HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study

Cognitive function and mortality among persons aging with HIV and injection drug use

OBJECTIVE

Cognitive impairment and frailty are critical, aging-related phenotypes prevalent among people with HIV (PWH). Yet, limited data exist isolating the determinants of cognitive function among persons with a history of injection drug use (PWID) with and at risk for HIV, or on the intersecting relationship of cognitive function and frailty with mortality in this population.

DESIGN/METHODS

Standard cognitive assessments were performed among PWID with and without HIV in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort. Frailty was assessed using the five Fried physical frailty phenotype criteria. An inflammatory index score was constructed from IL-6 and soluble TNF-α receptor-1 data. Cox proportional hazards models were utilized to estimate mortality risk.

RESULTS

Among 516 ALIVE participants, the median age was 52 years, and 41% were PWH. Hazardous alcohol use and older age were significantly associated with reductions in processing speed, motor function, and global cognitive function. In multivariable models, reduced processing speed, motor function, and global cognitive function were significantly associated with increased mortality. Reduced global cognitive function and frailty were independently associated with mortality. Reduced processing speed, motor function, executive function, and global cognitive function were significantly associated with heightened inflammation.

CONCLUSION

Reduced cognitive function is a significant predictor of death among PWH and PWID, independent of frailty, HIV disease stage, and comorbidity. Interventions that target both cognitive function and frailty, including those targeting inflammation pathways, among PWH and PWID may improve aging outcomes for these populations.

The Role of Nutrition in HIV-Associated Neurocognitive Disorders: Mechanisms, Risks, and Interventions

HIV-associated neurocognitive disorders (HANDs) refer to a range of cognitive deficits that afflict people living with the Human Immunodeficiency Virus (HIV). The fundamental processes of HAND include persistent inflammation, immunological activation, and direct viral impact on the central nervous system. Emerging research shows that nutritional status, especially food consumption and body weight, is critical in determining the course and severity of HAND. Malnutrition exacerbates neurocognitive impairment by increasing inflammation and oxidative stress, while obesity may contribute to HAND through the promotion of metabolic disruption, gut microbiota alterations, and systemic inflammation. Additionally, the introduction of antiretroviral treatment (ART) has substantially enhanced the prognosis of people living with HIV by lowering viral load and improving immune function. However, depending on the regimen, ART can cause changes in body weight, which may influence the progression of HAND. This emphasizes the intricate interplay between HIV, nutrition, body weight, and neurocognitive health. As a result, various dietary approaches are currently being investigated to improve the quality of life of individuals with HIV and possibly help prevent neurocognitive decline in this population. This review aims to elucidate the relationship between nutrition and neurocognitive function in individuals living with HIV, shedding light on aspects of HANDs related to diet, body weight fluctuations, and metabolic syndrome. It explores the shift from current pharmacological treatments to innovative non-pharmacological interventions, including specific dietary strategies, to support overall health and cognitive well being in HIV-positive people.

Analysis of dynamic network reconfiguration in HIV patients with cognitive impairment based multilayer network

Approximately half of HIV patients continue to experience HIV-associated neurocognitive disorders (HAND). Our study aims to evaluate changes in the dynamic activity patterns of functional brain communities in the early stages of HIV infection by comparing time-varying multilayer network metrics. A total of 165 persons living with HIV but without neurocognitive disorders (PWND), 173 individuals with asymptomatic neurocognitive impairment (ANI), and 100 matched healthy controls (HC) were enrolled. A time-varying multilayer network model was constructed, and global modularity (Q value) and nodal flexibility were calculated using different parameter settings (γ = [0.9, 1, 1.1], ω = [0.5, 0.75, 1]). Brain functional alterations in the PWND and ANI groups were evaluated from both global and nodal perspectives. Associations between network measures, clinical variables, and cognitive performance were also explored. Using the full connectivity matrix, no significant differences in global modularity (Q value) were found among the three groups. However, when thresholding the matrix to retain the top 10% of strongest connections, the ANI group showed significantly lower modularity than the HC group across all γ and ω combinations (p < 0.05). At γ = 0.9 and ω = 0.5, reduced nodal flexibility was observed in visual network regions in the PWND group, while the ANI group showed reduced flexibility in regions belonging to the default mode network (DMN), sensorimotor network (SMN), and limbic network (LIM). At γ = 0.9 and ω = 1, the ANI group exhibited increased flexibility in DMN regions compared to HC. Additionally, thresholding the top 10% connections revealed increased flexibility in the right lingual gyrus (visual network) in ANI compared to HC (FDR corrected, p < 0.05). Nodal flexibility was positively correlated with neurocognitive performance in the PWND group, whereas a significant negative correlation was observed in the ANI group. Regardless of cognitive impairment, HIV patients exhibit abnormalities in dynamic community structures. These findings provide new insights and perspectives for the early detection of brain damage, advancing our current understanding of time-varying multilayer networks in HIV patients.

Neurocognitive risks of asthma during childhood

The impact of chronic medical conditions on the developing brain has gained recent attention, but the neurocognitive risks associated with asthma, which has high prevalence in childhood, are still largely unknown. Recent findings have underscored that children with asthma may be at higher risk for developing cognitive difficulties. In this review, we examine the pathophysiology of asthma and its associations with brain and cognitive development based on rodent models and relatively scant research in humans. We also examine risk factors that may exacerbate asthma symptoms and neurocognitive outcomes, and we discuss why children may be particularly vulnerable to asthma-related neurocognitive consequences. We conclude by providing a framework for future research.

Neuroinflammation: An Oligodendrocentric View

Chronic neuroinflammation, driven by central nervous system (CNS)-resident astrocytes and microglia, as well as infiltration of the peripheral immune system, is an important pathologic mechanism across a range of neurologic diseases. For decades, research focused almost exclusively on how neuroinflammation impacted neuronal function; however, there is accumulating evidence that injury to the oligodendrocyte lineage is an important component for both pathologic and clinical outcomes. While oligodendrocytes are able to undergo an endogenous repair process known as remyelination, this process becomes inefficient and usually fails in the presence of sustained inflammation. The present review focuses on our current knowledge regarding activation of the innate and adaptive immune systems in the chronic demyelinating disease, multiple sclerosis, and provides evidence that sustained neuroinflammation in other neurologic conditions, such as perinatal white matter injury, traumatic brain injury, and viral infections, converges on oligodendrocyte injury. Lastly, the therapeutic potential of targeting the impact of inflammation on the oligodendrocyte lineage in these diseases is discussed.

Cerebrospinal fluid biomarkers of inflammation and immune activation associated with neurocognitive impairment among US Latinos with HIV

OBJECTIVE

Examine the association between markers of inflammation in the cerebrospinal fluid (CSF) and neurocognitive impairment (NCI) among diverse persons with HIV (PWH).

BACKGROUND

Latino PWH are at higher risk for NCI than non-Latino White PWH (NLW). Evidence of inflammation in CSF can be higher among racial and ethnic minority PWH and has been linked to NCI.

METHODS

We performed a retrospective cross-sectional analysis of 363 PWH who identified as Latinos or NLW. Neurocognitive performance was measured by a comprehensive battery. A focused panel of biomarkers [interleukin-6 (IL-6), soluble CD14 (sCD14), interferon-γ-inducible protein-10 (IP-10), neurofilament light chain (NFL)] was measured in CSF by immunoassay. Covariates included demographic, HIV disease, medical, psychiatric, and substance use characteristics.

RESULTS

The cohort consisted of 126 Latinos and 237 NLW (age: M  = 42.5, SD  = 11.0, 88% male, 51.5% AIDS history; 64% on antiretroviral therapy). Latinos had significantly higher NFL levels than NLW ( P  < 0.0001, adjusted Cohen's d 1.15), but not among virally-suppressed PWH. In the entire cohort, higher sCD14 was associated with NCI (adjusted odds ratio (aOR) = 2.6, confidence interval (CI) = 1.1-6.5] after adjusting for statistically significant covariates.

CONCLUSIONS

We did not identify a relationship between ethnicity, inflammation and NCI in this cohort. Future studies might examine sociocultural factors leading to increased inflammation in the CSF in diverse PWH.

Improving Cognitive and Psychological Functioning in Older Latinos With HIV: Results From a Pilot Health Promotion Intervention

BACKGROUND/OBJECTIVES

Older Latino persons with HIV (OLPWH) experience early-onset cognitive decline due to specific factors associated with accelerated aging as well as more established risk factors like depression, anxiety, and sedentary behavior. Yet, few behavioral interventions to improve OLPWH's psychological and cognitive health have been assessed. Thus, this pilot study evaluated the feasibility, acceptability, and preliminary intervention effects of the Happy Older Latinos are Active (HOLA) physical activity health promotion intervention on cognition and mental health among this underserved population.

RESEARCH DESIGN/METHODS

Thirty OLPWH (Age: M = 61.7 years, SD = 6.00 years 40% female, 46.7% less than high-school education) enrolled in a pilot single-arm selective prevention intervention trial evaluating changes in psychological and neurocognitive outcomes at two timepoints (baseline and postintervention). Participants were asked at the end of the study to offer qualitative feedback on their acceptance of and interest in the intervention. Results: Within 7-months, enrollment targets were met (<5% of eligible participants refusing participation) and lost-to-follow up was minimal (10%). Participants attended an average of 54% of sessions and reported a high degree of satisfaction with the intervention via the Client-Satisfaction-Questionnaire-8 (M = 30.5, SD = 2.2). Significant improvements in cognitive (delayed recall [aRR = 1.16], working memory [aRR = 0.79], verbal fluency [aRR = 1.09]) and psychological (depression [aRR = 0.63], and anxiety severity [aRR = 0.73]) domains were observed when controlling for age, gender, and education.

DISCUSSION/IMPLICATIONS

Results indicate that HOLA is an innovative and promising health promotion program that is uniquely tailored to address the multiple cognitive and psychological concerns affecting OLPWH in a nonstigmatizing and culturally acceptable manner.

Attention or memory deficits? An HIV study in Shanghai using local and norm-based controls

Objective

HIV-associated neurocognitive disorder is a major complication in people living with HIV (PLWH), with standardized neuropsychological tests being essential for clinical diagnosis. However, the selection of healthy controls significantly influences the interpretation of test results. This study compares neuropsychological outcomes using two control methods, local HIV-negative controls versus decades-old norms, to evaluate neurocognitive impairments in Shanghai and assess the applicability of existing norms to contemporary populations.

Methods

A total of 244 PLWH who attended the Shanghai Public Health Clinical Center between 2019 and 2024, along with 132 HIV-negative controls, participated in the study. Standardized neuropsychological tests covering seven cognitive domains were administered to provide a comprehensive cognitive function assessment. Neurocognitive impairments were defined by comparing them with either local controls or previously established norms.

Results

After adjusting for age, sex, and education level, PLWH demonstrated significantly lower standardized scores compared to people living without HIV (PLWoH) in attention/working memory (49.2 ± 7.62 vs. 53.1 ± 6.34, Bonferroni-corrected p < 0.001). Executive function scores showed a marginal difference (49.3 ± 6.61 vs. 51.5 ± 6.22, Bonferroni corrected p = 0.052). No significant group differences were observed in other cognitive domains. Norm-based analyses identified impairments in attention/working memory and executive function among PLWH, with 12% and 13% impairment rates, respectively. In contrast, impairment rates in memory (32%), learning (20%), and motor (14%) were higher, although they did not differ significantly between PLWH and PLWoH.

Conclusion

Neurocognitive impairments in PLWH from Shanghai primarily involve attention/working memory and executive function. However, norm-based analysis emphasized impairments in memory and learning, underscoring significant discrepancies between local controls and outdated norms. These findings underscore the limitations of relying on outdated norms for evaluating neurocognitive impairment and emphasize the importance of developing updated, localized norms for accurate diagnosis and effective interventions.

Two-year clinical trial examining the effects of speed of processing training on everyday functioning in adults with human immunodeficiency virus-associated neurocognitive disorder (HAND) and borderline HAND in the U.S. Deep South: Findings of the Think Fast Study

Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient's Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen's d) ranging 0.13-0.41 for MAQ and 0.02-0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.

Using network analysis to provide evidence for brain health as a unified construct relevant to aging with HIV

PURPOSE

Brain health is a dynamic state involving cognitive, emotional, and motor domains. Measuring brain health is a challenge owing to the uncertainty as to whether it is one or many constructs. This study aimed to contribute evidence for brain health as a unified construct by estimating the strength of relationships between and among patient-reported items related to the brain health construct in a population with brain vulnerability owing to HIV.

METHODS

Data for this cross-sectional analysis came from a Canadian cohort of people aging with HIV. The sample included 710 men recruited between 2014 and 2016 from five Canadian cities. A network analysis was conducted with 30 items selected from the brain-related domains of fatigue, cognition, depression, sleep, anxiety, and motivation. Node centrality measures were used to determine the most critical items in the network.

RESULTS

The network showed small-world properties, that is, most nodes can be reached from other nodes with few hops," indicating strong connectivity. The most central symptoms were "How much do you enjoy life?" and "How often do you have negative feelings?".

CONCLUSION

The small-world properties of the network structure indicate that brain health items are interconnected and may be influenced by shared underlying factors. The centrality indices suggest that items related to enjoyment of life and negative feelings may be particularly important for understanding brain health in this population. Future research should aim to replicate these findings in larger and more diverse samples to confirm their robustness and generalizability.

Hepcidin modifies the relationship between anemia, erythrocyte indices, and neurocognitive performance in virally suppressed people with HIV

OBJECTIVE

Neurocognitive impairment in people with HIV (PWH) is associated with erythrocyte indices, which may serve as indicators of iron metabolism, inflammation, and related factors. Erythropoiesis requires iron, regulated by a multifaceted system of peptide hormones, including hepcidin. This study postulated that hepcidin might modify the relationship between erythrocyte indices and neurocognitive performance in PWH.

METHODS

Plasma hepcidin and erythrocyte indices were quantified in 88 virally suppressed PWH who underwent comprehensive neurocognitive assessments. Global neurocognitive performance was summarized by global T -scores. Associations of global T -scores with anemia and erythrocyte indices were determined in univariable analyses. To examine the influence of hepcidin on the relationship between neurocognitive performance and erythrocyte indices, we evaluated interactions between these covariates in relation to global T -scores and then performed stratified analyses.

RESULTS

In multivariable analyses, hepcidin detectability interacted with age ( P  = 0.007) and mean corpuscular volume (MCV; P  = 0.031) in relation to the global T -score. Interactions between anemia and erythrocyte indices on global T -scores were significant (anemia × MCV, P  = 0.008; anemia × MCH, P  = 0.011). Stratified analyses identified that lower global T -scores were associated with older age ( P  = 0.001) and higher MCV ( P  = 0.0046) and mean corpuscular hemoglobin (MCH, P  = 0.026) only when hepcidin was undetectable. Among the anemic, worse global T -score was associated with higher MCV ( P  = 0.001) and MCH ( P  = 0.002).

CONCLUSION

Findings suggest that iron-related factors (hepcidin, anemia, MCV, MCH) and age influence neurocognitive health. This cross-sectional study underscores hepcidin as an effect modifier in the associations of erythrocyte indices, anemia, and age with neurocognitive function in PWH.

Predicting Trajectories of Everyday Functioning in Adults Aging with HIV Using Latent Growth Mixture Modeling

As the U.S. population of people with HIV (PWH) ages, PWH exhibit high rates of adverse health outcomes including everyday functioning decline. We aimed to (1) identify trajectories of self-reported everyday functioning and (2) examine baseline predictors (demographics, cognitive domains, psychiatric and medical comorbidities, HIV-disease characteristics) of trajectories among PWH. 742 PWH completed up to five semi-annual visits over two years. Latent growth mixture modeling identified a linear 3-class solution with good statistical fit and interpretability. Most PWH (88%) had good baseline functioning with stability. Two classes had elevated baseline functional declines with worsening (7%) or improvement (5%). Greater depressive symptoms and motor skills impairment predicted higher odds of impaired functioning. Having chronic pulmonary disease increased odds of improvement, which may reflect connection to care, while older age increased odds of worsening. Most aging PWH demonstrate stable everyday functioning; however, interventions for depression and motor skills may improve functioning.

The utility of nonhuman primate models for understanding acute HIV-1 infection

PURPOSE OF REVIEW

Nonhuman primate (NHP) models of HIV-1 infection provide complementary experimental pathways for assessing aspects of acute HIV-1 infection (AHI) that cannot be addressed in humans. This article reviews acute infection studies in SIV-infected or SHIV-infected macaque species over the previous 18 months.

RECENT FINDINGS

Reviewed studies examined the dynamics of replication-competent viral reservoir establishment during early infection, reservoir maintenance throughout therapy, and factors influencing viral rebound after treatment cessation. Also discussed are acute infection events in the central nervous system and liver and potential links between these events and manifestations of comorbidities during chronic infection. Additional studies addressed how occurrences during acute infection impact the development of natural viral control or posttreatment control. Another report evaluated treatment during acute infection with broadly neutralizing antibodies with enhanced ability to engage innate immune cells, highlighting the ability of this early intervention to shape innate and adaptive antiviral responses.

SUMMARY

NHP models of HIV-1 infection are a fundamental research tool for investigating AHI events. These models enable detailed pathogenesis characterization and the testing of hypothesis-driven strategies for altering disease courses through interventions during AHI, including targeting viral persistence and comorbidities that persist throughout chronic infection.

Neuropathogenesis of acute HIV: mechanisms, biomarkers, and therapeutic approaches

PURPOSE OF REVIEW

The neuropathogenesis of acute HIV leads to rapid central nervous system (CNS) involvement, characterized by early viral entry, immune activation, and the formation of viral reservoirs. Despite effective antiretroviral therapy (ART), these reservoirs persist, drive neuroinflammation and injury and lead to HIV-associated neurodegenerative disorders (HAND). This review provides an updated synthesis of the mechanisms in acute HIV neuropathogenesis, biomarkers of CNS injury and emerging therapeutic approaches. A deeper understanding of these mechanisms is critical for addressing persistent HAND in ART-treated individuals.

RECENT FINDINGS

Growing evidence now supports the principal role of infected CD4 + T cells in mediating HIV neuroinvasion alongside monocytes, resulting in seeding in perivascular macrophages, pericytes, and adjacent microglia and astrocytes. These reservoirs contribute to ongoing transcriptional activity and viral persistence despite antiretroviral therapy. Neuroinflammation, driven by activated microglia, astrocytes, inflammasomes, and neurotoxic viral proteins, disrupts neuronal homeostasis. Emerging therapies, including latency-reversing agents and transcription inhibitors, show promise in reducing neuroinflammation and reservoir activity.

SUMMARY

Understanding the mechanisms of HIV neuropathogenesis and reservoir persistence has significant implications for developing targeted therapies to mitigate HAND. Strategies to eliminate CNS reservoirs and reduce neuroinflammation should be prioritized to improve long-term cognitive outcomes in people with HIV.

Immune profiles and HIV reservoir in people switching to long-acting cabotegravir/rilpivirine: Findings from a real-life prospective study

INTRODUCTION

Data on the dynamics of HIV-DNA and immune profiles under treatment with long-acting cabotegravir and rilpivirine (LACR) are limited.

METHODS

We prospectively enrolled people living with HIV who initiated LACR in our centre and assessed changes in HIV-DNA levels (measured by digital droplet PCR), as well as immune activated, senescent, exhausted, and regulatory T and B cells (analysed by flow cytometry), in peripheral blood mononuclear cells (PBMC) from baseline (T0) to 48 weeks of treatment (T5). Bivariate analyses, one-way repeated measures ANOVA and mixed ANOVA were conducted to assess differences in characteristics and biomarker changes over time between individuals switching to LACR from a dual (Group A) or triple (Group B) antiretroviral regimen.

RESULTS

A total of 71 persons were included (77.5% males, median age of 48 years). Overall, HIV-DNA levels exhibited a slight non-significant decrease, whereas activated CD8 cells decreased significantly (p < 0.001). Proportions of activated CD4 and regulatory T cells showed strong negative trends, but decreases did not reach statistical significance (p = 0.002 and 0.005). The dynamics of these markers within the two subgroups mirrored those of the entire cohort, with some differences. At baseline, Group A tended to exhibit higher levels of HIV-DNA (96 [31-160] vs. 41 [6-93] copies/106 PBMC, p = 0.088), and activated CD4 (% activated CD4 cells: 2.3 [1-2.9] vs. 1 [0.7-2], p = 0.154) and CD8 cells (% activated CD8 cells: 4.9 [2.2-5.8] vs. 2.2 [1.2-3.5], p = 0.023) than Group B. Over the 48-week treatment period, HIV-DNA levels decreased slightly in both groups, remaining higher in Group A. At the end of the 48-week treatment period, the decrease of activated CD4 and CD8 cells was more pronounced in Group A than in Group B, ultimately reaching comparable levels between the two groups (% of activated CD4 cells: 0.9 [0.6-1.9] vs. 0.7 [0.6-1.1], p = 0.502): % of CD8 activated cells: (2 [1.3-2.5] vs. 1.6 [0.9-2.2], p = 0.278).

CONCLUSION

During the first year of treatment, LACR does not significantly impact the HIV reservoir. However, it may reduce immune activation, particularly in persons switching from a dual therapy regimen.

Mapping the intersection of HIV and Alzheimer's disease: a bibliometric analysis of emerging research trends

Background

HIV and Alzheimer's disease (AD) are significant global health challenges with overlapping neuroinflammatory and protein aggregation mechanisms. Understanding their intersection is critical for advancing therapeutic strategies, particularly in aging populations.

Objective

This study aims to provide a comprehensive bibliometric analysis of research trends at the intersection of HIV and AD, identify emerging themes, and highlight key contributors in this interdisciplinary field.

Methods

Using the Web of Science Core Collection, we retrieved 4,856 articles and reviews published between 1994 and 2025. Bibliometric analysis was conducted with VOSviewer, CiteSpace, and R software to examine publication trends, international collaboration, institutional contributions, journal dynamics, author networks, and thematic evolution.

Results

The analysis reveals a 14.18% annual growth rate in publications, with the U.S. leading in productivity, followed by China, Germany, and Japan. Key institutions include the NIH and the University of California System, while journals such as Journal of Biological Chemistry and PLOS ONE show significant growth. Prominent authors include Masliah, Eliezer, and Heaton, RK. Research highlights the overlap between HIV-associated neurocognitive disorders (HAND) and AD, emphasizing shared mechanisms like neuroinflammation, protein aggregation, and blood-brain barrier disruption. Recent advances focus on cerebrospinal fluid biomarkers, oxidative stress, and the impact of antiretroviral therapy (ART) on neurological outcomes. Studies increasingly explore the role of advanced methodologies, including machine learning, in elucidating shared mechanisms such as neuroinflammation, endoplasmic reticulum stress, and protein misfolding.

Conclusion

This bibliometric analysis underscores the dynamic and rapidly evolving research landscape at the intersection of HIV and AD, driven by collaborative efforts and technological advancements. Future research should prioritize longitudinal studies, mechanistic insights, and translational applications to address unanswered questions in this critical field.

Beneficial and adverse effects of THC on cognition in the HIV-1 transgenic rat model: Importance of exploring task- and sex-dependent outcomes

HIV-associated neurocognitive impairment (NCI) is an untreated concern among people living with HIV (PLWH). Cannabis use in PLWH may complicate outcomes on cognition, with evidence to suggest function-dependent effects that are modulated by several factors including use patterns (e.g., frequency of use) and demographic influences (e.g., age). Animal studies can control for these factors. Here, we characterized the impact of the primary psychoactive ingredient in cannabis (delta-9-tetrahydrocannabinol; THC), on function-dependent cognitive outcomes in HIV-1 transgenic (Tg) rats using cross-species translatable assays. Female and male HIV-1Tg rats and their controls were tested in the rat Iowa Gambling Task (IGT; to measure risk-based decision-making), and the Probabilistic Reversal Learning Task (PRLT; to measure learning and cognitive flexibility). Rats were tested at baseline, then retested following acute and chronic exposures to THC (0, 0.3, 3 mg/kg, intraperitoneal injection). At baseline, HIV-1Tg rats took longer to make decisions, but exhibited intact cognition across tasks, suggestive of a speed-accuracy trade-off and early cognitive deficits. Both acute and chronic THC exposures produced selective effects on primary performance measures in HIV-1Tg rats, including enhanced learning performance but worsened risk-based decision-making, not observed in controls. This work confirms function-dependent effects of THC on cognitive function in an animal model of HIV using cross-species translatable tasks used in the clinic. Findings are consistent with evidence for function-dependent cannabis effects observed in HIV, and suggest THC may drive cannabis-induced changes observed on cognitive performance in PLWH. These data may serve as guidance for clinicians prescribing cannabis to patients with HIV, and for further research exploring the interactive effects of HIV and cannabinoid treatment on cognitive function.

Neuroinflammation, Blood-Brain Barrier, and HIV Reservoirs in the CNS: An In-Depth Exploration of Latency Mechanisms and Emerging Therapeutic Strategies

Despite the success of antiretroviral therapy (ART) in suppressing viral replication in the blood, HIV persists in the central nervous system (CNS) and causes chronic neurocognitive impairment, a hallmark of HIV-associated neurocognitive disorders (HAND). This review looks at the complex interactions among HIV, the blood-brain barrier (BBB), neuroinflammation, and the roles of viral proteins, immune cell trafficking, and pro-inflammatory mediators in establishing and maintaining latent viral reservoirs in the CNS, particularly microglia and astrocytes. Key findings show disruption of the BBB, monocyte infiltration, and activation of CNS-resident cells by HIV proteins like Tat and gp120, contributing to the neuroinflammatory environment and neuronal damage. Advances in epigenetic regulation of latency have identified targets like histone modifications and DNA methylation, and new therapeutic strategies like latency-reversing agents (LRAs), gene editing (CRISPR/Cas9), and nanoparticle-based drug delivery also offer hope. While we have made significant progress in understanding the molecular basis of HIV persistence in the CNS, overcoming the challenges of BBB penetration and neuroinflammation is key to developing effective therapies. Further research into combination therapies and novel drug delivery systems will help improve outcomes for HAND patients and bring us closer to a functional cure for HIV.

Characteristics of cortical thickness in treated HIV-infected individuals with and without cognitive impairment

BACKGROUND

HIV can alter the brain structure and function in the early stage of infection. This study investigated the differences in cortical thickness patterns between healthy controls (HCs) and people living with HIV (PLWH) with asymptomatic neurocognitive impairment (ANI) or cognitive integrity (CI).

METHODS

Twenty-one ANI, 25 CI, and 24 HCs were recruited and underwent high-resolution T1-weighted magnetic resonance images. Cortical thickness was analyzed using the Computational Anatomy Toolbox, and the correlation analysis was conducted between cortical thickness and clinical and neuropsychological variables.

RESULTS

Both CI and ANI exhibited decreased cortical thickness, primarily in the left frontal cortices and bilateral limbic system. ANI demonstrated a more pronounced and widespread pattern of cortical thinning. Lower CD4+ counts and higher peak plasma viral load were associated with decreased cortical thickness of the right pericallosal sulcus and middle-posterior part of cingulate gyrus and sulcus in ANI. Conversely, compared to HCs, both ANI and CI showed cortical thickening in the left insula cortex, and ANI tended to have a thicker cortex. Moreover, the increased thickness of left insula cortex in both CI and ANI were positively correlated with attention and working memory.

CONCLUSIONS

The cortical thickness thinning was observed in the frontal and limbic systems in both ANI and CI. Meanwhile, the thickening of the insular cortex may represent mild neuroinflammation or a transient compensatory mechanism. This study provides new insights into the neural mechanisms underlying HIV-related cognitive impairment and highlights the importance of cortical thickness alteration patterns when assessing cognitive function of PLWH.

Differential roles of the ADAM9/NF-κB and the ADAM9/STAT3 feedback loops in HIV-1 Tat-induced microglial inflammatory response and subsequent neuronal apoptosis

ADAM has been implicated in causing several neurodegenerative diseases to progress. However, the precise function they play in HIV-associated neurocognitive disorders (HAND) remains incompletely elucidated. The HIV-1 transcriptional activator (Tat) has the capacity to evoke an inflammatory reaction within the microglia of the central nervous system. This, subsequently, initiates the apoptosis of neuronal cells. In the present research, our attention was centered on the part that ADAM9 plays in the microglia's response to Tat. We discovered that the stimulation with soluble Tat remarkably enhanced the manifestation of ADAM9 by means of the NF-κB and STAT3 pathway. In contrast, inhibition of ADAM9 significantly reduced Tat-triggered NF-κB and STAT3 signaling. Moreover, both ADAM9/NF-κB and ADAM9/STAT3 feedback loops exacerbated Tat-induced microglia inflammatory responses. However, further studies showed that the ADAM9/NF-κB feedback loop more significantly promoted neuronal apoptosis mediated by conditioned medium secreted by microglia after Tat stimulation. This study offers a novel perspective on the function of diverse feedback circuits in the etiopathogenesis of HAND. It can be posited that, when considered as a collective entity, ADAM9 may represent a viable candidate for therapeutic intervention in the context of preventing neuronal injury associated with HAND by modulating the inflammatory response of microglia and influencing neuronal injury.

Health literacy mediates the association between cognition and healthcare provider interactions among gay and bisexual men with HIV disease

Introduction: Gay and bisexual men (GBM) account for the highest rates of incident infection with HIV in the U.S., and experience social, systemic barriers to accessing and engaging in healthcare services. Interacting with healthcare providers can be a complex process for some GBM with HIV disease. The current study examined the contributions of cognition and health literacy to perceived interactions with healthcare providers among GBM with HIV disease. Methods: The sample included 100 adults with HIV disease (ages 24-75) who identified as GBM. All participants completed the Dealing with Health Professionals subscale of the Beliefs Related to Medication Adherence survey, as well as the Cogstate neuropsychological battery, self-report measures of cognitive symptoms, and well-validated measures of health literacy. Results: Worse performance-based cognition and subjective cognitive symptoms were both associated with perceived difficulties dealing with healthcare providers, but these associations were fully mediated by lower health literacy. Conclusion: Health literacy may play a role in the association between poorer cognitive functioning and difficulties navigating healthcare interactions among GBM with HIV disease. Further studies are needed to determine whether cognitive approaches to enhancing the access, understanding, and use of health information in GBM with HIV disease improves healthcare interactions and outcomes.

Heat shock protein 90 is a chaperone regulator of HIV-1 latency

An estimated 32 million people live with HIV-1 globally. Combined antiretroviral therapy suppresses viral replication but therapy interruption results in viral rebound from a latent reservoir mainly found in memory CD4+ T cells. Treatment is therefore lifelong and not curative. Eradication of this viral reservoir requires hematopoietic stem cell transplantation from hemizygous or homozygous ΔCCR5 donors, which is not broadly applicable. Alternative cure strategies include the pharmacological reactivation of latently infected cells to promote their immune-mediated clearance, or the induction of deep latency. HIV-1 latency is multifactorial and linked to the activation status of the infected CD4+ T cell. Hence to perturb latency, multiple pathways need to be simultaneously targeted without affecting CD4+ T cell function. Hsp90 has been shown to regulate HIV-1 latency, although knowledge on the pathways is limited. Because Hsp90 promotes the proper folding of numerous cellular proteins required for HIV-1 gene expression, we hypothesized that Hsp90 might be a master regulator of latency. We tested this hypothesis using a polyclonal Jurkat cell model of latency and ex-vivo latently infected primary CD4+ T cells. We found that, in the Jurkat model, Hsp90 is required for HIV-1 reactivation mediated by the T-cell receptor, phorbol esters, TNF-α, inhibition of FOXO-1, and agonists of TLR-7 and TLR-8. In primary cells, Hsp90 regulates HIV-1 gene expression induced by stimulation of the T-cell receptor or in the presence of IL-7/IL-15 or a FOXO-1 inhibitor. Chemical inhibition of Hsp90 abrogated activation of the NF-kB, NFAT and AP-1 signal transduction pathways. Within the CD4+ T cell population, CDRA45+ CCR7+ "naïve" and CD45RA- CCR7- "effector memory" cells were most sensitive to Hsp90 inhibition, which did not perturb their phenotype or activation state. Our results indicate that Hsp90 is a master regulator of HIV-1 latency that can potentially be targeted in cure strategies.

Pigtail Macaque (Macaca nemestrina) Performance Differs Across Multiple Cognitive Domains in Comparison to Rhesus Macaques (Macaca mulatta)

Rhesus and pigtail macaques are closely related and have similar social structures, yet differences in their behavior, socio-ecology, and personality have been observed, although not systematically documented. Given these differences, it is important to assess pigtail macaque cognition independently, rather than relying on rhesus macaque findings as a proxy. To gain a better understanding of pigtail macaque cognition, we used a battery of three cognitive tasks. Rhesus macaques were tested on the same tasks to validate our methods and to allow for comparison. Across just three tasks, we found significant differences between the two closely related species. In the three cups task, which tests short-term memory, both pigtail and rhesus macaques performed significantly better when they had to recall the location of a hidden food reward after a 0 s delay compared to a 15 s delay. However, in the 15 s delay condition, only rhesus macaques performed above chance levels, whereas pigtail macaques did not. In the reversal learning task, which tested rule learning and cognitive flexibility, we found species differences in learning performance. For the quantity discrimination task, which tests numerosity, we found that both rhesus and pigtail macaques were more accurate at discriminating "easy" ratios of foods (e.g., 1 vs. 5 or 2 vs. 6) than the "hard" ratios (e.g., 2 vs. 3 or 4 vs. 5). However, pigtail macaques were more accurate than rhesus macaques in the hard ratio trials. These contribute to a novel understanding of cognition in pigtail macaques while also increasing research rigor in translational research.

Functional and Structural Network Alterations in HIV-Associated Asymptomatic Neurocognitive Disorders: Evidence for Functional Disruptions Preceding Structural Changes

Purpose

This study focuses on the asymptomatic neurocognitive impairment (ANI) stage of HIV-associated neurocognitive disorders (HAND). Using multimodal MRI and large-scale brain network analysis, we aimed to investigate alterations in functional networks, structural networks, and functional-structural coupling in persons with ANI.

Patients and Methods

A total of 95 participants, including 48 healthy controls and 47 persons with HIV-ANI, were enrolled. Resting-state fMRI and diffusion tensor imaging were used to construct functional and structural connectivity matrices. Graph-theoretical analysis was employed to assess inter-group differences in global metrics, nodal characteristics, and functional-structural coupling patterns. Furthermore, machine learning classifiers were used to construct and evaluate classification models based on imaging features from both groups. The performance of different models was compared to identify the optimal diagnostic model for detecting HIV-ANI.

Results

Structural network analysis showed no significant changes in the global or local topological properties of persons with ANI. In contrast, functional networks exhibited significant reorganization in key regions, including the visual, executive control, and default mode networks. Functional-structural coupling was significantly enhanced in the occipital and frontal networks. These changes correlated with immune status, infection duration, and cognitive performance. Furthermore, the classification model integrating graph-theoretical topological features and functional connectivity achieved the best performance, with an area under the curve (AUC) of 0.962 in the test set.

Conclusion

Functional network reorganization and enhanced functional-structural coupling may reflect early synaptic and dendritic damage in persons with ANI, serving as potential early warning signals for HAND progression. These findings provide sensitive biomarkers and valuable perspectives for early diagnosis and intervention.

Predicting Neurobehavioral Outcomes in People with HIV

We aimed to identify complex, multidimensional, longitudinal biopsychosocial phenotypes (MLBPSPs) in people with HIV (PWH) and evaluate their associations with baseline clinical characteristics. We included 506 PWH in the multi-site CHARTER study who underwent assessments at four visits, six months apart. Using machine learning, we identified four MLBPSP clusters based on means and nonlinear trajectories of biopsychosocial characteristics. These characteristics included neurocognition, depressed mood, self-reported cognitive symptoms, and activities of daily living at each visit. The largest MLBPSP cluster (C1, N = 231) had the best average scores across all domains and remained stable over 18 months of follow-up. Other clusters showed varying degrees of cognitive impairment, depressed mood, and functional disability. In multivariable analyses, several baseline clinical characteristics, including chronic pulmonary disease, distal neuropathic pain, polypharmacy, and creatinine levels, significantly predicted one or more adverse MLBPSP trajectories. These findings have implications for HIV care by identifying PWH at risk for future adverse trajectories. The results may lead to insights informing future personalized interventions targeted to vulnerable subpopulations of PWH.

Implications of Cognitive Impairment on Antihypertensive Medication Use in HIV

BACKGROUND

Aging-related comorbidities such as cardiovascular disease and neurocognitive impairment are more common among people with HIV (PWH). Hypertension (HTN) has been implicated in cognitive decline, and antihypertensives with anticholinergic properties may exacerbate this decline. Our research probed the relationship between neurocognitive performance and antihypertensives in hypertensive PWH and in those without HIV (PWoH), examining whether increased antihypertensives followed the worsening in neurocognitive performance.

METHODS

This longitudinal analysis encompassed seven visits over five years, enrolled between 1999 and 2022. Participants were included if they reported HTN or used antihypertensives. All participants underwent comprehensive cognitive assessments, and their global cognitive performance was evaluated using summary, demographically corrected T-scores. The association between the global T-score and the number of antihypertensives was evaluated using generalized linear mixed-effects models. Summary regression-based change score (sRCS) was analyzed as an indicator of global performance over time.

RESULTS

Among 1158 hypertensive PWH (79.9% were on ART), worsening cognitive performance was associated with an increased number of antihypertensives (p = 0.012) but not in PWoH (p = 0.58). PWH had lower mean arterial pressure (MAP) than PWoH after adjusting for demographics (β = -5.05, p = 2.3 × 10-11). In PWH, an association between mean arterial pressure (MAP) and sRCS suggested that those with cognitive improvement had lower MAP (p = 0.027). PWH taking more anticholinergics were more likely to have worse cognitive performance over time (p < 0.001).

CONCLUSIONS

PWH with declining neurocognitive performance over time used increasing numbers of antihypertensives, suggesting that their providers prescribed more antihypertensives because of either treatment refractory HTN or poor adherence. Prescribers should avoid using antihypertensives with anticholinergic properties when possible.

Graph theory analysis reveals functional brain network alterations in HIV-associated asymptomatic neurocognitive impairment in virally suppressed homosexual males

BACKGROUND

This study aimed to investigate the global and nodal functional network alterations, abnormal connections of brain regions, and potential imaging biomarkers in virally suppressed people living with HIV (PLH) with asymptomatic neurocognitive impairment (ANI) using graph theory analysis.

METHODS

The study included 64 men with ANI (mean age 32.45 years) and 64 healthy controls (HC) (mean age 31.31 years). The functional network was established through the graph theory method and Automated Anatomic Labeling (AAL) 90 atlas, which provides a cerebrum parcellation framework. Moreover, hub regions were identified based on betweenness centrality (Bc). Functional connectivity (FC) differences were investigated between the two groups, these connections were located in the resting-state network (RSN). Neuropsychological (NP) tests were performed, and relationships between graph theory measures, clinical data, and NP tests were analyzed. Multiple comparisons were used to correct for false-positive findings.

RESULTS

On the global level, small-worldness, global efficiency (Eg), and local efficiency (Eloc) were significantly decreased in ANI subjects. On a nodal level, brain regions in the frontal and subcortical regions showed significantly decreased nodal measures, while regions in the parietal, temporal, and occipital lobes showed increased nodal measures. Increased FCs were found between brain regions in the visual, frontoparietal, and somatomotor networks. Hub regions overlapped highly between the two groups. Age was negatively correlated with graph theory measures.

CONCLUSION

Our findings demonstrate the global and nodal alterations in the functional network of virally suppressed homosexual males in the ANI stage. Frontal and subcortical brain regions may be important for finding the imaging biomarkers for HIV-associated neurocognitive disorder.

Sleep Disorders Are Associated with Mental Health, Quality of Life and Stigma in an Italian Cohort of People Living with HIV

Objectives: The aim of this study was to assess sleep quality in people living with HIV (PLWH), and to examine how the sleep sphere interacts with mental health, quality of life and internalized stigma. Methods: A total of 250 PLWH were consecutively enrolled during routine outpatient visits. Each participant completed a 67-item questionnaire. Sleep disturbances were measured using the Pittsburgh Sleep Quality Index (PSQI). The Depression, Anxiety and Stress Scale (DASS-21) was used to measure the mental health status. The Short Form 12 (SF-12) questionnaire was used to measure participants' quality of life. Internalized HIV-related stigma was evaluated using the modified six-item internalized AIDS-related stigma scale. Results: Many of the PLWH were male (69.2%) and the time between HIV diagnosis and first antiretroviral therapy (ART) was over 10 years (69.2% and 64%, respectively). The PSQI component most-cited as problematic by PLWH was habitual sleep efficiency (52.4%). In multivariate analysis models, a higher mean in the PSQI total score was significantly associated with internalized stigma (mean change 1.10), depression (mean change 6. 20), anxiety (mean change 12.15), stress (mean change 6.24), physical (mean change 7.54) and mental (mean change 3.56) quality of life, health status (mean change -6.04), ART adherence (mean change -5.08) and physical activity (mean change -6.20). Conclusions: Our results confirm the role of sleep quality in both mental and physical health and suggest that sleep disorders might also be a significant indicator of psychosocial challenges faced by PLWH.

HIV-1 Tat protein alters medial prefrontal cortex neuronal activity and recognition memory

Despite advancements in combined antiretroviral therapy, human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) continue to affect 40%-50% of people living with HIV. While neuroimaging studies have revealed HIV-1-induced alterations in cortical networks and brain macrostructures, it still remains unclear how individual neurons in the medial prefrontal cortex (mPFC) are affected during recognition memory. Using in vivo calcium imaging in an HIV-1 transactivator of transcription (Tat) transgenic mouse model, we examined mPFC neuronal activity during a novel object recognition memory task. Our findings show that HIV Tat expression reduces overall neuronal activity in Tat(+) mice without altering the number of activated cells. Moreover, distinct neuronal subpopulations are up- and downmodulated in both Tat(-) and Tat(+) mice depending on object exploration. Importantly, familiarity-driven increases in mPFC activity were disrupted by HIV Tat expression. These findings enhance our understanding of HAND and may inform future pharmacological strategies aimed at restoring cognitive function.

HIV-associated neurocognitive disorders (HAND): Optimal diagnosis, antiviral therapy, pharmacological treatment, management, and future scopes

In the context of HIV infection, HIV-associated neurocognitive disorders (HAND) have become a serious concern. An extensive summary of the diagnosis, care, and mental health consequences related to HAND is given in this article. The diagnosis of HAND entails a multimodal approach that includes neuroimaging, cognition tests, and clinical examinations. Numerous screening instruments and standardized evaluations have been created to support the early identification and tracking of HAND. Appropriate actions and individualized treatment plans are made possible by prompt diagnosis. A multidisciplinary approach is used in the treatment of HAND, aiming to address various elements of cognitive impairment. The main stream of treatment is still antiretroviral medication (ART), which successfully lowers viral loads and stops further neurocognitive deterioration. Adjunctive treatments are essential for treating cognitive symptoms and improving overall quality of life. These therapies include cognitive rehabilitation, pharmaceutical interventions, and psychological support. Our knowledge of the pathophysiology of HAND has improved with the identification of the inflammatory milieu and persistent viral persistence in the central nervous system (CNS), which has also aided in the creation of biomarkers for CNS illness. Although biomarkers show inflammation, neuronal damage, and monocyte activity, their clinical use is still restricted. Although new techniques to treating HAND have been developed as a result of a better knowledge of pathogenic processes, the best course of action is still unknown.

Antiretroviral drug therapy does not reduce neuroinflammation in an HIV-1 infection brain organoid model

BACKGROUND

HIV-1-associated neurocognitive impairment (HIV-1-NCI) is marked by ongoing and chronic neuroinflammation with loss and decline in neuronal function even when antiretroviral drug therapy (ART) successfully suppresses viral replication. Microglia, the primary reservoirs of HIV-1 in the central nervous system (CNS), play a significant role in maintaining this neuroinflammatory state. However, understanding how chronic neuroinflammation is generated and sustained by HIV-1, or impacted by ART, is difficult due to limited access to human CNS tissue.

METHODS

We generated an in vitro model of admixed hematopoietic progenitor cell (HPC) derived microglia embedded into embryonic stem cell (ESC) derived Brain Organoids (BO). Microglia were infected with HIV-1 prior to co-culture. Infected microglia were co-cultured with brain organoids BOs to infiltrate the BOs and establish a model for HIV-1 infection, "HIV-1 M-BO". HIV-1 M-BOs were treated with ART for variable directions. HIV-1 infection was monitored with p24 ELISA and by digital droplet PCR (ddPCR). Inflammation was measured by cytokine or p-NF-kB levels using multiplex ELISA, flow cytometry and confocal microscopy.

RESULTS

HIV-1 infected microglia could be co-cultured with BOs to create a model for "brain" HIV-1 infection. Although HIV-1 infected microglia were the initial source of pro-inflammatory cytokines, astrocytes, neurons and neural stem cells also had increased p-NF-kB levels, along with elevated CCL2 levels in the supernatant of HIV-1 M-BOs compared to Uninfected M-BOs. ART suppressed the virus to levels below the limit of detection but did not decrease neuroinflammation.

CONCLUSIONS

These findings indicate that HIV-1 infected microglia are pro-inflammatory. Although ART significantly suppressed HIV-1 levels, neuronal inflammation persisted in ART-treated HIV-1 M-BOs. Together, these findings indicate that HIV-1 infection of microglia infiltrated into BOs provides a robust in vitro model to understand the impact of HIV-1 and ART on neuroinflammation.

Emerging role of natural killer cells in non-AIDS comorbidities during suppressive antiretroviral therapy

PURPOSE OF REVIEW

Despite decades of insights about the role of natural killer (NK) cells in HIV infection, their persistent dysregulation despite antiretroviral therapy (ART) and its pathological consequences have been incompletely delineated. In this review, we highlight recent findings on the immunophenotypic and functional alterations of NK cells during virally suppressed HIV infection and explore their potential impact on promoting non-AIDS related comorbidities among people living with HIV (PLWH).

RECENT FINDINGS

Of note are the apparent persistent activated profiles of NK cells and pathophysiological events such as endoplasmic reticulum (ER) stress in potentially driving NK cell derived inflammation and tissue destruction. Additionally, recent interest in trained immunity is discussed as a potential mediator of ongoing NK cell dysregulation, contributing to comorbidities such as cardiovascular disease and neurocognitive disorders, both with an inflammatory etiology.

SUMMARY

Clinical and mechanistic evidence suggests persistent activation and dysregulation of the innate immune system are major drivers of non-AIDS comorbidities during virally suppressed HIV infection. Delineating the mechanistic role of specific components of innate immunity such as NK cells in inducing these pathologies will lead to the identification of novel therapeutic/prophylactic strategies to improve the overall health of PLWH.

Agingassociated challenges to persons living with HIV/AIDS in Vietnam: integrated perspectives from multiple stakeholders

This study examined the aging-associated health and care needs among the HIV population in Vietnam, integrating perspectives from healthcare professionals, PLWH, and their caregivers. Qualitative data were collected through five focus group interviews involving ten PLWH, nine caregivers, and eight healthcare providers in Hanoi, Vietnam, in March 2023. Thematic analyses uncovered recurring patterns and themes across the three participant groups. PLWH reflected diverse experiences, showing mental health struggles, aging-related concerns, and a lack of preparation due to health challenges or unexpected longevity. Resilience and optimism are also manifested in PLWH. Caregivers demonstrated crucial roles, including bridging care, medication adherence, and financial and emotional support. Both PLWH and caregivers expressed a desire for education on HIV and aging. Healthcare providers reported mental and physical health changes among aging PLWH, such as insomnia, forgetfulness, and memory deterioration. They noted a lack of resources and called for comprehensive training across medical staff to enhance the well-being of the aging PLWH. This study demonstrates the complicated age-associated needs among PLWH in Vietnam and underscores the need for policy and practice innovations to address aging-related cognitive, mental health, and long-term care concerns.

Cannabis use is associated with a lower likelihood of presence of HIV drug resistance mutations in a retrospective cohort of adults with HIV

Objectives

A significant clinical concern in the era of Pre-Exposure Prophylaxis (PrEP) is the increased incidence of HIV Anti-Retroviral Drug Resistance Mutations (ARV-DRM). Previous research has indicated that there is an association between substance use and failed viral suppression, which can lead to ARV-DRM. The goal of this retrospective study was to investigate whether substance use as determined by at least one positive urinalysis screen is associated with increased/decreased odds of having a ARV-DRM.

Methods

This study used firth logistic regression analyses of data retrieved from the National NeuroAIDS Tissue Consortium Data Coordinating Center to examine the relationship between substance use and ARV-DRM. The dataset analyzed 614 participants with the following criteria: HIV+ status, at least one paired plasma and cerebrospinal fluid (CSF) viral load measurement, at least one urinalysis of substance use, at least 18 years of age, and analysis of DRM in CSF/Plasma.

Results

Cannabis use was a significant predictor of ARV-DRM and was associated with a lower odds of having ARV-DRM (odds ratio=0.189), after accounting for demographic variables and the interaction between polysubstance use and cannabis use. A significant negative relationship was observed between a cannabis positive test and high viremia (>1,000 copies/mL) but not between a cannabis positive test and CSF Escape (viral load CSF>viral load plasma).

Conclusions

The above results may suggest an immunomodulatory role for cannabis that impacts the propensity for ARV-DRM. These findings could incentivize future research to further investigate effects of cannabis use on the development of HIV ARV-DRM.

Assessing cognitive impairment in HIV-infected: a comparative study of international HIV Dementia Scale, HIV Dementia Scale Italian version and Montreal cognitive assessment in clinical practice

The combination of antiretroviral therapy (cART) and preventive measures has significantly enhanced the management of Human Immunodeficiency Virus (HIV) infection. However, HIV-associated neurocognitive disorders (HAND) remain a challenge. This study aims to compare cognitive impairment (CI) assessments in people living with HIV/AIDS (PLWHA) using the International HIV Dementia Scale (IHDS), HIV Dementia Scale-Italian Version (HDS-IT) and MoCA (Montreal Cognitive Assessment), while also identifying significant associations. The cross-sectional study encompassed 294 outpatient PLWHA (median age: 57) on cART. Participants underwent cognitive, functional, and depression assessments, laboratory testing and CNS Penetration-Effectiveness (CPE) index assessment. IHDS, HDS-IT and MoCA identified CI in different proportions of PLWHA. Factors such as age, education level, infection duration, and substance use were associated with CI. The IHDS score (OR 0.79) and Level CD4 + T-lymphocytes nadir (OR 0.99) demonstrated independent and negative associations with the CPE-index. IHDS and MoCA tests appear to be useful for detecting CI in outpatient settings, enabling healthcare providers to conduct initial evaluations of PLWHA. IHDS assessment may be used for detecting CI related to high CPE regimens, while the MoCA provides a comprehensive assessment, also in domains not studied by IHDS. However, further research is needed to confirm these findings and refine their clinical applicability.

Shared interactions of six neurotropic viruses with 38 human proteins: a computational and literature-based exploration of viral interactions and hijacking of human proteins in neuropsychiatric disorders

INTRODUCTION

Viral infections may disrupt the structural and functional integrity of the nervous system, leading to acute conditions such as encephalitis, and neuropsychiatric conditions as mood disorders, schizophrenia, and neurodegenerative diseases. Investigating viral interactions of human proteins may reveal mechanisms underlying these effects and offer insights for therapeutic interventions. This study explores molecular interactions of virus and human proteins that may be related to neuropsychiatric disorders.

METHODS

Herpes Simplex Virus-1 (HSV-1), Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Influenza A virus (IAV) (H1N1, H5N1), and Human Immunodeficiency Virus (HIV1&2) were selected as key viruses. Protein structures for each virus were accessed from the Protein Data Bank and analyzed using the HMI-Pred web server to detect interface mimicry between viral and human proteins. The PANTHER classification system was used to categorize viral-human protein interactions based on function and cellular localization.

RESULTS

Energetically favorable viral-human protein interactions were identified for HSV-1 (467), CMV (514), EBV (495), H1N1 (3331), H5N1 (3533), and HIV 1&2 (62425). Besides immune and apoptosis-related pathways, key neurodegenerative pathways, including those associated with Parkinson's and Huntington's diseases, were frequently interacted. A total of 38 human proteins, including calmodulin 2, Ras-related botulinum toxin substrate 1 (Rac1), PDGF-β, and vimentin, were found to interact with all six viruses.

CONCLUSION

The study indicates a substantial number of energetically favorable interactions between human proteins and selected viral proteins, underscoring the complexity and breadth of viral strategies to hijack host cellular mechanisms. Further in vivo and in vitro validation is required to understand the implications of these interactions.

Asymptomatic Cerebrospinal Fluid HIV-1 Escape: Incidence and Consequences

BACKGROUND

The incidence and clinical relevance of asymptomatic cerebrospinal fluid escape (CSFE) during antiretroviral therapy (ART) is uncertain. We examined the impact and incidence of asymptomatic CSFE in a Swedish HIV cohort.

METHODS

Neuroasymptomatic people with HIV (PWH) who have been on ART for at least 6 months with suppressed plasma viral load were followed longitudinally. CSFE was defined as either increased CSF HIV-1 RNA with concurrent plasma suppression or CSF HIV-1 RNA exceeding that in plasma when both were quantifiable. Paired CSF and plasma were analyzed for HIV-1 RNA, neopterin, neurofilament light protein (NfL), white blood cell (WBC) count, and albumin ratio.

RESULTS

Asymptomatic CSFE (cutoff 50 copies/mL) was found in 4 of 173 PWH (2%) and 5 of 449 samples (1%). The corresponding proportions were 8% of PWH and 4% for samples using a 20 copies/mL cutoff for CSF HIV-1 RNA. CSFE samples (cutoff 20 copies/mL) had a 25% higher geometric mean of CSF neopterin (P = .01) and 8% higher albumin ratio (P = .04) compared to samples without CSFE. No differences were observed in CSF NfL levels (P = .8). The odds ratio for increased CSF WBC (≥ 3 cells/μL) in samples with CSFE was 3.9 (P = .004), compared to samples without elevated CSF viral load.

CONCLUSIONS

Asymptomatic CSFE was identified in only 4 (2%) PWH, with no cases of continuous CSFE observed. Increased CSF HIV-1 RNA was associated with biomarkers of CNS immune activation and blood-brain barrier impairment, but not with biomarkers of neuronal injury.

The Role of HMGB1 in Infection-Related Cognitive Deficits

Infectious diseases caused by fungi, viruses, or bacteria can have a profound impact on human cognition. This can be due to either direct spread to the central nervous system (CNS) or indirect neuroinflammation. Ultimately causing neuronal damage and even neurodegeneration. Deteriorations in cognition, such as poor encoding and attention deficits, have been reported secondary to infectious diseases. Preclinical studies have identified the underlying mechanisms of these infection-related cognitive effects, such as through blood-brain barrier (BBB) disruption and M1 microglial polarization. These mechanisms are spearheaded by inflammatory markers that are released/initiated by the pathogens over the course of the infection. Among them, the high mobility group box 1 (HMGB1) protein is a common biomarker implicated across several infection-related cognitive deficits. Understanding these effects and mechanisms is crucial for the development of strategies to prevent and treat infection-related cognitive impairment. This review will thus consolidate and elucidate the current knowledge on the potential role of HMGB1 as a therapeutic target for infection-related cognitive impairments. This review will not only advance scientific understanding but also have significant clinical and public health implications, especially considering recent global health challenges. Based on the selected articles, extracellular HMGB1, as opposed to intracellular HMGB1, acts as damage-associated molecular patterns (DAMPs) or alarmins when released in the peripheries secondary to inflammasome activation. Due to their low molecular weight, they then enter the CNS through routes such as retrograde transport along the afferent nerves, or simple diffusion across the impaired BBB. This results in further disruption of the brain microenvironment due to the dysregulation of other regulatory pathways. The outcome is structural neuronal changes and cognitive impairment. Given its key role in neuroinflammation, HMGB1 holds promise as both a biomarker for diagnostic detection and a potential therapeutic target candidate for preventing infection-related cognitive impairment.

Altered angular gyrus activation during the digit symbol substitution test in people living with HIV: beyond information processing speed deficits

Speed-of-information processing (SIP) is often impaired in people living with HIV (PLWH), typically assessed through tests such as the digit symbol (DS) and symbol search, which also rely on motor and executive functions. This study aims to disentangle SIP deficits from other cognitive impairments in PLWH using an MRI-adapted digit symbol substitution test (mDSST). Fifty-seven PLWH (34.7 ± 11.2 years) and 50 age-matched people living without HIV (PLWoH, 31.8 ± 9.9 years) completed standardized neuropsychological tests and the mDSST. Behavioral performances and brain activations were compared, with correlations drawn between group-differentiating brain activations and clinical ratings of cognitive domains. Results showed that PLWH performed worse in DS and symbol search, made fewer responses, and was slower in mDSST, with performances correlating to SIP and motor ratings. Notably, PLWH showed greater deficits in attention compared to PLWoH, rather than in SIP or motor. PLWH also exhibited greater primary motor cortex activation and reduced right angular gyrus activation. These findings suggest that slower performances on SIP-related tests in PLWH may be partially linked to abnormal visuospatial attention, as reflected by reduced angular gyrus activation, with higher motor cortex activation potentially serving as a compensatory mechanism. Future studies should explore whether prefrontal regions implicated in SIP are impaired in more severely affected PLWH.

Neuroimaging advances in neurocognitive disorders among HIV-infected individuals

Although combination antiretroviral therapy (cART) has been widely applied and effectively extends the lifespan of patients infected with human immunodeficiency virus (HIV), these patients remain at a substantially increased risk of developing neurocognitive impairment, commonly referred to as HIV-associated neurocognitive disorders (HAND). Magnetic resonance imaging (MRI) has emerged as an indispensable tool for characterizing the brain function and structure. In this review, we focus on the applications of various MRI-based neuroimaging techniques in individuals infected with HIV. Functional MRI, structural MRI, diffusion MRI, and quantitative MRI have all contributed to advancing our comprehension of the neurological alterations caused by HIV. It is hoped that more reliable evidence can be achieved to fully determine the driving factors of cognitive impairment in HIV through the combination of multi-modal MRI and the utilization of more advanced neuroimaging analysis methods.

Immune Alterations and Viral Reservoir Atlas in SIV-Infected Chinese Rhesus Macaques

BACKGROUND/OBJECTIVES

Over the last decades, our projects have been dedicated to clarifying immunopathological and virological events associated with Human Immunodeficiency Virus (HIV) infection.

METHODS

By using non-human primate models of pathogenic and non-pathogenic lentiviral infections, we aimed at identifying the cells and tissues in which the virus persists, despite antiretroviral therapy (ART). Indeed, the eradication of viral reservoirs is a major challenge for HIV cure.

RESULTS

We present a series of results performed in rhesus macaques of Chinese origin deciphering the virological and immunological events associated with ART that can be of interest for people living with HIV.

CONCLUSIONS

This model could be of interest for understanding in whole body the clinical alteration that persist despite ART.

MALAT1 is important for facilitating HIV-1 latency reversal in latently infected monocytes

Long non-coding RNAs (lncRNAs) are long RNA transcripts with length >200 nucleotides that do not encode proteins. They play a crucial role in regulating HIV-1 infection, yet their involvement in myeloid cells remains underexplored. Myeloid cells are susceptible to HIV infection and contribute substantially to the latent HIV reservoir. Therefore, disruption of latency within these reservoirs is crucial for achieving a definite cure. In this study, we aimed to ascertain the role of MALAT1 lncRNA in reversal of HIV-1 latency. Latently HIV-infected cell line, U1 was treated with SAHA, followed by qRT-PCR assays to confirm HIV-1 reactivation, and MALAT1 expression was assessed. The in vitro experiments revealed a significant increase in MALAT1 expression following latency reactivation and HIV-1 infection, while its knockdown using siRNA resulted in suppression of HIV transcription, which implies that MALAT1 play a significant role in facilitating the reversal of HIV-1 latency by promoting HIV transcription. Clinical samples were analysed to measure MALAT1 and pro-inflammatory cytokines expression. The elevated MALAT1 expression in treatment-naïve subjects compared to those on ART and HIV-negative controls suggests its association with HIV replication. Moreover, correlation analysis revealed a positive association between MALAT1 expression and pro-inflammatory cytokines, TNF-α and IP-10. To conclude, MALAT1 lncRNA emerged as a crucial facilitator of HIV-1 latency reversal in latently infected monocytes by inducing the expression of pro-inflammatory factors. These findings highlight that MALAT1 could potentially be explored as the therapeutic intervention to reactivate latent cells in monocytes.

Development of research on HIV-associated neurocognitive disorder and emerging trends: a visualization analysis via CiteSpace

Background

In the combination antiretroviral therapy era, HIV-associated neurocognitive disorder (HAND) is still widespread among HIV-infected individuals. However, there is no effective treatment for HAND, and the exact pathogenic mechanism of HAND remains unknown. This paper aims to provide a reference for further exploration in the field of HAND research.

Methods

We used CiteSpace software to collect 3057 articles related to HAND in the Web of Science Core Collection for comprehensive analysis. Betweenness centrality, count, and burst values were used as indicators in the visualization analysis, aiming to predict future new directions and cutting-edge trends.

Results

The last decade has been the peak period of HAND research, with the most prominent contributions by authors, countries, and institutions being Grant, Igor (135), the USA (2211), and the University of California System (758), respectively. The most frequently cited article is "HIV-associated neurocognitive disorders persist in the area of potent antiretroviral therapy: CHARTER Study." The hotspots in this field are "neurocognitive impairment," "central nervous system," "cerebrospinal fluid," "HIV-1 tat," "SIV," "inflammation," "infection," and "pathogenesis." The current research direction of HAND is focused on exploring the pathogenic mechanism underlying HIV-associated neurocognitive impairment and potential therapeutic targets.

Conclusion

This study provides a bibliometric visualization of HAND-related literature to gain insight into the development and frontiers of this research field. The study also provides scholars with detailed references and identifies future research directions to better promote the development of this field of research.

Generating fair, reliable, and accurate neuropsychological test norms for people with HIV in a low- or middle-income country

Effective neuropsychological assessment of people with HIV (PWH) in low- and middle-income countries (LMICs) is hampered by the unavailability of adequate test norms. We aimed to: (1) develop demographically-corrected (regression-based) South African (SA) normative data for an HIV appropriate neuropsychological test battery for Xhosa home-language speakers; (2) compare the utility of those norms to that of (i) internal standardization norms and (ii) US test publisher norms; and (3) determine the criterion validity of the newly-developed norms. 114 controls and 102 demographically comparable Xhosa home-language people living with HIV completed a well-establised, standard HIV neuropsychological test battery assessing seven cognitive domains. Using a common performance metric (z-score), we compared control and PWH test performance and examined the extent to which the three different normative datasets embedded demographic effects e.g., education. Using internal standardization norms, analyses detected medium-sized correlations of overall test performance with age and education. Correlations were fully corrected for by the newly-developed demographically-corrected norms. Using demographically-corrected norms, PWH performed significantly more poorly than controls in five cognitive domains, whereas using internal standardization norms and test-publisher norms, PWH performed significantly more poorly than controls in one and two domains, respectively. Demographically-corrected norms estimated 43.1% of PWH were cognitively impaired; these estimates were 22.5% using test-publisher norms and 19.6% using internal standardization norms. Demographically-corrected SA norms were more sensitive to cognitive impairment in PWH than the other sets of norms. Expansion of this regression-based method to create population-appropriate norms will benefit research and clinical practice in LMICs.

Influence of plasma exosomes from women living with HIV Stratified by HAND on monocyte subpopulations from healthy women without HIV

The role of plasma exosomes from people living with HIV (PLWH) with HAND in the phenotypic profile of uninfected monocytes remains unknown. We hypothesized that these exosomes influence the CD14/CD16 phenotypical profile of uninfected monocytes in a time-dependent manner. Exosomes were collected via ultracentrifugation from the plasma of women living with HIV (WLWH) and healthy controls stratified according to their cognition into normal cognition (NC) or symptomatic neurocognitive impairment (SNI) groups. Monocyte subsets were identified via flow cytometry by using anti-CD14 and anti-CD16 fluorescent antibodies. Exosome uptake and changes in the percentages of monocyte subpopulations were analyzed from 1 to 24 h. The following results were obtained. (1) The uptake of HIV-negative exosomes by total uninfected monocytes was observed at 24 h, whereas the uptake of HIV-positive exosomes was observed at an earlier time point at 6 h. (2) HIV-positive exosomes significantly decreased the percentage of classical monocytes and increased intermediate and nonclassical monocytes at 24 h. (3) The uptake of NC exosomes was observed at an early time point at 6 h compared with SNI in all of the monocyte subsets. (4) Higher percentages of monocyte subsets were observed when cells were exposed to NC exosomes at 1 h, 6 h, or 24 h than when monocytes were exposed to exosomes from SNI patients. Our findings may help to identify new targets and molecular mechanisms that are involved in the pathogenesis of HAND.

The incidence of symptomatic CSF viral escape in patients on antiretroviral therapy in western India: a retrospective cohort study

Antiretroviral treatment (ART) effectively suppresses viral loads in both plasma and cerebrospinal fluid (CSF). Patients with discordant plasma and CSF viral loads may experience chronic-progressive or fluctuating neurocognitive dysfunctions. This study examined the incidence of symptomatic CSF viral escape (CSFVE) in patients receiving ART. This retrospective cohort study was conducted between 2000 and 2023. The primary outcome measure was the incidence of symptomatic CSFVE. Nonparametric Mann-Whitney U and Fisher exact/χ 2 tests were applied for continuous and categorical variables, respectively. The cumulative incidence function with Gray's test was used to compare the incidence of CSFVE across the treatment regimens. During the study period, 52 of the 8415 patients were diagnosed with CSFVE. The median duration of HIV diagnosis in patients with CSF VE was 150 (12-288) months, with a median nadir CD4 + T-cell count 96.5 (13-601 cells/L)], and 75% of the patients were on a ritonavir-boosted protease inhibitor (PI/r) regimen. The cumulative incidence of symptomatic CSFVE at a follow-up of 14 years was 1% (95% CI, 0-1%). PI/r (HR 34.73; 95% CI 13.5 to 89.4; p < 0.001) and integrase strand transfer inhibitor (INSTI) (HR 3.42; 95% CI 1.94 to 6.02; p < 0.001) regimens were significantly more likely to be associated with CSFVE than the Non-nucleoside reverse transcriptase inhibitors (NNRTIs) regimens. NNRTIs had the lowest risk of CSFVE compared to the PI/r and INSTI regimens. A rapid and complete recovery is possible with symptomatic CSFVE if it is diagnosed and treated early.

Viruses and the Brain-A Relationship Prone to Trouble

Neurological disorders, some of which are associated with viral infections, are growing due to the aging and expanding population. Despite strong defenses of the central nervous system, some viruses have evolved ways to breach them, which often result in dire consequences. In this review, we recount the various ways by which different viruses can enter the CNS, and we describe the consequences of such invasions. Consequences may manifest as acute disease, such as encephalitis, meningitis, or result in long-term effects, such as neuromuscular dysfunction, as occurs in poliomyelitis. We discuss evidence for viral involvement in the causation of well-known chronic neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, as well as vascular dementia in the elderly. We also describe the approaches currently available to control a few of the neural viral infections. These include antivirals that are effective against human immunodeficiency virus and herpes simplex virus, as well as vaccines valuable for controlling rabies virus, poliomyelitis virus, and some flavivirus infections. There is an urgent need to better understand, at a molecular level, how viruses contribute to acute and, especially, chronic neurological diseases and to develop more precise and effective vaccines and therapies.

SIV infection induces alterations in gene expression and loss of interneurons in Rhesus Macaque frontal cortex during early systemic infection

Understanding the neurobiological mechanisms underlying HIV-associated neurocognitive decline in people living with HIV is frequently complicated by an inability to analyze changes across the course of the infection and frequent presence of comorbid psychiatric and substance use disorders. Preclinical non-human primate simian immunodeficiency virus (SIV) models help address these shortcomings. However, SIV studies frequently target protracted endpoints, limiting our understanding of the neuromolecular alterations during the early post-infection window. To begin to address this knowledge gap, we utilized single nuclei transcriptomics to examine frontal cortex samples of rhesus macaques 10- and 20-days post-SIV infection, compared to non-infected controls. We identify and validated a decrease in inhibitory neurons during the early post infection window, representing a potential substrate of longer-term injury and neurocognitive impairment in people living with HIV. Differential expression identified alterations in cellular subtype gene expression that persisted over the 20-day time course and short-lived differences only detected at 10-days post-SIV infection. In silico predicted regulatory mechanisms and dysregulated neural signaling pathways are presented. Analysis of cell-cell interaction networks identify altered signal pathways in the frontal cortex that may represent regional alterations in cell-cell communications. In total, these results identify cell type-specific molecular mechanisms putatively capable of underlying long-term neurocognitive alterations in persons living with HIV.

Neurocognitive Impairment and HIV Treatment Engagement in Men Who Have Sex With Men Living With HIV Who Report Chronic Pain and Substance Use

This study explored relationships between neurocognitive impairment (NCI), engagement in HIV care, and functional disability among sexual minority men aged 50 years or older living with HIV, chronic pain, and recent substance use. Sixty-three participants completed cross-sectional assessments including a neurocognitive screening measure, self-reported HIV medication adherence, past-year attendance at HIV-care appointments, and indices of pain and functional impairment. Mean participant age was 57.2 years; most identified as White (55%), followed by Black/African American (42%). On average, participants reported moderate pain; 66.7% met DSM-5 criteria for a substance use disorder. Average Montreal Cognitive Assessment (MoCA) performance reflected mild NCI. Regression analyses indicated an association between poorer MoCA performance and past-year missed HIV-care appointments (B = -0.09, t (59) = -3.10, p = 0.004). Self-reported cognitive impairment was associated with more missed HIV-care visits (B = 0.20, t (59) = 4.82, p < 0.001) and greater functional disability, whereas poorer semantic fluency was associated with fewer missed HIV-care visits (B = -0.49, t (59) = -3.99, p < 0.001). Increased brief neuropsychological assessment and linkage to tailored interventions for HIV-care engagement and substance use mitigation are warranted to support PLWH with NCI in clinical care.