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Trunfio M, Sacchi A, Vai D, Pittaluga F, Croce M, Cavallo R, Imperiale D, Bonora S, Di Perri G, Letendre SL, Calcagno A. Intrathecal production of anti-Epstein-Barr virus viral capsid antigen IgG is associated with neurocognition and tau proteins in people with HIV. AIDS 2024; 38:477-486. [PMID: 37939156 DOI: 10.1097/qad.0000000000003775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE HIV and Epstein-Barr virus (EBV) co-infection has been linked to increased immune activation and larger HIV reservoir. We assessed whether anti-EBV humoral responses are associated with increased cerebrospinal fluid (CSF) inflammation and with neurocognitive impairment (NCI) in people with HIV (PWH). DESIGN Cross-sectional analysis in 123 EBV-seropositive PWH either on antiretroviral therapy ( n = 70) or not. METHODS Serum and CSF anti-EBV viral capsid antigen immunoglobulin G (anti-EVI) and CSF EBV DNA were measured by commercial immunoassay and RT-PCR. Seventy-eight participants without neurological confounding factors underwent neurocognitive assessment (Global Deficit Score, GDS). CSF total tau and 181-phosphorylated-tau (ptau) were measured by immunoassays together with biomarkers of blood-brain barrier (BBB) integrity, immune activation, astrocytosis, and intrathecal synthesis. Logistic and linear regressions and moderation analysis were used to investigate the relationships between CSF anti-EVI, GDS, and biomarkers. RESULTS Twenty-one (17.1%) and 22 participants (17.9%) had detectable CSF anti-EVI (10.5-416.0 U/ml) and CSF EBV DNA (25-971 copies/ml). After adjusting for BBB integrity, age, and clinical factors, the presence of CSF anti-EVI was only associated with serum levels of anti-EVI, and not with CSF EBV DNA. CSF anti-EVI, tau and ptau showed reciprocal interactions affecting their associations with GDS. After adjusting for demographics and clinical parameters, higher CSF anti-EVI levels were associated with worse GDS (aβ 0.45, P < 0.001), and CSF levels of tau and ptau had a moderation effect on the strength of this association (models' P < 0.001). CONCLUSION Humoral immune responses against EBV within the central nervous system may contribute to NCI in PWH through mechanisms that involve neuronal injury.
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Affiliation(s)
- Mattia Trunfio
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, UCSD, La Jolla, CA, USA
| | - Alessandra Sacchi
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino
| | - Daniela Vai
- Neurology unit, Maria Vittoria Hospital, Turin, Italy
| | - Fabrizia Pittaluga
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino
| | - Michele Croce
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino
| | | | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Scott Lee Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, UCSD, La Jolla, CA, USA
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
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Grasina A, Espirito-Santo H, Lemos L, Vilar MM, Simões-Cunha L, Daniel F. Mini-ACE: Validation Study Among Older People in Long-Term Care. J Cogn 2024; 7:5. [PMID: 38223221 PMCID: PMC10785962 DOI: 10.5334/joc.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/25/2023] [Indexed: 01/16/2024] Open
Abstract
Background The Mini-Addenbrooke's Cognitive Examination (M-ACE) is a valid and reliable tool that accurately differentiates various types of cognitive impairment from Normal-cognition assessed in multiple settings. However, its validity among older individuals in long-term care (LTC) was not yet established. Therefore, we sought to assess the Portuguese M-ACE's validity, reliability, and accuracy in detecting cognitive impairment no-dementia (CIND) in LTC users. Methods A comprehensive assessment was performed on 196 LTC Portuguese users aged ≥ 60 years, among whom 71 had Normal-cognition, and 125 had CIND. Results The M-ACE was found to be reliable (McDonald's ω = .86, Cronbach's α = .85) and consistent over time (r = .72; ICC = .83) and between raters (k = .92). Strong correlations with related measures supported construct validity (both r = .67). The M-ACE accurately distinguished CIND from Normal-cognition with a cut-off of 17 points (AUC = 0.81, Sensitivity = 81.7%, Specificity = 74.4%). Conclusion Our findings suggest that the Portuguese M-ACE is a valid and reliable cognitive assessment tool for LTC users, allowing for accurate differentiation between CIND and Normal-cognition. Thus, the M-ACE's use could contribute to the early detection and intervention of cognitive disorders, especially among older adults in LTC.
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Affiliation(s)
| | - Helena Espirito-Santo
- Miguel Torga Institute of Higher Education (ISMT), Coimbra, PT
- Centro de Estudos e Investigação em Saúde, Universidade de Coimbra, Coimbra, Portugal
- Centro de Investigação em Neuropsicologia e Intervenção Cognitiva e Comportamental, Portugal
| | - Laura Lemos
- Miguel Torga Institute of Higher Education (ISMT), Coimbra, PT
- Centro de Estudos e Investigação em Saúde, Universidade de Coimbra, Coimbra, Portugal
| | - Maria Manuela Vilar
- Faculdade de Psicologia e de Ciências de Educação da Universidade de Coimbra (FPCEUC), Coimbra, Portugal
| | - Luís Simões-Cunha
- Miguel Torga Higher Education Institute (ISMT), Coimbra, Portugal
- Research and Development Center of the Military University Institute, Lisboa, Portugal
| | - Fernanda Daniel
- Centro de Inovação em Biomedicina e Biotecnologia da Universidade de Coimbra, Coimbra, Portugal
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Trunfio M, Mighetto L, Napoli L, Atzori C, Nigra M, Guastamacchia G, Bonora S, Di Perri G, Calcagno A. Cerebrospinal Fluid CXCL13 as Candidate Biomarker of Intrathecal Immune Activation, IgG Synthesis and Neurocognitive Impairment in People with HIV. J Neuroimmune Pharmacol 2023; 18:169-182. [PMID: 37166552 DOI: 10.1007/s11481-023-10066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
Plasma C-X-C-motif chemokine ligand-13 (CXCL13) has been linked to disease progression and mortality in people living with HIV (PLWH) and is a candidate target for immune-based strategies for HIV cure. Its role in central nervous system (CNS) of PLWH has not been detailed. We described CSF CXCL13 levels and its potential associations with neurological outcomes. Cross-sectional study enrolling PLWH without confounding for CXCL13 production. Subjects were divided according to CSF HIV-RNA in undetectable (< 20 cp/mL) and viremics. CSF CXCL13, and biomarkers of blood-brain barrier (BBB) impairment, intrathecal synthesis, and immune activation were measured by commercial immunoturbidimetric and ELISA assays. All subjects underwent neurocognitive assessment. Sensitivity analyses were conducted in subjects with intact BBB only. 175 participants were included. Detectable CSF CXCL13 was more common in the viremic (31.4%) compared to the undetectable group (13.5%; OR 2.9 [1.4-6.3], p = 0.006), but median levels did not change (15.8 [8.2-91.0] vs 10.0 [8.1-14.2] pg/mL). In viremics (n = 86), CXCL13 associated with higher CSF HIV-RNA, proteins, neopterin, intrathecal synthesis and BBB permeability. In undetectable participants (n = 89), CXCL13 associated with higher CD4+T-cells count, CD4/CD8 ratio, CSF proteins, neopterin, and intrathecal synthesis. The presence of CXCL13 in the CSF of undetectable participants was associated with increased odds of HIV-associated neurocognitive disorders (58.3% vs 28.6%, p = 0.041). Sensitivity analyses confirmed all these findings. CXCL13 is detectable in the CSF of PLWH that show increased intrathecal IgG synthesis and immune activation. In PLWH with CSF viral suppression, CXCL13 was also associated with neurocognitive impairment.
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Affiliation(s)
- Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Torino, 10149, Italy.
- HIV Neurobehavioral Research Center (HNRC), Department of Psychiatry, University of California San Diego, San Diego, CA, 92093, USA.
| | - Lorenzo Mighetto
- Diagnostic Laboratory Unit, Maria Vittoria Hospital, ASL Città di Torino, Torino, 10144, Italy
| | - Laura Napoli
- Infectious Diseases Unit, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Torino, 10149, Italy
| | - Cristiana Atzori
- Unit of Neurology, Maria Vittoria Hospital, ASL Città di Torino, Torino, 10144, Italy
| | - Marco Nigra
- Diagnostic Laboratory Unit, Maria Vittoria Hospital, ASL Città di Torino, Torino, 10144, Italy
| | - Giulia Guastamacchia
- Unit of Neurology, Maria Vittoria Hospital, ASL Città di Torino, Torino, 10144, Italy
| | - Stefano Bonora
- Infectious Diseases Unit, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Torino, 10149, Italy
| | - Giovanni Di Perri
- Infectious Diseases Unit, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Torino, 10149, Italy
| | - Andrea Calcagno
- Infectious Diseases Unit, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Torino, 10149, Italy
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