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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O’Cleirigh C, Thomas KGF, Joska JA. Sex Differences in the Cognitive Performance of a South African Cohort of People With HIV and Comorbid Major Depressive Disorder. J Int Assoc Provid AIDS Care 2023; 22:23259582231203192. [PMID: 37787183 PMCID: PMC10548808 DOI: 10.1177/23259582231203192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
Women with HIV (WWH) may be more vulnerable to cognitive impairment than men with HIV (MWH), which may be explained by the direct effects of HIV or by sociodemographic and psychiatric characteristics. We recruited 105 people with HIV (PWH; 76 women) with incomplete antiretroviral therapy adherence, comorbid major depressive disorder, and socioeconomically disadvantaged backgrounds. Participants completed neuropsychological testing and measures gathering sociodemographic, medical, and psychiatric information. We compared WWH and MWH cognitive performance using unadjusted and adjusted regressions, and within each respective group, we explored predictors of cognitive performance. Results showed no significant between-sex differences in cognitive performance, both globally and within domains. Fewer years of education (β = 0.94), illiteracy (β = 4.55), and greater food insecurity (β = -0.28) predicted lower cognitive performance in WWH but not MWH. We conclude that sex differences in PWH are likely due to sample characteristics representing broader inequalities, rather than true biological differences.
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Affiliation(s)
- Anna J. Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - Jasper S. Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Hetta Gouse
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, , Coral Gables, FL, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - Kevin G. F. Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
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Dreyer AJ, Munsami A, Williams T, Andersen LS, Nightingale S, Gouse H, Joska J, Thomas KGF. Cognitive Differences between Men and Women with HIV: A Systematic Review and Meta-Analysis. Arch Clin Neuropsychol 2021; 37:479-496. [PMID: 34417599 DOI: 10.1093/arclin/acab068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Although many studies report that women with HIV (WWH) are more vulnerable to cognitive impairment than men with HIV (MWH), this trend is not described consistently in the literature. In this systematic review and meta-analysis, we investigated whether the weight of evidence supports the existence of a significant sex difference in cognitive functioning among people with HIV and, if so, whether specific domains are affected. METHOD A systematic literature search retrieved 4,062 unique articles published between January 2000 and June 2019. Eligibility criteria were that studies directly compared adult WWH and MWH using a neuropsychological test battery. After extensive screening, we included 11 studies in the systematic review (N = 3,333) and 6 in the meta-analysis (N = 2,852). RESULTS Six studies included in the systematic review found WWH performed significantly more poorly on measures of cognitive performance than MWH; the other five found no sex differences. Meta-analytic results indicated that WWH performed significantly more poorly than MWH in three cognitive domains (psychomotor coordination, visuospatial learning, and memory), but magnitudes of effect sizes were small (d = -.16, -.43, and - .30, respectively). Analyses detected no sex differences in global cognitive functioning and in the other cognitive domains. CONCLUSIONS Sex differences in cognitive performance are small, and sociodemographic and psychiatric characteristics of WWH and MWH differ between studies. Cognitive differences between WWH and MWH may be explained by sex-based variation in these characteristics, the impact of which seems to outweigh that of HIV-related clinical variables (e.g., CD4 count and viral load).
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Affiliation(s)
- Anna J Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Adele Munsami
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Taryn Williams
- Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kevin G F Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
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Müller-Oehring EM, Fama R, Levine TF, Hardcastle C, Goodcase R, Martin T, Prabhakar V, Brontë-Stewart HM, Poston KL, Sullivan EV, Schulte T. Cognitive and motor deficits in older adults with HIV infection: Comparison with normal ageing and Parkinson's disease. J Neuropsychol 2020; 15:253-273. [PMID: 33029951 DOI: 10.1111/jnp.12227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/10/2020] [Indexed: 12/24/2022]
Abstract
Despite the life-extending success of antiretroviral pharmacotherapy in HIV infection (HIV), the prevalence of mild cognitive impairment in HIV remains high. Near-normal life expectancy invokes an emerging role for age-infection interaction and a potential synergy between immunosenescence and HIV-related health factors, increasing risk of cognitive and motor impairment associated with degradation in corticostriatal circuits. These neural systems are also compromised in Parkinson's disease (PD), which could help model the cognitive deficit pattern in HIV. This cross-sectional study examined three groups, age 45-79 years: 42 HIV, 41 PD, and 37 control (CTRL) participants, tested at Stanford University Medical School and SRI International. Neuropsychological tests assessed executive function (EF), information processing speed (IPS), episodic memory (MEM), visuospatial processing (VSP), and upper motor (MOT) speed and dexterity. The HIV and PD deficit profiles were similar for EF, MEM, and VSP. Although only the PD group was impaired on MOT compared with CTRL, MOT scores were related to cognitive scores in HIV but not PD. Performance was not related to depressive symptoms, socioeconomic status, or CD4+ T-cell counts. The overlap of HIV-PD cognitive deficits implicates frontostriatal disruption in both conditions. The motor-cognitive score relation in HIV provides further support for the hypothesis that these processes share similar underlying mechanisms in HIV infection possibly expressed with or exacerbated by ageing.
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Affiliation(s)
- Eva M Müller-Oehring
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA.,Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Rosemary Fama
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA.,Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Taylor F Levine
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA
| | - Cheshire Hardcastle
- Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Ryan Goodcase
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA
| | - Talora Martin
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA
| | - Varsha Prabhakar
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA
| | - Helen M Brontë-Stewart
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA.,Neurosurgery, Stanford University School of Medicine, California, USA
| | - Kathleen L Poston
- Neurology and Neurological Sciences, Stanford University School of Medicine, California, USA.,Neurosurgery, Stanford University School of Medicine, California, USA
| | - Edith V Sullivan
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA
| | - Tilman Schulte
- Neuroscience Program, Bioscience Division, Center for Health Sciences, SRI International, Menlo Park, California, USA.,Clinical Psychology, Palo Alto University, California, USA
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Sumonu T, Imarhiagbe F, Owolabi L, Ogunrin O, Komolafe M, Ilesanmi O. Cognitive functions in newly diagnosed patients with HIV infection in a tertiary health facility: Assessment using community screening interview for dementia. eNeurologicalSci 2017; 9:8-13. [PMID: 29260041 PMCID: PMC5731538 DOI: 10.1016/j.ensci.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/15/2017] [Accepted: 10/20/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Neurocognitive dysfunction is a detrimental complication of HIV infection. In this study we attempt to characterize the pattern of cognitive dysfunction in a sample of Nigerian patients with newly diagnosed HIV infection. METHODS We conducted a prospective study in which 50 patients with newly diagnosed HIV infection were studied along with 50 normal control subjects. The participants were evaluated with the medical history, general, physical and neurological examination. Laboratory evaluation and chest X-Ray were done for all patients. The Community Screening Interview for Dementia (CSID) questionnaire was administered to all the study participants. RESULTS About 70% of the patients were in advanced disease stage. The mean age (SD) of the patients and controls in years were 36.44 ± 8.22 and 35.40 ± 11.53 respectively. More than half (56%) of the patients had secondary level of education (12 years of education). About 20% of the patients had severe neurocognitive impairment while 48% had minor neurocognitive disorder. The patients with HIV infection performed poorly in the domains of language, memory, orientation, attention/calculation and praxis relative to controls (p < 0.05).There were no significant effect of gender, age, sex and level of education on cognitive functions in the patients (p > 0.05) but the presence of opportunistic infections had negative impact on the performances on orientation and total CSID scores in the patients with HIV infection (p < 0.05). CONCLUSION Patients with newly diagnosed HIV infection have poor cognitive functions when compared to normal controls and some presence of opportunistic infections in the patient is a significant risk factor for cognitive impairment.
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Affiliation(s)
- T.A. Sumonu
- Neurology Unit, Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - F. Imarhiagbe
- Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - L.F. Owolabi
- Neurology Unit, Department of Medicine, Aminu kano Teaching Hospital, Kano, Kano State, Nigeria
| | - O.A. Ogunrin
- Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - M.A. Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University, Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - O.S. Ilesanmi
- Department of Community Health, Federal Medical Centre, Owo, Ondo State, Nigeria
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Steenkamp L, Goosen A, Venter D, Beeforth M. Food insecurity among students living with HIV: Strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa. SAHARA J 2016; 13:106-112. [PMID: 27687153 PMCID: PMC5642430 DOI: 10.1080/17290376.2016.1218791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The HIV prevalence in South Africa among students at higher education institutions (HEIs) in 2008 was reported to be 3.4%, with the highest HIV prevalence found in the Eastern Cape Province. Students at these facilities are also increasingly affected by socio-economic constraints that may impact on food security. Little is known about the impact of food insecurity on HIV-infected students in HEIs in South Africa. The purpose of this paper is to describe food insecurity and the nutritional status among HIV-infected students on the Nelson Mandela Metropolitan University campuses in South Africa, as well as current initiatives to strengthen the safety nets for food-insecure students. This descriptive, cross-sectional survey was conducted among a convenience sample of known HIV-infected, registered students (n = 63), older than 18 years of age and managed as part of the Campus Health Service antiretroviral therapy (ART) programme. Ethical approval for the study was obtained from the Research Ethics Committee (NMMU) and participants were included in the sample after providing written, informed consent. Findings indicate that food insecurity was common with more than 60% of the sample reporting food insecurity at the household level during the previous month. Of the sample, 51% were classified as being either overweight or obese. Although food insecurity did not contribute to weight loss in our sample, food-insecure students were more likely to consume inadequate amounts of vitamins and minerals, especially antioxidants that are important in supporting the immune system. Food insecurity has been identified as affecting the majority of HIV-infected students in this study, especially regarding their difficulty in accessing nutritious foods. As overweight and obesity also seem to threaten the health and future well-being of the students, appropriate management of the overweight individuals and those with obesity should be instituted in order to prevent the development of chronic diseases of lifestyle, thus allowing for a healthier more productive life. Current intervention strategies to strengthen food security have made inroads to improve access to healthier food options.
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Affiliation(s)
- L. Steenkamp
- PhD (Dietetics), is a Research Associate at the HIV&AIDS Research Unit, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - A. Goosen
- MCur (Advanced Primary Health Care), is a Head of Department at the Campus Health Service, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - D. Venter
- PhD, is a Statistical Consultant at the Unit for Statistical Consultation at the Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - M. Beeforth
- BSc Dietetics, is a Postgraduate Student at the Department of Dietetics, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
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Sunmonu TA, A.Ogunrin O, Imarhiagbe FA, Owolabi LF, Komolafe MA, llesanmi OS. Cognitive function in patients with newly diagnosed HIV infection in a tertiary health facility in south - west Nigeria: Assessment using computer-assisted neuropsychological test battery. eNeurologicalSci 2016; 3:54-59. [PMID: 29430537 PMCID: PMC5803067 DOI: 10.1016/j.ensci.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/15/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cognitive dysfunction is common among patients with human immunodeficiency virus (HIV) infection however there are few reports from sub-Saharan Africa. METHODS We studied fifty seropositive patients with human immunodeficiency virus (HIV) infection along with fifty matched seronegative control. Medical history taking and general physical and neurological examinations were done for all study participants. Laboratory evaluations and chest X-ray were done for all the patients. The cognitive function was done with the aid of 'Fepsy' automated test battery for all the study participants. The data was analyzed with statistical package for social sciences software version 21.0 (SPSS Chicago IL). RESULT About 70% of the HIV patients were in advanced disease stage. The auditory and visual reaction times, binary choice reaction times, and computerized visual scanning task time were more prolonged in the HIV group (p < 0.05). There were also increased memory accuracy and binary choice task accuracy in the HIV group (p < 0.05). However the vigilance task performance was similar between the two groups (p > 0.05). Among the patients with HIV infection, the presence of anemia and central nervous system toxoplasmosis infection was associated with prolonged auditory and visual reaction times. CONCLUSION There was a high rate of cognitive dysfunction in patients with HIV infection in this study.
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Affiliation(s)
- Taofiki A. Sunmonu
- Neurology Unit, Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Olubunmi A.Ogunrin
- Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Frank A. Imarhiagbe
- Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Aminu Kano University teaching Hospital, Kano, Nigeria
| | - Morenikeji A. Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-ife, Osun State, Nigeria
| | - Olayinka S. llesanmi
- Department of Community Health, Federal Medical Centre, Owo, Ondo State, Nigeria
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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.
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Applebaum AJ, Reilly LC, Gonzalez JS, Richardson MA, Leveroni CL, Safren SA. The impact of neuropsychological functioning on adherence to HAART in HIV-infected substance abuse patients. AIDS Patient Care STDS 2009; 23:455-62. [PMID: 19519229 DOI: 10.1089/apc.2008.0181] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study assessed the frequency of neuropsychological impairment and its relationship to adherence in a sample of HIV-infected injection drug users (IDUs) in treatment. One hundred eight participants recruited between September 2006 and October 2008 completed psychodiagnostic and neuropsychological assessments and monitored HAART adherence over a 2-week period via the use of Medication Event Monitoring System (MEMS) electronic pill caps and self-report. Assessment of concurrent functioning included clinician-rated scales of depression and substance use severity, and a battery of neuropsychological tests. Findings from individual neuropsychological tests were converted to Z scores relative to standard norms and averaged to form a composite score (NPZ). NPZ was generally poor (mean = -1.505, standard deviation = 1.120), with 76.9% of the sample being classified as highly impaired. Self-reported adherence was significantly higher than MEMS cap adherence. In contrast with previous studies, overall neuropsychological functioning was not a significant predictor of electronically monitored or self-reported adherence. However, examiner-rated current global severity of substance use and delayed word list recall emerged as significant predictors of self-reported adherence. Additionally, estimated premorbid verbal intelligence emerged as a significant predictor of the discrepancy between electronically monitored and self-reported adherence. Given the extent of neuropsychological impairment in this sample, future studies should examine the degree to which the impact of neuropsychological impairment may moderate interventions for this population, and the extent to which skills to cope with neuropsychological problems may boost the potential efficacy of such interventions.
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Affiliation(s)
- Allison J. Applebaum
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychology, Boston University, Boston, Massachusetts
| | - Laura C. Reilly
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey S. Gonzalez
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Yeshiva University, Bronx, New York
| | - Mark A. Richardson
- Department of Psychology, Boston University, Boston, Massachusetts
- Division of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Catherine L. Leveroni
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Steven A. Safren
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Huang JS, Letendre S, Marquie-Beck J, Cherner M, McCutchan JA, Grant I, Ellis R. Low CSF leptin levels are associated with worse learning and memory performance in HIV-infected men. J Neuroimmune Pharmacol 2007; 2:352-8. [PMID: 18040853 DOI: 10.1007/s11481-007-9093-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The main objective of this study was to investigate the association between human CSF leptin levels and neuropsychological (NP) performance in the setting of HIV infection. We hypothesized that human CSF leptin levels positively correlate with NP performance. BACKGROUND Leptin is an adipocyte-derived hormone that influences brain development and function, particularly learning and memory, in the mouse model. The extent to which leptin contributes to neurocognitive functioning in humans is less clear. METHOD A cross-sectional evaluation of CSF leptin and NP performance was performed. Leptin levels in CSF and serum samples from 59 HIV-positive men were measured by ELISA. Comprehensive, standardized NP testing was used to determine impairment status in global and specific domains. RESULTS Lower CSF leptin levels and reduced leptin uptake into the central nervous system (CNS) correlated with impaired learning and memory performance in both univariate and multivariate analyses. In multivariate analyses, lower CSF leptin levels and reduced CNS leptin uptake were associated with worse NP performance in learning and memory, adjusting for CD4 nadir, antiretroviral treatment exposure, and HIV RNA levels in CSF. CONCLUSIONS Low CSF leptin levels are associated with poorer performance in learning and memory among HIV-infected men adjusting for usual predictors of HIV-associated neurocognitive impairment. This association is consistent with prior in vitro and animal data suggesting leptin has a trophic or facilitatory role in the hippocampus, above and beyond its role in hypothalamic regulation.
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Affiliation(s)
- J S Huang
- Department of Pediatrics, University of California, San Diego, USA.
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Villamor E, Saathoff E, Msamanga G, O'Brien ME, Manji K, Fawzi WW. Wasting during pregnancy increases the risk of mother-to-child HIV-1 transmission. J Acquir Immune Defic Syndr 2005; 38:622-6. [PMID: 15793376 DOI: 10.1097/01.qai.0000143601.48986.47] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine whether wasting during pregnancy, as measured by weight loss and low weight gain, is associated with increased mother-to-child transmission (MTCT) of HIV-1. METHODS This was a cohort study in Dar es Salaam, Tanzania, among 957 HIV-1-infected pregnant women. Weight was measured at the first prenatal visit and every month thereafter until delivery. Weight loss was defined as a weekly rate of weight gain </=0 and low weight gain as a weekly rate >0 and </=166 g/wk. The incidences of presumptive intrauterine transmission (HIV status at birth) and presumptive intrapartum and early breast-feeding transmission (HIV status at 6 weeks) were examined in relation to baseline anthropometric characteristics and weight change during pregnancy using 2xn tables and multivariable binomial regression. RESULTS Compared with women who gained >/=167 g/wk, weight loss during pregnancy was related to higher risk of intrauterine MTCT (adjusted relative risk [RR] = 2.32, 95% CI = 1.23-4.36, P = 0.009), HIV positive at birth or fetal death (RR = 2.13, 95% CI = 1.40-3.24, P = 0.0004), and HIV positive at birth or early neonatal death (RR = 1.96, 95% CI = 1.26-3.07, P = 0.003). The rate of weight gain during the 3rd trimester was inversely related to the risk of intrapartum/early breast-feeding transmission (adjusted P value, test for trend = 0.05). CONCLUSIONS Weight loss during pregnancy increases the risk of early MTCT. Identifying causes of wasting during pregnancy may provide clues for new strategies to prevent MTCT.
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Affiliation(s)
- Eduardo Villamor
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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