evidence deficits in time interval judgment suggestive of failures in basic attentional and memory processes.
Collapse
|
173
|
Abstract
OBJECTIVE To determine the effect of virally suppressive antiretroviral therapy (ART) on cortical neurodegeneration and associated neurocognitive impairment. DESIGN Retrospective, postmortem observational study. METHODS Clinical neuropsychological and postmortem neuropathology data were analyzed in 90 HIV-infected volunteers from the general community who had never undergone ART (n = 7, 'naive') or who had undergone ART and whose plasma viral load was detectable (n = 64 'unsuppressed') or undetectable (n = 19, 'suppressed') at the last clinical visit before death. Individuals were predominately men (74/90, 82%) with a mean age of 44.7 years (SD 9.8). Cortical neurodegeneration was quantified by measuring microtubule-associated protein (MAP2) and synaptophysin (SYP) density in midfrontal cortex tissue sections. RESULTS The suppressed group had higher SYP density than the naive group (P = 0.007) and higher MAP2 density than the unsuppressed group (P = 0.04). The suppressed group had lower odds of HIV-associated neurocognitive disorders than naive [odds ratio (OR) 0.07, P = 0.03]. Higher SYP was associated with lower likelihood of HIV-associated neurocognitive disorders in univariable (OR 0.8, P = 0.03) and multivariable models after controlling for ART and brain HIV p24 protein levels (OR 0.72, P = 0.01). CONCLUSION We conclude that virally suppressive ART protects against cortical neurodegeneration. Further, we find evidence supporting the causal chain from treatment-mediated peripheral and central nervous system viral load suppression to reduced neurodegeneration and improved neurocognitive outcomes.
Collapse
|
174
|
McDonnell J, Haddow L, Daskalopoulou M, Lampe F, Speakman A, Gilson R, Phillips A, Sherr L, Wayal S, Harrison J, Antinori A, Maruff P, Schembri A, Johnson M, Collins S, Rodger A. Minimal cognitive impairment in UK HIV-positive men who have sex with men: effect of case definitions and comparison with the general population and HIV-negative men. J Acquir Immune Defic Syndr 2015; 67:120-7. [PMID: 24991974 PMCID: PMC4175121 DOI: 10.1097/qai.0000000000000273] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: To determine the prevalence of neurocognitive impairment (NCI) in UK HIV-positive and HIV-negative men who have sex with men (MSM). Methods: HIV-positive and HIV-negative participants were recruited to a cross-sectional study from 2 London clinics and completed computer-assisted neuropsychological tests and questionnaires of depression, anxiety, and activities of daily living. Published definitions of HIV-associated neurocognitive disorders (HAND) and global deficit scores were used. Age- and education-adjusted neuropsychological test scores were directly compared with reference population data. Results: A total of 248 HIV-positive and 45 HIV-negative MSM participated. In the HIV-positive group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells per cubic millimeter, and 88% were on antiretroviral therapy. Prevalence of HAND was 21.0% in HIV-positive MSM (13.7% asymptomatic neurocognitive impairment, 6.5% mild neurocognitive disorder, and 0.8% HIV-associated dementia). Using a global deficit score threshold of 0.5, the prevalence of NCI was 31.5% (when averaged over 5 neuropsychological domains) and 40.3% (over 10 neuropsychological test scores). These results were not significantly different from the HIV-negative study sample. No consistent pattern of impairment was seen in HIV-positive patients relative to general male population data (n = 380). Conclusions: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV-positive MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV-positive MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.
Collapse
Affiliation(s)
- Jeffrey McDonnell
- *Research Department of Infection and Population Health, University College London, London, United Kingdom; †Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; ‡National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy; §CogState, Melbourne, Victoria, Australia; ‖Department of Sexual Health and HIV, Royal Free London NHS Foundation Trust, London, United Kingdom; and ¶HIV I-Base, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
175
|
Clifford DB, Vaida F, Kao YT, Franklin DR, Letendre SL, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, Grant I, Heaton RK. Absence of neurocognitive effect of hepatitis C infection in HIV-coinfected people. Neurology 2014; 84:241-50. [PMID: 25503616 DOI: 10.1212/wnl.0000000000001156] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To investigate the effect of hepatitis C virus (HCV) on neurocognitive performance in chronically HIV-infected patients enrolled in the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study. METHODS A total of 1,582 participants in CHARTER who were tested for HCV antibody underwent neurocognitive testing; serum HCV RNA was available for 346 seropositive patients. Neurocognitive performance was compared in 408 HCV-seropositive and 1,174 HCV-seronegative participants and in a subset of 160 seropositive and 707 seronegative participants without serious comorbid neurologic conditions that might impair neurocognitive performance, using linear regression and taking into account HIV-associated and demographic factors (including IV drug use) and liver function. RESULTS Neurocognitive performance characterized by global deficit scores and the proportion of individuals who were impaired were the same in the HCV-seropositive and HCV-seronegative groups. In univariable analyses in the entire sample, only verbal domain scores showed small statistically different superior performance in the HCV+ group that was not evident in multivariable analysis. In the subgroup without significant comorbidities, scores in all 7 domains of neurocognitive functioning did not differ by HCV serostatus. Among the HCV-seropositive participants, there was no association between neurocognitive performance and serum HCV RNA concentration. CONCLUSION In HIV-infected patients, HCV coinfection does not contribute to neurocognitive impairment, at least in the absence of substantial HCV-associated liver damage, which was not evident in our cohort.
Collapse
Affiliation(s)
- David B Clifford
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY.
| | - Florin Vaida
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Yu-Ting Kao
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Donald R Franklin
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Scott L Letendre
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Ann C Collier
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Christina M Marra
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Benjamin B Gelman
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Justin C McArthur
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Susan Morgello
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - David M Simpson
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Igor Grant
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | - Robert K Heaton
- From Washington University (D.B.C.), St. Louis, MO; University of California (F.V., Y.-T.K., D.R.F., S.L.L., I.G., R.K.H.), San Diego; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas at Galveston (B.B.G.); Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY
| | | |
Collapse
|
176
|
Casaletto KB, Cattie J, Franklin DR, Moore DJ, Woods SP, Grant I, Heaton RK. The Wide Range Achievement Test-4 Reading subtest "holds" in HIV-infected individuals. J Clin Exp Neuropsychol 2014; 36:992-1001. [PMID: 25283135 DOI: 10.1080/13803395.2014.960370] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In order to detect HIV-associated neurocognitive decline, it is important to accurately estimate individuals' premorbid levels of cognitive functioning. Although previous studies have operated under the assumption that word reading tests are valid and stable indicators of premorbid abilities in HIV infection, studies of other populations have found that this is not always the case. Therefore, it is important to empirically examine the validity of word reading tests as estimates of premorbid functioning specifically within the HIV population. METHOD The Wide Range Achievement Test-4 Reading subtest (WRAT-4 Reading) was administered along with comprehensive neurocognitive assessments to 150 HIV seropositive (HIV+) and 76 HIV seronegative (HIV-) age-, education-, and sex-matched participants; a subset of 48 HIV+ individuals completed a second study visit (M = 14.4 months), in which the alternate version of the WRAT-4 was administered. RESULTS Although HIV+ individuals evidenced worse current neurocognitive functioning than HIV- participants, WRAT-4 Reading performance was comparable between groups. Longitudinally, HIV+ participants evidenced improved disease and neuropsychological functioning, yet WRAT-4 Reading demonstrated strong test-retest reliability and no practice effect, and did not differ between the initial and follow-up assessments. Test-retest differences in reading performance were minor and were not associated with changes in neurocognitive performance or changes in HIV disease. CONCLUSIONS We found no evidence of WRAT-4 Reading performance decline in HIV infection, despite HIV+/HIV- group differences in neurocognitive functioning. Additionally, reading performances among HIV+ individuals demonstrated consistency across study visits. These results begin to support the validity of the WRAT-4 Reading subtest as an indicator of premorbid cognitive functioning in HIV+ individuals.
Collapse
Affiliation(s)
- Kaitlin B Casaletto
- a San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA
| | | | | | | | | | | | | | | |
Collapse
|
177
|
Abstract
The success of combination antiretroviral therapy (cART) in transforming the lives of HIV-infected individuals with access to these drugs is tempered by the increasing threat of HIV-associated neurocognitive disorders (HAND) to their overall health and quality of life. Intensive investigations over the past two decades have underscored the role of host immune responses, inflammation, and monocyte-derived macrophages in HAND, but the precise pathogenic mechanisms underlying HAND remain only partially delineated. Complicating research efforts and therapeutic drug development are the sheer complexity of HAND phenotypes, diagnostic imprecision, and the growing intersection of chronic immune activation with aging-related comorbidities. Yet, genetic studies still offer a powerful means of advancing individualized care for HIV-infected individuals at risk. There is an urgent need for 1) longitudinal studies using consistent phenotypic definitions of HAND in HIV-infected subpopulations at very high risk of being adversely impacted, such as children, 2) tissue studies that correlate neuropathological changes in multiple brain regions with genomic markers in affected individuals and with changes at the RNA, epigenomic, and/or protein levels, and 3) genetic association studies using more sensitive subphenotypes of HAND. The NIH Brain Initiative and Human Connectome Project, coupled with rapidly evolving systems biology and machine learning approaches for analyzing high-throughput genetic, transcriptomic and epigenetic data, hold promise for identifying actionable biological processes and gene networks that underlie HAND. This review summarizes the current state of understanding of host genetic factors predisposing to HAND in light of past challenges and suggests some priorities for future research to advance the understanding and clinical management of HAND in the cART era.
Collapse
Affiliation(s)
- Asha R Kallianpur
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/Mail Code NE50, Cleveland, OH, 44195, USA,
| | | |
Collapse
|
178
|
Kolson D, Buch S. More than two HANDs to tango. J Neuroimmune Pharmacol 2014; 8:1051-4. [PMID: 24233518 PMCID: PMC3889221 DOI: 10.1007/s11481-013-9513-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022]
Abstract
Developing a validated tool for the rapid and efficient assessment of cognitive functioning in HIV-infected patients in a typical outpatient clinical setting has been an unmet goal of HIV research since the recognition of the syndrome of HIV-associated dementia (HAD) nearly 20 years ago. In this issue of JNIP Cross et al. report the application of the International HIV Dementia Scale (IHDS) in a U.S.-based urban outpatient clinic to evaluate its utility as a substitute for the more time- and effort-demanding formalized testing criteria known as the Frascati criteria that was developed in 2007 to define the syndrome of HIV-associated neurocognitive disorders (HAND). In this study an unselected cohort of 507 individuals (68 % African American) that were assessed using the IHDS in a cross-sectional study revealed a 41 % prevalence of cognitive impairment (labeled ‘symptomatic HAND’) that was associated with African American race, older age, unemployment, education level, and depression. While the associations between cognitive impairment and older age, education, unemployment status and depression in HIV-infected patients are not surprising, the association with African American ancestry and cognitive impairment in the setting of HIV infection is a novel finding of this study. This commentary discusses several important issues raised by the study, including the pitfalls of assessing cognitive functioning with rapid screening tools, cognitive testing criteria, normative testing control groups, accounting for HAND co-morbidity factors, considerations for clinical trials assessing HAND, and selective population vulnerability to HAND.
Collapse
|
179
|
Pérez-Valero I, González-Baeza A, Estébanez M, Monge S, Montes-Ramírez ML, Bayón C, Pulido F, Bernardino JI, Zamora FX, González-García JJ, Lagarde M, Hernando A, Arnalich F, Arribas JR. A prospective cohort study of neurocognitive function in aviremic HIV-infected patients treated with 1 or 3 antiretrovirals. Clin Infect Dis 2014; 59:1627-34. [PMID: 25114032 DOI: 10.1093/cid/ciu640] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The evolution of neurocognitive performance in aviremic human immunodeficiency virus (HIV)-positive patients treated with <3 antiretrovirals is unknown. METHODS We prospectively included aviremic (≥1 year) HIV-positive patients, without concomitant major neurocognitive confounders, currently receiving boosted lopinavir or darunavir as monotherapy (n = 67) or triple antiretroviral therapy (ART) (n = 67) for ≥1 year. We evaluated neurocognitive function (7 domains) at baseline and after 1 year. We performed analysis of covariance to evaluate if 1 additional year of exposure to monotherapy compared with triple ART had an effect on Global Deficit Score (GDS) changes after adjustment for potential confounders. We also compared the evolution of neurocognitive performance and impairment rates. RESULTS Intention-to-treat analysis showed that monotherapy did not influence 1-year GDS change after adjustment for significant confounders (age, ethnicity, duration of therapy, hepatitis C virus status, and HOMA-IR index); the adjusted effect was -0.04 (95% confidence interval, -.14 to .05; P = .38). Neurocognitive stability was observed with monotherapy and triple therapy (GDS crude mean change, -0.09 [95% confidence interval, -.16 to -.01] vs -0.08 [-.14 to -.02]), after 1 year of follow-up, similar proportions of patients changed neurocognitive status from impaired to unimpaired (monotherapy, 4 of 18 [22.2%]; triple therapy, 4 of 19 [21.1%]; P = .91) and vice versa (monotherapy, 5 of 44 [10.2%] and triple therapy, 3 of 45 [6.3%]; P = .48). Similar results were observed in an on-treatment analysis and with use of clinical ratings instead of GDS changes. CONCLUSIONS The number of antiretrovirals included in the ART regimen does not seem to influence the evolution of neurocognitive function in HIV-infected patients with suppressed plasma viremia.
Collapse
Affiliation(s)
| | | | | | - Susana Monge
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III
| | | | - Carmen Bayón
- Psychiatry Service, Hospital Universitario La Paz-IdiPAZ
| | - Federico Pulido
- HIV Unit-Internal Medicine Service, Hospital Universitario 12 de Octubre, i+12, Madrid
| | | | | | | | - María Lagarde
- HIV Unit-Internal Medicine Service, Hospital Universitario 12 de Octubre, i+12, Madrid
| | - Asunción Hernando
- Departamento de Especialidades Médicas, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | | | | |
Collapse
|
180
|
Arenas-Pinto A, Winston A, Stöhr W, Day J, Wiggins R, Quah SP, Ainsworth J, Fleck S, Dunn D, Accoroni A, Paton NI. Neurocognitive function in HIV-infected patients: comparison of two methods to define impairment. PLoS One 2014; 9:e103498. [PMID: 25078406 PMCID: PMC4117499 DOI: 10.1371/journal.pone.0103498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 07/02/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To compare two definitions of neurocognitive impairment (NCI) in a large clinical trial of effectively-treated HIV-infected adults at baseline. Methods Hopkins Verbal Learning test-Revised (HVLT-R), Colour Trail (CTT) and Grooved Pegboard (GPT) tests were applied exploring five cognitive domains. Raw scores were transformed into Z-scores and NCI defined as summary NPZ-5 score one standard deviation below the mean of the normative dataset (i.e. <−1SD) or Z-scores <−1SD in at least two individual domains (categorical scale). Principal component analysis (PCA) was performed to explore the contribution of individual tests to the total variance. Results Mean NPZ-5 score was −0.72 (SD 0.98) and 178/548 (32%) participants had NPZ-5 scores <−1SD. When impairment was defined as <−1SD in at least two individual tests, 283 (52%) patients were impaired. Strong correlations between the two components of the HVLT-R test (learning/recall) (r = 0.73), and the CTT and (attention/executive functioning) (r = 0.66) were observed. PCA showed a clustering with three components accounting for 88% of the total variance. When patients who scored <−1SD only in two correlated tests were considered as not impaired, prevalence of NCI was 43%. When correlated test scores were averaged, 36% of participants had NPZ-3 scores <−1SD and 32% underperformed in at least two individual tests. Conclusion Controlling for differential contribution of individual test-scores on the overall performance and the level of correlation between components of the test battery used appear to be important when testing cognitive function. These two factors are likely to affect both summary scores and categorical scales in defining cognitive impairment. Trial registration EUDRACT: 2007-006448-23 and ISRCTN04857074.
Collapse
Affiliation(s)
- Alejandro Arenas-Pinto
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
- Centre for Sexual Health and HIV Research, University College London, London, United Kingdom
- * E-mail:
| | - Alan Winston
- Section of Infectious Diseases, Division of Medicine, Imperial College, St Mary’s Hospital Campus, London, United Kingdom
- Department of HIV and GU Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Wolfgang Stöhr
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - John Day
- Infectious Diseases, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Rebecca Wiggins
- Centre for Immunology and Infection, Department of Biology, University of York, York, United Kingdom
| | - Say Pheng Quah
- Department of GU Medicine, Royal Victoria Hospital, Belfast, United Kingdom
| | - Jonathan Ainsworth
- Infectious Diseases, North Middlesex University Hospital, London, United Kingdom
| | - Sue Fleck
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - David Dunn
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Alex Accoroni
- Psychology and Psychotherapy Department, The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Nicholas I. Paton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | |
Collapse
|
181
|
Problematic alcohol use among individuals with HIV: relations with everyday memory functioning and HIV symptom severity. AIDS Behav 2014; 18:1302-14. [PMID: 23979498 DOI: 10.1007/s10461-013-0602-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Problematic alcohol use has been shown to negatively impact cognitive functions germane to achieving optimal HIV health outcomes. The present study, a secondary data analysis, examined the impact of problematic alcohol use on aspects of everyday memory functioning in a sample of 172 HIV-infected individuals (22 % female; Mage = 48.37 years, SD = 8.64; 39 % Black/non-Hispanic). Additionally, we tested whether self-reported memory functioning explained the relation between problematic alcohol use and HIV symptom severity. Results indicated that problematic patterns of alcohol use were associated with lower total memory functioning, retrieval (e.g., recall-difficulty) and memory for activity (e.g., what you did yesterday) and greater HIV symptom severity. Memory functioning mediated the relation between problematic alcohol use and HIV symptom severity. However, the direction of this relation was unclear as HIV symptom severity also mediated the relation between problematic alcohol use and memory functioning. Findings highlight the importance of integrated care for HIV and alcohol use disorders and suggest that routine alcohol and cognitive screenings may bolster health outcomes among this vulnerable population.
Collapse
|
182
|
Genetic, transcriptomic, and epigenetic studies of HIV-associated neurocognitive disorder. J Acquir Immune Defic Syndr 2014; 65:481-503. [PMID: 24583618 DOI: 10.1097/qai.0000000000000069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Human Genome Project, coupled with rapidly evolving high-throughput technologies, has opened the possibility of identifying heretofore unknown biological processes underlying human disease. Because of the opaque nature of HIV-associated neurocognitive disorder (HAND) neuropathogenesis, the utility of such methods has gained notice among NeuroAIDS researchers. Furthermore, the merging of genetics with other research areas has also allowed for application of relatively nascent fields, such as neuroimaging genomics, and pharmacogenetics, to the context of HAND. In this review, we detail the development of genetic, transcriptomic, and epigenetic studies of HAND, beginning with early candidate gene association studies and culminating in current "omics" approaches that incorporate methods from systems biology to interpret data from multiple levels of biological functioning. Challenges with this line of investigation are discussed, including the difficulty of defining a valid phenotype for HAND. We propose that leveraging known associations between biology and pathology across multiple levels will lead to a more reliable and valid phenotype. We also discuss the difficulties of interpreting the massive and multitiered mountains of data produced by current high-throughput omics assays and explore the utility of systems biology approaches in this regard.
Collapse
|
183
|
Cysique LA, Heaton RK, Kamminga J, Lane T, Gates TM, Moore DM, Hubner E, Carr A, Brew BJ. HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research. J Neurovirol 2014; 20:258-68. [PMID: 24696363 DOI: 10.1007/s13365-014-0242-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/28/2014] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
The Australian HIV-infected (HIV+) population is largely comprised of high-functioning men who have sex with men (MSM). Like other English-speaking countries, Australia mostly relies on US neuropsychological normative standards to detect and determine the prevalence of neurological disorders. Whether the US neuropsychological (NP) normative standards are appropriate in Australian HIV+ MSM has not been established. Ninety virally suppressed HIV+ and 49 HIV-uninfected (HIV-) men (respectively 86 and 85 % self-reported MSM; mean age 54 and 56 years, mean premorbid verbal IQ estimate 110 and 111) undertook standard NP testing. The raw neuropsychological data were transformed using the following: (1) US standards as uncorrected scaled scores and demographically corrected T scores (US norms); and (2) z scores (without demographic corrections) derived from Australian comparison group scaled scores (local norms). To determine HIV-associated neurocognitive disorder prevalence, we used a standard definition of impairment based upon a battery-wide summary score: the global deficit score (GDS). Impairment classification (GDS ≥ 0.5) based on the local norms was best at discriminating between the two groups (HIV- = 14.3 % vs. HIV+ = 53.3 %; p < 0.0001). This definition was significantly associated with age. Impairment classification based on the US norms yielded much lower impairment rate regardless of the HIV status (HIV- = 4.1 % vs. HIV+ = 14.7 %; p = 0.05), but was associated with historical AIDS, and not age. Both types of summary scores were associated with reduced independence in activities of daily living (p ≤ 0.03). Accurate neuropsychological classifications of high (or low) functioning individuals may need country-specific norms that correct for performance-based (e.g., reading) estimates of premorbid cognition in addition to the traditional demographic factors.
Collapse
Affiliation(s)
- Lucette A Cysique
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia,
| | | | | | | | | | | | | | | | | |
Collapse
|
184
|
Abstract
Sensorimotor inhibition, or the ability to filter out excessive or irrelevant information, theoretically supports a variety of higher-level cognitive functions. Impaired inhibition may be associated with increased impulsive and risky behavior in everyday life. Individuals infected with HIV frequently show impairment on tests of neurocognitive function, but sensorimotor inhibition in this population has not been studied and may be a contributor to the profile of HIV-associated neurocognitive disorders (HAND). Thirty-seven HIV-infected individuals (15 with HAND) and 48 non-infected comparison subjects were assessed for prepulse inhibition (PPI), an eyeblink startle paradigm measuring sensorimotor gating. Although HIV status alone was not associated with PPI deficits, HIV-positive participants meeting criteria for HAND showed impaired PPI compared to cognitively intact HIV-positive subjects. In HIV-positive subjects, PPI was correlated with working memory but was not associated with antiretroviral therapy or illness factors. In conclusion, sensorimotor disinhibition in HIV accompanies deficits in higher-order cognitive functions, although the causal direction of this relationship requires investigation. Subsequent research on the role of sensorimotor gating on decision-making and risk behaviors in HIV may be indicated.
Collapse
|