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Scutari R, Alteri C, Perno CF, Svicher V, Aquaro S. The Role of HIV Infection in Neurologic Injury. Brain Sci 2017; 7:E38. [PMID: 28383502 PMCID: PMC5406695 DOI: 10.3390/brainsci7040038] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 12/20/2022] Open
Abstract
The central nervous system (CNS) is a very challenging HIV-1 sanctuary, in which HIV-1 replication is established early on during acute infection and can persist despite potent antiretroviral treatments. HIV-1 infected macrophages play a pivotal role acting as vehicles for HIV-1 to spread into the brain, and can be the major contributor of an early compartmentalization. HIV-1 infection in CNS may lead to a broad spectrum of neurological syndromes, such as dementia, mild neurocognitive disorders, and asymptomatic impairment. These clinical manifestations are caused by the release of neurotoxins from infected cells (mainly macrophages), and also by several HIV-1 proteins, able to activate cell-signaling involved in the control of cellular survival and apoptosis. This review is aimed at highlighting the virological aspects associated with the onset of neurocognitive disorders and at addressing the novel therapeutic approaches to stop HIV-1 replication in this critical sanctuary.
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Affiliation(s)
- Rossana Scutari
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Claudia Alteri
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome 00133, Italy.
| | - Stefano Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende (CS) 87036, Italy.
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Rajalakshmy AR, Malathi J, Madhavan HN. Serum-derived hepatitis C virus 1a infection of human astrocyte cell line SVG. J Viral Hepat 2016; 23:211-6. [PMID: 26469941 DOI: 10.1111/jvh.12480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/04/2015] [Indexed: 01/26/2023]
Abstract
Neuroinvasion of hepatitis C virus (HCV) is evidenced by recent clinical studies. In this study, serum-derived HCV infection of astrocytes was analysed. Astrocytes were infected with HCV-positive serum, and viral replication was assessed on different days postinfection. RT-PCR was positive for HCV-negative strand on 5th and 7th day postinfection in the HCV-positive serum-infected astrocytes. Real-time RNA count in the cell culture supernatant was steadily increasing from day 3 to day 7. To reconfirm the viral replication, astrocytes were treated with an antiviral before the serum infection, and the antiviral treatment significantly reduced the viral RNA count. Further, the virus-infected cells stained positive for the presence of viral core protein. Electron microscopy revealed the presence of HCV-like particles in the astrocyte cell culture supernatant. In conclusion, serum-derived HCV replicates in human astrocyte cell line SVG.
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Affiliation(s)
- A R Rajalakshmy
- L & T Microbiology Research Centre, Vision Research Foundation, Chennai, 600006, India.,Centre for Nanotechnology and Advanced Biomaterials, SASTRA, Thanjavur, 612001, India
| | - J Malathi
- L & T Microbiology Research Centre, Vision Research Foundation, Chennai, 600006, India
| | - H N Madhavan
- L & T Microbiology Research Centre, Vision Research Foundation, Chennai, 600006, India
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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.
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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
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Bladowska J, Knysz B, Zimny A, Małyszczak K, Kołtowska A, Szewczyk P, Gąsiorowski J, Furdal M, Sąsiadek MJ. Value of perfusion-weighted MR imaging in the assessment of early cerebral alterations in neurologically asymptomatic HIV-1-positive and HCV-positive patients. PLoS One 2014; 9:e102214. [PMID: 25013963 PMCID: PMC4094508 DOI: 10.1371/journal.pone.0102214] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/16/2014] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Asymptomatic central nervous system (CNS) involvement occurs in the early stage of the human immunodeficiency virus (HIV) infection. It has been documented that the hepatitis C virus (HCV) can replicate in the CNS. The aim of the study was to evaluate early disturbances in cerebral microcirculation using magnetic resonance (MR) perfusion-weighted imaging (PWI) in asymptomatic HIV-1-positive and HCV-positive patients, as well as to assess the correlation between PWI measurements and the clinical data. Materials and Methods Fifty-six patients: 17 HIV-1-positive non-treated, 18 HIV-1-positive treated with combination antiretroviral therapy (cART), 7 HIV-1/HCV-positive non-treated, 14 HCV-positive before antiviral therapy and 18 control subjects were enrolled in the study. PWI was performed with a 1.5T MR unit using dynamic susceptibility contrast (DSC) method. Cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) were evaluated in the posterior cingulated region (PCG), basal ganglia (BG), temporoparietal (TPC) and frontal cortices (FC), as well as in white matter of frontoparietal areas. Correlations of rCBV values with immunologic data and liver histology activity index (HAI) were analyzed. Results Significantly lower rCBV values were found in the right TPC and left FC as well as in PCG in HIV-1-positive naïve (p = 0.009; p = 0.020; p = 0.012), HIV-1 cART treated (p = 0.007; p = 0.009; p = 0.033), HIV-1/HCV-positive (p = 0.007; p = 0.027; p = 0.045) and HCV-positive patients (p = 0.010; p = 0.005; p = 0.045) compared to controls. HIV-1-positive cART treated and HIV-1/HCV-positive patients demonstrated lower rCBV values in the right FC (p = 0.009; p = 0.032, respectively) and the left TPC (p = 0.036; p = 0.005, respectively), while HCV-positive subjects revealed lower rCBV values in the left TPC region (p = 0.003). We found significantly elevated rCBV values in BG in HCV-positive patients (p = 0.0002; p<0.0001) compared to controls as well as to all HIV-1-positive subjects. There were no significant correlations of rCBV values and CD4 T cell count or HAI score. Conclusions PWI examination enables the assessment of HIV-related as well as HCV-related early cerebral dysfunction in asymptomatic subjects. HCV-infected patients seem to reveal the most pronounced perfusion changes.
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Affiliation(s)
- Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | - Brygida Knysz
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Zimny
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Małyszczak
- Division of Psychotherapy and Psychosomatic Medicine, Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | - Anna Kołtowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Szewczyk
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Gąsiorowski
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Furdal
- Regional Specialistic Hospital, Department of Cardiology, Wroclaw, Poland
| | - Marek J. Sąsiadek
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
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Bladowska J, Zimny A, Kołtowska A, Szewczyk P, Knysz B, Gąsiorowski J, Furdal M, Sąsiadek MJ. Evaluation of metabolic changes within the normal appearing gray and white matters in neurologically asymptomatic HIV-1-positive and HCV-positive patients: magnetic resonance spectroscopy and immunologic correlation. Eur J Radiol 2012; 82:686-92. [PMID: 23246331 DOI: 10.1016/j.ejrad.2012.11.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/14/2012] [Accepted: 11/21/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate early metabolic changes using proton MR spectroscopy (MRS) in asymptomatic HIV-1-positive and HCV-positive patients without abnormalities in the structural MR examination. METHODS Sixty-five asymptomatic patients: 21 HIV-1-positive naive, 20 HIV-1-positive with combination antiretroviral therapy (cART), 9 HIV-1/HCV-positive naive, 15 HCV-positive naive and 18 normal subjects were enrolled in the study. The MRS examinations were performed with a 1.5T MR scanner. Voxels were located in the following regions: posterior cingulate gyrus (PCG), anterior cingulate gyrus (ACG), parietal white matter (PWM), left basal ganglia (BG) and frontal white matter (FWM). The NAA/Cr, Cho/Cr, mI/Cr ratios and correlations of MRS measurements with the immunologic data were analyzed. RESULTS There was a significant decrease (p<0.05) of the NAA/Cr ratios in PCG, ACG and PWM regions in HIV-1-positive cART treated patients compared to the normal subjects. The significantly decreased NAA/Cr ratios in PWM and FWM were observed in HCV infected patients. The subjects with HIV-1/HCV co-infection revealed significantly lower NAA/Cr ratios in the ACG area. Other metabolite ratios in all analyzed regions, as well as the NAA/Cr ratios in BG showed no significant differences. The decrease of CD4n T cell count was associated with the decease of the NAA/Cr ratio in the PCG area and the increase of Cho/Cr ratio in the FWM region. CONCLUSIONS The metabolic changes - reduction of NAA/Cr ratios are most pronounced in HIV-1-positive patients using cART. The low CD4n T cell count is a risk factor for neurocognitive impairment in HIV-1-positive patients.
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Affiliation(s)
- Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
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Neurocognitive deficits in patients with human immunodeficiency virus infection. HANDBOOK OF CLINICAL NEUROLOGY 2012. [PMID: 22608646 DOI: 10.1016/b978-0-444-52002-9.00035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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Sikk K, Kõks S, Soomets U, Schalkwyk LC, Fernandes C, Haldre S, Aquilonius SM, Taba P. Peripheral blood RNA expression profiling in illicit methcathinone users reveals effect on immune system. Front Genet 2012; 2:42. [PMID: 22303338 PMCID: PMC3268596 DOI: 10.3389/fgene.2011.00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/22/2011] [Indexed: 02/05/2023] Open
Abstract
Methcathinone (ephedrone) is relatively easily accessible for abuse. Its users develop an extrapyramidal syndrome and it is not known if this is caused by methcathinone itself, by side-ingredients (manganese), or both. In the present study we aimed to clarify molecular mechanisms underlying this condition. We used microarrays to analyze whole-genome gene expression patterns of peripheral blood from 20 methcathinone users and 20 matched controls. Gene expression profile data were analyzed by Bayesian modeling and functional annotation. Of 28,869 genes on the microarrays, 326 showed statistically significant differential expression with FDR adjusted p-values below 0.05. Quantitative real-time PCR confirmed differential expression for the most of the genes selected for validation. Functional annotation and network analysis indicated activation of a gene network that included immunological disease, cellular movement, and cardiovascular disease functions (enrichment score 42). As HIV and HCV infections were confounding factors, we performed additional stratification of subjects. A similar functional activation of the “immunological disease” category was evident when we compared subjects according to injection status (past versus current users, balanced for HIV and HCV infection). However, this difference was not large therefore the major effect was related to the HIV status of the subjects. Mn–methcathinone abusers have blood RNA expression patterns that mostly reflect their HIV and HCV infections.
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Affiliation(s)
- Katrin Sikk
- Department of Neurology and Neurosurgery, University of Tartu Tartu, Estonia
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Schuster RM, Gonzalez R. Substance Abuse, Hepatitis C, and Aging in HIV: Common Cofactors that Contribute to Neurobehavioral Disturbances. ACTA ACUST UNITED AC 2012; 2012:15-34. [PMID: 24014165 DOI: 10.2147/nbhiv.s17408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although the prevalence of neurocognitive disturbances among individuals with HIV has decreased in recent years, rates of impairment still remain high. This review presents findings from comorbid conditions that may contribute to further neurocognitive impairments in this already vulnerable population. We will focus on three co-factors that have received substantial attention in the neuroAIDS literature: drug use, hepatitis C co-infection (HCV), and aging. All three conditions commonly co-occur with HIV and likely interact with HIV in complex ways. Collectively, the extant literature suggests that drug use, HCV, and aging serve to worsen the neurocognitive profile of HIV through several overlapping mechanisms. A better understanding of how specific comorbidities interact with HIV may reveal specific phenotypes of HIV-associated neurocognitive disorder that may aid in the development of more targeted behavioral and pharmacological treatment efforts.
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Vivithanaporn P, Nelles K, DeBlock L, Newman SC, Gill MJ, Power C. Hepatitis C virus co-infection increases neurocognitive impairment severity and risk of death in treated HIV/AIDS. J Neurol Sci 2011; 312:45-51. [PMID: 21925684 DOI: 10.1016/j.jns.2011.08.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 06/17/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
Previous studies have reported that hepatitis C virus (HCV) co-infection worsens neurocognitive status among individuals with human immunodeficiency virus (HIV)-1 infection. We assessed the prevalence of neurologic disorders and the severity of HIV-associated neurocognitive impairment among HIV-infected individuals in two centralized HIV clinics in Alberta, Canada from 1998 to 2010 based on their HCV serostatus. Of 456 HIV-infected persons without concurrent substance abuse, 91 (20.0%) were HCV seropositive. Of 58 neurologic disorders identified in the cohort, HIV/HCV co-infected individuals exhibited a higher prevalence of multiple neurologic disorders compared to HIV-infected individuals (60.4% vs. 46.6%, p<0.05) and a higher frequency of seizures (28.6% vs. 17.8%, p<0.05). Unlike HIV mono-infected persons, the risk of seizures was independent of immune status in HIV/HCV co-infected individuals (p<0.05). Symptomatic HIV-associated neurocognitive disorders (sHAND) were more severe among HIV/HCV co-infected persons (p<0.05). HCV co-infection was associated with an increased mortality rate (24.2% vs. 14.5%, p<0.05) with a mortality hazard ratio of 2.38 after adjusting for demographic and clinical variables. Our results indicate that the presence of HCV co-infection among HIV-infected individuals increased neurologic disease burden and risk of death, underscoring HCV's capacity to affect the nervous system and survival of HIV-infected persons.
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Vivithanaporn P, Maingat F, Lin LT, Na H, Richardson CD, Agrawal B, Cohen ÉA, Jhamandas JH, Power C. Hepatitis C virus core protein induces neuroimmune activation and potentiates Human Immunodeficiency Virus-1 neurotoxicity. PLoS One 2010; 5:e12856. [PMID: 20877724 PMCID: PMC2943470 DOI: 10.1371/journal.pone.0012856] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 08/18/2010] [Indexed: 12/11/2022] Open
Abstract
Background Hepatitis C virus (HCV) genomes and proteins are present in human brain tissues although the impact of HIV/HCV co-infection on neuropathogenesis remains unclear. Herein, we investigate HCV infectivity and effects on neuronal survival and neuroinflammation in conjunction with HIV infection. Methodology Human microglia, astrocyte and neuron cultures were infected with cell culture-derived HCV or exposed to HCV core protein with or without HIV-1 infection or HIV-1 Viral Protein R (Vpr) exposure. Host immune gene expression and cell viability were measured. Patch-clamp studies of human neurons were performed in the presence or absence of HCV core protein. Neurobehavioral performance and neuropathology were examined in HIV-1 Vpr-transgenic mice in which stereotaxic intrastriatal implants of HCV core protein were performed. Principal Findings HCV-encoded RNA as well as HCV core and non-structural 3 (NS3) proteins were detectable in human microglia and astrocytes infected with HCV. HCV core protein exposure induced expression of pro-inflammatory cytokines including interleukin-1β, interleukin-6 and tumor necrosis factor-α in microglia (p<0.05) but not in astrocytes while increased chemokine (e.g. CXCL10 and interleukin-8) expression was observed in both microglia and astrocytes (p<0.05). HCV core protein modulated neuronal membrane currents and reduced both β-III-tubulin and lipidated LC3-II expression (p<0.05). Neurons exposed to supernatants from HCV core-activated microglia exhibited reduced β-III-tubulin expression (p<0.05). HCV core protein neurotoxicity and interleukin-6 induction were potentiated by HIV-1 Vpr protein (p<0.05). HIV-1 Vpr transgenic mice implanted with HCV core protein showed gliosis, reduced neuronal counts together with diminished LC3 immunoreactivity. HCV core-implanted animals displayed neurobehavioral deficits at days 7 and 14 post-implantation (p<0.05). Conclusions HCV core protein exposure caused neuronal injury through suppression of neuronal autophagy in addition to neuroimmune activation. The additive neurotoxic effects of HCV- and HIV-encoded proteins highlight extrahepatic mechanisms by which HCV infection worsens the disease course of HIV infection.
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Affiliation(s)
- Pornpun Vivithanaporn
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Ferdinand Maingat
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Liang-Tzung Lin
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hong Na
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Babita Agrawal
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Éric A. Cohen
- Institut de recherches cliniques de Montréal (IRCM) and Department of Microbiology and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Jack H. Jhamandas
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Power
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Cherry CL, Affandi JS, Brew BJ, Creighton J, Djauzi S, Hooker DJ, Imran D, Kamarulzaman A, Kamerman P, McArthur JC, Moore RD, Price P, Smyth K, Tan IL, Vanar S, Wadley A, Wesselingh SL, Yunihastuti E. Hepatitis C seropositivity is not a risk factor for sensory neuropathy among patients with HIV. Neurology 2010; 74:1538-42. [PMID: 20458071 DOI: 10.1212/wnl.0b013e3181dd436d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sensory neuropathy (SN) is common in patients with HIV. Hepatitis C (HCV) coinfection is often cited as an HIV-SN risk factor, but data to support this are lacking. This collaboration aimed to examine the association between HCV serostatus and SN risk among ambulatory HIV-positive patients. METHODS Patients with HIV were assessed in cross-sectional studies in Baltimore, Jakarta, Johannesburg, Kuala Lumpur, Melbourne, and Sydney for SN (defined by both supportive symptoms and signs). HCV seropositivity was assessed as an SN risk using a chi(2) test, followed by logistic regression modeling to correct for treatment exposures and demographics. RESULTS A total of 837 patients of African, Asian, and Caucasian descent were studied. HCV seroprevalence varied by site (Baltimore n = 104, 61% HCV+; Jakarta 96, 51%; Johannesburg 300, 1%; Kuala Lumpur 97, 10%; Melbourne 206, 16%; Sydney 34, 18%). HCV seropositivity was not associated with increased SN risk at any site, but was associated with reduced SN risk in Melbourne (p = 0.003). On multivariate analyses, the independent associations with SN were increasing age, height, and stavudine exposure. HCV seropositivity was not independently associated with an increased SN risk at any site, but associated independently with reduced SN risk in Baltimore (p = 0.04) and Melbourne (p = 0.06). CONCLUSIONS Hepatitis C (HCV) seropositivity was not associated with increased sensory neuropathy risk among HIV-positive patients at any site. While we were unable to assess HCV RNA or liver damage, the data suggest that HCV coinfection is not a major contributor to HIV-SN. HCV = hepatitis C; SN = sensory neuropathy.
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Affiliation(s)
- C L Cherry
- The Alfred Hospital, Melbourne, Victoria 3004, Australia.
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Ho EL, Jay CA. Altered Mental Status in HIV-Infected Patients. Emerg Med Clin North Am 2010; 28:311-23, Table of Contents. [DOI: 10.1016/j.emc.2010.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hightower GK, Letendre SL, Cherner M, Gibson SA, Ellis RJ, Wolfson TJ, Gamst AC, Ignacio CC, Heaton RK, Grant I, Richman DD, Smith DM. Select resistance-associated mutations in blood are associated with lower CSF viral loads and better neuropsychological performance. Virology 2009; 394:243-8. [PMID: 19762060 DOI: 10.1016/j.virol.2009.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 06/10/2009] [Accepted: 08/04/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND When antiretroviral therapy does not fully suppress HIV replication, suboptimal levels of antiretrovirals can select for antiretroviral resistant variants of HIV. These variants may exhibit reduced replication capacity and result in lower viral loads in blood. Our study evaluated whether antiretroviral resistance was associated with viral loads in the cerebrospinal fluid (CSF) and better neuropsychological (NP) performance. METHODS We enrolled 94 participants and each participant underwent a comprehensive neuromedical evaluation that used structured clinical assessments of medical history, ART and other medication use, comprehensive NP testing, and neurological and general physical signs of disease. Blood was collected by venipuncture, and all participants were offered lumbar puncture. Univariate and multivariate statistical methods were used to analyze the relationship between antiretroviral resistance, blood and CSF HIV RNA levels, substance use, and NP performance. RESULTS Antiretroviral resistance, detected in blood, was associated with lower CSF viral loads (p<0.01) and better NP performance (p=0.04) in multivariate analyses, independent of past and current ARV use and blood viral loads (model: p<0.01). However, HIV RNA levels in CSF did not independently correlate with NP performance. Low viral loads in the CSF limited our ability to investigate the relationship between antiretroviral resistance detected in CSF and NP performance. CONCLUSIONS Even in the absence of ART, antiretroviral resistance-associated mutations correlate with better NP performance possibly because these mutations reflect reduced neurovirulence compared with wild-type HIV.
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Norman LR, Basso M, Kumar A, Malow R. Neuropsychological consequences of HIV and substance abuse: a literature review and implications for treatment and future research. CURRENT DRUG ABUSE REVIEWS 2009; 2:143-56. [PMID: 19630745 PMCID: PMC6167747 DOI: 10.2174/1874473710902020143] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neuropsychological dysfunction, ranging from mild cognitive symptoms to dementia has been a consistent part of the clinical picture of HIV/AIDS. However, advances in clinical management, particularly antiretroviral (ARV) treatment, have mitigated the neuropsychological effects of HIV and revised the pattern and nature of cognitive deficits, which are observed in HIV-infected individuals. The attendant improvements in mortality and morbidity have led to a need for programs and interventions that sustain healthy behavior and prevent a resurgence of HIV transmission risk. Psychiatric risk factors, particularly substance use, which often contribute to initial acquisition of HIV, still require attention. These risk factors may also exacerbate neuropsychological dysfunction and compromise adherence to prevention recommendations and treatment. Specifically, a more complete understanding of the effects of substance abuse on the progression of HIV related cognitive decline can inform evaluation and management of HIV seropositives with concurrent substance use disorders. This review provides an overview of the neuropsychology of HIV and substance abuse and the extant research that has examined the effects of both HIV disease and substance use on neuropsychological functioning and implications for treatment and future research.
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Affiliation(s)
- Lisa R Norman
- AIDS Research Program, Ponce School of Medicine, Ponce, PR 00732.
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15
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Ances BM, Clifford DB. HIV-associated neurocognitive disorders and the impact of combination antiretroviral therapies. Curr Neurol Neurosci Rep 2008; 8:455-61. [PMID: 18957181 DOI: 10.1007/s11910-008-0073-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) are the most common preventable and treatable cause of dementia. While the incidence of the most severe form of HAND, HIV-associated dementia, has decreased since the introduction of combination antiretroviral therapy (cART), the prevalence of less severe forms of HAND has continued to rise. HAND leads to a subcortical dementia consisting of a triad of cognitive, behavior, and motor dysfunction. No single laboratory test can establish HAND, but ancillary studies including neuropsychological testing, neuroimaging studies, and cerebrospinal fluid (CSF) analysis are useful for supporting or refuting the diagnosis. More recent evidence has suggested that higher central nervous system-penetrating cART may lead to greater suppression of CSF HIV viral loads and improved cognition. Because viral control generally has been successful without eliminating cognitive dysfunction, further clinical studies that assess adjunctive neuroprotective drugs are likely to be required.
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Affiliation(s)
- Beau M Ances
- Department of Neurology, University of Washington, St. Louis, MO 63130, USA
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Gonzalez R, Cherner M. Co-factors in HIV neurobehavioural disturbances: substance abuse, hepatitis C and aging. Int Rev Psychiatry 2008; 20:49-60. [PMID: 18240062 DOI: 10.1080/09540260701872028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neurocognitive disturbances associated with HIV infection may be modulated or confounded by coexisting and comorbid conditions that reflect the changing populations affected by the disease. HIV infection is often accompanied by substance dependence and/or hepatitis C co-infection. Both of these cofactors that may lead to brain dysfunction on their own, and therefore can affect the nature and course neurocognitive functioning in HIV. Improvements in antiretroviral therapies translate into greater longevity for people infected with HIV, many of whom are now entering their 6th and 7th decade of life and beyond. The increasing proportion of older persons with HIV is also the result of new infections in this age group. As aging confers additional metabolic, neurologic, and neuropsychiatric vulnerability, it is important to understand how this constellation of changes affects neurocognitive functioning in the context of HIV.
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Affiliation(s)
- Raul Gonzalez
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
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Asif G, Hurwitz SJ, Shi J, Hernandez-Santiago BI, Schinazi RF. Pharmacokinetics of the antiviral agent beta-D-2'-deoxy-2'-fluoro-2'-C-methylcytidine in rhesus monkeys. Antimicrob Agents Chemother 2007; 51:2877-82. [PMID: 17562805 PMCID: PMC1932527 DOI: 10.1128/aac.00193-07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
beta-D-2'-Deoxy-2'-fluoro-2'-C-methylcytidine (PSI-6130) is an effective inhibitor of hepatitis C virus (HCV) replication in vitro. The purpose of this study was to evaluate the single-dose pharmacokinetics of PSIota-6130 in rhesus monkeys following intravenous (i.v.) and oral administration. Noncompartmental analysis of the serum data obtained following oral and i.v. administration was performed. Pharmacokinetic studies with rhesus monkeys indicated slow and incomplete absorption with a mean absorption time (MAT) of 4.6 h and an oral bioavailability of 24.0% +/- 14.3% (mean +/- standard deviation), with comparable mean apparent half-lives following i.v. (4.54 +/- 3.98 h) and oral (5.64 +/- 1.13 h) administrations. The average percentages of the total dose recovered unchanged and in deaminated form in the urine were 32.9% +/- 12.6% and 18.9% +/- 6.6% (i.v.) and 6.0% +/- 3.9% and 3.9% +/- 1.0% (oral), respectively. The total bioavailability, taking into account the parent drug and its deaminated metabolite 2'-deoxy-2'-fluoro-2'-C-methyluridine (PSI-6206), was 64% +/- 26%. PSI-6130 was present in the cerebrospinal fluid after oral and i.v. dosing. However, no deamination of radiolabeled PSI-6130 was detected after 8 h of incubation in monkey and human whole blood. An N(4)-modified prodrug of PSI-6130 (PSI-6419) was orally administered to monkeys, but it failed to improve the oral bioavailability of PSI-6130. Further studies are warranted to improve the oral bioavailability and reduce the deamination of PSI-6130 in order to explore the potential of this drug for the treatment of HCV-infected individuals.
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Affiliation(s)
- Ghazia Asif
- Veterans Affairs Medical Center, Medical Research 151H, Decatur, GA 30033, USA
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Cinque P, Robertson K, Antinori A, Price RW. Neurological complications of HIV infection and AIDS: Current and future perspectives. J Neurovirol 2005; 11 Suppl 3:1-5. [PMID: 16540446 DOI: 10.1080/13550280600558923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Paola Cinque
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
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