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Mitchell BI, Yazel Eiser IE, Kallianpur KJ, Gangcuangco LM, Chow DC, Ndhlovu LC, Paul R, Shikuma CM. Dynamics of peripheral T cell exhaustion and monocyte subpopulations in neurocognitive impairment and brain atrophy in chronic HIV infection. J Neurovirol 2024:10.1007/s13365-024-01223-w. [PMID: 38949728 DOI: 10.1007/s13365-024-01223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND HIV-associated neurocognitive disorders (HAND) is hypothesized to be a result of myeloid cell-induced neuro-inflammation in the central nervous system that may be initiated in the periphery, but the contribution of peripheral T cells in HAND pathogenesis remains poorly understood. METHODS We assessed markers of T cell activation (HLA-DR + CD38+), immunosenescence (CD57 + CD28-), and immune-exhaustion (TIM-3, PD-1 and TIGIT) as well as monocyte subsets (classical, intermediate, and non-classical) by flow cytometry in peripheral blood derived from individuals with HIV on long-term stable anti-retroviral therapy (ART). Additionally, normalized neuropsychological (NP) composite test z-scores were obtained and regional brain volumes were assessed by magnetic resonance imaging (MRI). Relationships between proportions of immune phenotypes (of T-cells and monocytes), NP z-scores, and brain volumes were analyzed using Pearson correlations and multiple linear regression models. RESULTS Of N = 51 participants, 84.3% were male, 86.3% had undetectable HIV RNA < 50 copies/ml, median age was 52 [47, 57] years and median CD4 T cell count was 479 [376, 717] cells/uL. Higher CD4 T cells expressing PD-1 + and/or TIM-3 + were associated with lower executive function and working memory and higher CD8 T cells expressing PD-1+ and/or TIM-3+ were associated with reduced brain volumes in multiple regions (putamen, nucleus accumbens, cerebellar cortex, and subcortical gray matter). Furthermore, higher single or dual frequencies of PD-1 + and TIM-3 + expressing CD4 and CD8 T-cells correlated with higher CD16 + monocyte numbers. CONCLUSIONS This study reinforces evidence that T cells, particularly those with immune exhaustion phenotypes, are associated with neurocognitive impairment and brain atrophy in people living with HIV on ART. Relationships revealed between T-cell immune exhaustion and inflammatory in CD16+ monocytes uncover interrelated cellular processes likely involved in the immunopathogenesis of HAND.
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Affiliation(s)
- Brooks I Mitchell
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St., Biomedical Sciences Building 231, Honolulu, HI, 96813, USA
- Department of Tropical Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Isabelle E Yazel Eiser
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St., Biomedical Sciences Building 231, Honolulu, HI, 96813, USA
- Department of Tropical Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Kalpana J Kallianpur
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St., Biomedical Sciences Building 231, Honolulu, HI, 96813, USA
- Department of Tropical Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
- Kamehameha Schools- Kapālama, Honolulu, HI, USA
| | - Louie Mar Gangcuangco
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St., Biomedical Sciences Building 231, Honolulu, HI, 96813, USA
- Department of Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Dominic C Chow
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St., Biomedical Sciences Building 231, Honolulu, HI, 96813, USA
- Department of Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Lishomwa C Ndhlovu
- Department of Tropical Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine New York, New York, USA
| | - Robert Paul
- Department of Psychological Sciences, Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Cecilia M Shikuma
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St., Biomedical Sciences Building 231, Honolulu, HI, 96813, USA.
- Department of Tropical Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
- Department of Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
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Moschopoulos CD, Stanitsa E, Protopapas K, Kavatha D, Papageorgiou SG, Antoniadou A, Papadopoulos A. Multimodal Approach to Neurocognitive Function in People Living with HIV in the cART Era: A Comprehensive Review. Life (Basel) 2024; 14:508. [PMID: 38672778 PMCID: PMC11050956 DOI: 10.3390/life14040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Combination antiretroviral treatment (cART) has revolutionized the management of human immunodeficiency virus (HIV) and has markedly improved the disease burden and life expectancy of people living with HIV. HIV enters the central nervous system (CNS) early in the course of infection, establishes latency, and produces a pro-inflammatory milieu that may affect cognitive functions, even in the cART era. Whereas severe forms of neurocognitive impairment (NCI) such as HIV-associated dementia have declined over the last decades, milder forms have become more prevalent, are commonly multifactorial, and are associated with comorbidity burdens, mental health, cART neurotoxicity, and ageing. Since 2007, the Frascati criteria have been used to characterize and classify HIV-associated neurocognitive disorders (HAND) into three stages, namely asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). These criteria are based on a comprehensive neuropsychological assessment that presupposes the availability of validated, demographically adjusted, and normative population data. Novel neuroimaging modalities and biomarkers have been proposed in order to complement NCI assessments, elucidate neuropathogenic mechanisms, and support HIV-associated NCI diagnosis, monitoring, and prognosis. By integrating neuropsychological assessments with biomarkers and neuroimaging into a holistic care approach, clinicians can enhance diagnostic accuracy, prognosis, and patient outcomes. This review interrogates the value of these modes of assessment and proposes a unified approach to NCI diagnosis.
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Affiliation(s)
- Charalampos D. Moschopoulos
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Evangelia Stanitsa
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.S.); (S.G.P.)
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Dimitra Kavatha
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.S.); (S.G.P.)
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (K.P.); (D.K.); (A.A.); (A.P.)
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Burdo TH, Robinson JA, Cooley S, Smith MD, Flynn J, Petersen KJ, Nelson B, Westerhaus E, Wisch J, Ances BM. Increased Peripheral Inflammation Is Associated With Structural Brain Changes and Reduced Blood Flow in People With Virologically Controlled HIV. J Infect Dis 2023; 228:1071-1079. [PMID: 37352555 PMCID: PMC10582906 DOI: 10.1093/infdis/jiad229] [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: 01/13/2023] [Revised: 06/08/2023] [Accepted: 06/22/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND While antiretroviral therapy (ART) has improved outcomes for people with HIV (PWH), brain dysfunction is still evident. Immune activation and inflammation remain elevated in PWH receiving ART, thereby contributing to morbidity and mortality. Previous studies demonstrated reduced functional and structural changes in PWH; however, underlying mechanisms remain elusive. METHODS Our cohort consisted of PWH with ART adherence and viral suppression ( < 50 copies/mL; N = 173). Measurements included immune cell markers of overall immune health (CD4/CD8 T-cell ratio) and myeloid inflammation (CD16+ monocytes), plasma markers of inflammatory status (soluble CD163 and CD14), and structural and functional neuroimaging (volume and cerebral blood flow [CBF], respectively). RESULTS Decreased CD4/CD8 ratios correlated with reduced brain volume, and higher levels of inflammatory CD16+ monocytes were associated with reduced brain volume in total cortex and gray matter. An increase in plasma soluble CD14-a marker of acute peripheral inflammation attributed to circulating microbial products-was associated with reduced CBF within the frontal, parietal, temporal, and occipital cortices and total gray matter. CONCLUSIONS CD4/CD8 ratio and number of CD16+ monocytes, which are chronic immune cell markers, are associated with volumetric loss in the brain. Additionally, this study shows a potential new association between plasma soluble CD14 and CBF.
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Affiliation(s)
- Tricia H Burdo
- Department of Microbiology, Immunology, and Inflammation, Center for Neurovirology and Gene Editing, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jake A Robinson
- Department of Microbiology, Immunology, and Inflammation, Center for Neurovirology and Gene Editing, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sarah Cooley
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Mandy D Smith
- Department of Microbiology, Immunology, and Inflammation, Center for Neurovirology and Gene Editing, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jacqueline Flynn
- Department of Microbiology, Immunology, and Inflammation, Center for Neurovirology and Gene Editing, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Kalen J Petersen
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Brittany Nelson
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Elizabeth Westerhaus
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Julie Wisch
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Beau M Ances
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
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McMahan C, Dietrich DK, Horne EF, Kelly E, Geannopoulos K, Siyahhan Julnes PS, Ham L, Santamaria U, Lau CY, Wu T, Hsieh HC, Ganesan A, Berjohn C, Kapetanovic S, Reich DS, Nair G, Snow J, Agan BK, Nath A, Smith BR. Neurocognitive Dysfunction With Neuronal Injury in People With HIV on Long-Duration Antiretroviral Therapy. Neurology 2023; 100:e2466-e2476. [PMID: 37105760 PMCID: PMC10264056 DOI: 10.1212/wnl.0000000000207339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Neurologic outcomes in people with HIV (PWH) on long-duration antiretroviral therapy (ART) are not fully understood, and the underlying pathophysiology is unclear. To address this, we established a cohort of such individuals and compared them with HIV-negative controls using a novel matching technique. Both groups underwent extensive cognitive testing, evaluation for psychiatric measures, and MRI and CSF analyses. METHODS Participants underwent comprehensive neuropsychological testing and completed standardized questionnaires measuring depressive symptoms, perceptions of own functioning, and activities of daily living as part of an observational study. Brain MRI and lumbar puncture were optional. Coarsened Exact Matching was used to reduce between-group differences in age and sex, and weighted linear/logistic regression models were used to assess the effect of HIV on outcomes. RESULTS Data were analyzed from 155 PWH on ART for at least 15 years and 100 HIV-negative controls. Compared with controls, PWH scored lower in the domains of attention/working memory (PWH least square mean [LSM] = 50.4 vs controls LSM = 53.1, p = 0.008) and motor function (44.6 vs 47.7, p = 0.009) and a test of information processing speed (symbol search 30.3 vs 32.2, p = 0.003). They were more likely to self-report a higher number of cognitive difficulties in everyday life (p = 0.011). PWH also reported more depressive symptoms, general anxiety, and use of psychiatric medications (all with p < 0.05). PWH had reduced proportions of subcortical gray matter on MRI (β = -0.001, p < 0.001), and CSF showed elevated levels of neurofilament light chain (664 vs 529 pg/mL, p = 0.01) and tumor necrosis factor α (0.229 vs 0.156 ng/mL, p = 0.0008). DISCUSSION PWH, despite effective ART for over a decade, displayed neurocognitive deficits and mood abnormalities. MRI and CSF analyses revealed reduced brain volume and signs of ongoing neuronal injury and neuroinflammation. As the already large proportion of virologically controlled PWH continues to grow, longitudinal studies should be conducted to elucidate the implications of cognitive, psychiatric, MRI, and CSF abnormalities in this group.
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Affiliation(s)
- Cynthia McMahan
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Devon K Dietrich
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Elizabeth F Horne
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Erin Kelly
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Katrina Geannopoulos
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Peter Selim Siyahhan Julnes
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Lillian Ham
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Ulisses Santamaria
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Chuen-Yen Lau
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Tianxia Wu
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Hsing-Chuan Hsieh
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Anuradha Ganesan
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Catherine Berjohn
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Suad Kapetanovic
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Daniel S Reich
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Govind Nair
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Joseph Snow
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Brian K Agan
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Avindra Nath
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles
| | - Bryan R Smith
- From the Section of Infections of the Nervous System (C.M., D.K.D., E.F.H., E.K., K.G., P.S.S.J., A.N., B.R.S.), Office of the Clinical Director (T.W.),, and Translational Neuroradiology Section (D.S.R., G.N.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; University of Pittsburgh School of Medicine (C.M.), PA; Duke University School of Medicine (E.F.H.), Durham, NC; Virginia Commonwealth University School of Medicine (E.K.), Richmond; Department of Neurology (K.G.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; Department of Psychiatry (P.S.S.J.), Washington University School of Medicine, St. Louis, MO; Office of the Clinical Director (L.H., J.S.), National Institute of Mental Health, NIH, Bethesda, MD; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (L.H.); Leidos Biomedical Research (U.S.), Frederick, MD; HIV Dynamics and Replication Program (C.-Y.L.), NCI, NIH, Bethesda, Infectious Diseases Clinical Research Program (H.-C.H., A.G., B.K.A.), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda,; The Henry M. Jackson Foundation for the Advancement of Military Medicine (H.-C.H., A.G., B.K.A.), Bethesda,; Department of Medicine (A.G., B.K.A.), Uniformed Services University, Bethesda, MD; Division of Infectious Diseases (C.B.), Naval Medical Center San Diego, CA; and Department of Psychiatry and the Behavioral Sciences (S.K.), University of Southern California Keck School of Medicine, Los Angeles.
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O’Connor EE, Sullivan EV, Chang L, Hammoud DA, Wilson TW, Ragin AB, Meade CS, Coughlin J, Ances BM. Imaging of Brain Structural and Functional Effects in People With Human Immunodeficiency Virus. J Infect Dis 2023; 227:S16-S29. [PMID: 36930637 PMCID: PMC10022717 DOI: 10.1093/infdis/jiac387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Before the introduction of antiretroviral therapy, human immunodeficiency virus (HIV) infection was often accompanied by central nervous system (CNS) opportunistic infections and HIV encephalopathy marked by profound structural and functional alterations detectable with neuroimaging. Treatment with antiretroviral therapy nearly eliminated CNS opportunistic infections, while neuropsychiatric impairment and peripheral nerve and organ damage have persisted among virally suppressed people with HIV (PWH), suggesting ongoing brain injury. Neuroimaging research must use methods sensitive for detecting subtle HIV-associated brain structural and functional abnormalities, while allowing for adjustments for potential confounders, such as age, sex, substance use, hepatitis C coinfection, cardiovascular risk, and others. Here, we review existing and emerging neuroimaging tools that demonstrated promise in detecting markers of HIV-associated brain pathology and explore strategies to study the impact of potential confounding factors on these brain measures. We emphasize neuroimaging approaches that may be used in parallel to gather complementary information, allowing efficient detection and interpretation of altered brain structure and function associated with suboptimal clinical outcomes among virally suppressed PWH. We examine the advantages of each imaging modality and systematic approaches in study design and analysis. We also consider advantages of combining experimental and statistical control techniques to improve sensitivity and specificity of biotype identification and explore the costs and benefits of aggregating data from multiple studies to achieve larger sample sizes, enabling use of emerging methods for combining and analyzing large, multifaceted data sets. Many of the topics addressed in this article were discussed at the National Institute of Mental Health meeting "Biotypes of CNS Complications in People Living with HIV," held in October 2021, and are part of ongoing research initiatives to define the role of neuroimaging in emerging alternative approaches to identifying biotypes of CNS complications in PWH. An outcome of these considerations may be the development of a common neuroimaging protocol available for researchers to use in future studies examining neurological changes in the brains of PWH.
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Affiliation(s)
- Erin E O’Connor
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Linda Chang
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Ann B Ragin
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Coughlin
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Beau M Ances
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Alterations of gray and white matter volumes and cortical thickness in treated HIV-positive patients. Magn Reson Imaging 2023; 95:27-38. [PMID: 36265696 DOI: 10.1016/j.mri.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
Brain structural changes in HIV identified by voxel-based morphometry (VBM) alone could arise from a variety of causes that are difficult to distinguish without further information, such as cortical thickness (CT), gyrification index (GI) or sulcal depth (SD). Hence, our goal was to assess these additional metrics in HIV using high-resolution 3D T1-weighted images and investigate if surface-based morphometric (SBM) analysis would reveal significant changes in the gray matter (GM) and white matter (WM) volumes combined with alterations in cortical thickness (CT), gyrification index (GI), sulcal depth (SD). T1-w magnetization-prepared-rapid-acquisition gradient-echo (MP-RAGE) scans were acquired in 27 HIV-infected individuals on antiretroviral therapy (ART) and 15 HIV-uninfected healthy controls using a 3T MRI scanner equipped with a 16-channel head "receive" and a quadrature body "transmit" coil. Voxel-based and surface-based morphometric analyses were performed using the MATLAB based SPM Computational Anatomy Toolbox (CAT12.7(1700)). HIV-infected patients showed significantly altered GM and WM volumes, CT, GI, and SD, in multiple brain regions. This study showed the association of altered GM and WM volumes in local brain regions with the changes in region-wise CT, GI and SD measures of HIV-infected patients, especially in the parahippocampal and middle frontal regions as compared to uninfected healthy controls. The outcome of this study suggests that the findings of VBM may not necessarily indicate the volumetric shrinkage or increase alone, but might also be due to altered CT, GI, or SD. Correlation analysis showed a significantly accelerated gray matter loss with age in HIV-infected individuals compared to uninfected healthy controls.
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Nuzhnyi EP, Brsikyan LA, Fedotova EY, Illarioshkin SN. [Cerebellar degeneration associated with HIV infection]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:123-130. [PMID: 37315251 DOI: 10.17116/jnevro2023123051123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe the features of the clinical presentation and evaluate the incidence of HIV-associated cerebellar degeneration in patients with progressive cerebellar ataxia. MATERIAL AND METHODS Three hundred and seventy-seven patients with progressive cerebellar ataxia were studied. Brain MRI study, assessment by the Scale for the Assessment and Rating of Ataxia (SARA), screening for cognitive impairment by the Montreal Cognitive Assessment Scale (MoCA) were performed. In patients with HIV infection, autoimmune, deficient and other causes of ataxia, as well as opportunistic infections, multiple system atrophy and frequent forms of hereditary spinocerebellar ataxias were excluded. RESULTS Five patients (1.3%) were identified with a combination of cerebellar ataxia and HIV infection (2 men, 3 women, aged 31 to 52 years). The median duration of HIV infection was 5 years, the duration of ataxia was 1 year. In the clinical findings, in addition to progressive ataxia, pyramidal signs, dysphagia, less often ophthalmoparesis, dystonia, postural hand tremor, affective and mild cognitive impairment were observed. In three patients, brain MRI revealed signs of olivopontocerebellar atrophy, two patients had isolated cerebellar degeneration (mainly of the vermis). All patients received combination of antiretroviral therapy in various regimens, but despite this, ataxia was progressive. CONCLUSION HIV infection is a rare cause of cerebellar degeneration. This diagnosis remains a diagnosis of exclusion to this day. Cerebellar degeneration can occur and progress even after achieving a stable remission of HIV infection while taking highly active antiretroviral therapy.
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Affiliation(s)
- E P Nuzhnyi
- Research Center of Neurology, Moscow, Russia
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Nass SR, Ohene-Nyako M, Hahn YK, Knapp PE, Hauser KF. Neurodegeneration Within the Amygdala Is Differentially Induced by Opioid and HIV-1 Tat Exposure. Front Neurosci 2022; 16:804774. [PMID: 35600626 PMCID: PMC9115100 DOI: 10.3389/fnins.2022.804774] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
Opioid use disorder (OUD) is a critical problem that contributes to the spread of HIV and may intrinsically worsen neuroHIV. Despite the advent of combined antiretroviral therapies (cART), about half of persons infected with HIV (PWH) experience cognitive and emotional deficits that can be exacerbated by opioid abuse. HIV-1 Tat is expressed in the central nervous system (CNS) of PWH on cART and is thought to contribute to neuroHIV. The amygdala regulates emotion and memories associated with fear and stress and is important in addiction behavior. Notwithstanding its importance in emotional saliency, the effects of HIV and opioids in the amygdala are underexplored. To assess Tat- and morphine-induced neuropathology within the amygdala, male Tat transgenic mice were exposed to Tat for 8 weeks and administered saline and/or escalating doses of morphine twice daily (s.c.) during the last 2 weeks of Tat exposure. Eight weeks of Tat exposure decreased the acoustic startle response and the dendritic spine density in the basolateral amygdala, but not the central nucleus of the amygdala. In contrast, repeated exposure to morphine alone, but not Tat, increased the acoustic startle response and whole amygdalar levels of amyloid-β (Aβ) monomers and oligomers and tau phosphorylation at Ser396, but not neurofilament light chain levels. Co-exposure to Tat and morphine decreased habituation and prepulse inhibition to the acoustic startle response and potentiated the morphine-induced increase in Aβ monomers. Together, our findings indicate that sustained Tat and morphine exposure differentially promote synaptodendritic degeneration within the amygdala and alter sensorimotor processing.
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Affiliation(s)
- Sara R. Nass
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael Ohene-Nyako
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States
| | - Yun K. Hahn
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, United States
| | - Pamela E. Knapp
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, United States
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
| | - Kurt F. Hauser
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, United States
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Kurt F. Hauser,
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Zheng Y, Reiner B, Liu J, Xu L, Xiong H. Methamphetamine augments HIV-1 gp120 inhibition of synaptic transmission and plasticity in rat hippocampal slices: Implications for methamphetamine exacerbation of HIV-associated neurocognitive disorders. Neurobiol Dis 2022; 168:105712. [PMID: 35337950 PMCID: PMC9150446 DOI: 10.1016/j.nbd.2022.105712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
Methamphetamine (Meth) abuse and human immunodeficiency virus type 1 (HIV-1) infection are two major public health problems worldwide. Being frequently comorbid with HIV-1 infection, Meth abuse exacerbates neurocognitive impairment in HIV-1-infected individuals even in the era of combined antiretroviral therapy. While a large body of research have studied the individual effects of Meth and HIV-1 envelope glycoprotein 120 (gp120) in the brain, far less has focused on their synergistic influence. Moreover, it is well-documented that the hippocampus is the primary site of spatial learning and long-term memory formation. Dysregulation of activity-dependent synaptic transmission and plasticity in the hippocampus is believed to impair neurocognitive function. To uncover the underlying mechanisms for increased incidence and severity of HIV-1-associated neurocognitive disorders (HAND) in HIV-1-infected patients with Meth abuse, we investigated acute individual and combined effects of Meth (20 μM) and gp120 (200 pM) on synaptic transmission and plasticity in the CA1 region of young adult male rat hippocampus, a brain region known to be vulnerable to HIV-1 infection. Our results showed that acute localized application of Meth and gp120 each alone onto the CA1 region reduced short-term dynamics of input-output responses and frequency facilitation, and attenuated long-term potentiation (LTP) induced by either high frequency stimulation or theta burst stimulation. A synergistic augmentation on activity-dependent synaptic plasticity was observed when Meth and gp120 were applied in combination. Paired-pulse facilitation results exhibited an altered facilitation ratio, suggesting a presynaptic site of action. Further studies revealed an involvement of microglia NLRP3 inflammasome activation in Meth augmentation of gp120-mediated attenuation of LTP. Taken together, our results demonstrated Meth augmented gp120 attenuation of LTP in the hippocampus. Since LTP is the accepted experimental analog of learning at the synaptic level, such augmentation may underlie Meth exacerbation of HAND observed clinically.
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Affiliation(s)
- Ya Zheng
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | - Benjamin Reiner
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | - Jianuo Liu
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | - Linda Xu
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | - Huangui Xiong
- The Neurophysiology Laboratory, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA.
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Longitudinal trajectories of brain volume in combined antiretroviral therapy treated and untreated simian immunodeficiency virus-infected rhesus macaques. AIDS 2021; 35:2433-2443. [PMID: 34870927 PMCID: PMC8631166 DOI: 10.1097/qad.0000000000003055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We used simian immunodeficiency virus (SIV)-infected nonhuman primates to investigate longitudinal changes of brain volume caused by SIV and the effect of combined antiretroviral therapy (cART). In addition, the relation between viral load, immune status, and brain volume were explored. DESIGN A longitudinal study of two healthy controls, five SIVmac239-infected macaques received cART (SIV+cART+) at 40 days postinnoculation, and five SIVmac239-infected macaques received no therapy (SIV+cART-). METHODS Structural T1-weighted MRI, blood and cerebrospinal fluid testing were acquired at multiple time points for 48 weeks postinfection (wpi). Brain volume was estimated using region of interest (ROI)-based analysis. Volume differences were compared among three groups. Linear regression models tested the associations between brain volumes and biomarkers (viral load, CD4+ T-cell count, CD4+/CD8+ ratio). RESULTS In our model, brain volume alteration in SIV-infected macaques can be detected at 12 wpi in several brain regions. As the infection progresses, the SIV+cART- macaques displayed generalized gray matter atrophy at the endpoint. Though initiate cART right after acute infection, SIV+cART+ macaques still displayed brain atrophy but showed signs of reversibility. Plasma viral load is mainly associated with subcortical nucleus volume whereas CD4+ T-cell count and CD4+/CD8+ ratio in plasma were associated with widespread cortical volume. CONCLUSION The SIVmac239-infected Chinese origin macaque is a valid model for neuroHIV. Brain atrophy caused by SIV infection can be relieved, even reversed, by cART. Our model also provides new insights into understanding the pathogenesis of brain injury in people with HIV (PWH).
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O’Connor EE, Zeffiro TA, Lopez OL, Becker JT. Differential Effects of AIDS and Chronic Human Immunodeficiency Virus Infection on Gray Matter Volume. Clin Infect Dis 2021; 73:e2303-e2310. [PMID: 33053187 PMCID: PMC8492157 DOI: 10.1093/cid/ciaa1552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Age, human immunodeficiency virus (HIV) infection, illicit drug use, and central nervous system (CNS) opportunistic infections can affect brain structure, with the striatum being particularly sensitive to HIV effects. Nevertheless, the impact of non-CNS AIDS-defining illness (ADI) on brain structure has been less investigated. We examined ADI and HIV effects on brain volume. METHODS In a cross-sectional study, including 95 virally suppressed seropositive and 84 demographically matched, seronegative participants, we examined serostatus and ADI effects. Cortical and subcortical gray matter volume (GMV) regions of interest were estimated with computational neuroanatomy techniques applied to high-resolution, T1-weighted magnetic resonance imaging data. Linear regression was used to model HIV serostatus and ADI effects on global and regional GMV, adjusting for age, sex, CD4 nadir, drug use, and total intracranial volume. RESULTS While HIV serostatus was associated with lower striatal volume (B = -.59 [95% confidence interval {CI}, -1.08 to -.10]), co-occurring ADI was independently associated with lower striatal volume (B = -.73 [95% CI, -1.36 to -.09]). ADI was also associated with lower global (B = -19.35 [95% CI, -32.42 to -6.29]) and regional GMV. CONCLUSIONS While HIV infection is associated with a localized effect on striatal structure, having a prior ADI is a strong predictor of smaller global and regional GMV. The lack of interaction between HIV serostatus or ADI with age suggests that chronic HIV infection and ADI have independent effects on brain structure, without associated accelerated lower volume with age. ADI history should be incorporated into statistical adjustments in HIV neuroimaging analysis. These findings also lend support to current HIV treatment guidelines urging prompt antiretroviral therapy initiation after HIV diagnosis.
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Affiliation(s)
- Erin E O’Connor
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Thomas A Zeffiro
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James T Becker
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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12
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Cooley SA, Navid J, Wisch JK, Boerwinkle A, Doyle J, Paul RH, Ances BM. Relationships Between Viral Load, Neuroimaging, and NP in Persons Living With HIV. J Acquir Immune Defic Syndr 2021; 87:985-992. [PMID: 33675615 PMCID: PMC8192437 DOI: 10.1097/qai.0000000000002677] [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: 09/29/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study examined whether recommended viral load (VL) classifications by the Department of Health and Human Services map onto changes in brain integrity observed in people living with HIV (PLWH). METHODS Three hundred forty-nine PLWH on combination antiretroviral therapy meeting criteria for virologic suppression (VS) (VL ≤ 20 copies/mL; n = 206), "low-level viremia" (20-200 copies/mL; n = 63), or virologic failure (VF) (>200 copies/mL; n = 80) and 195 demographically similar HIV-negative controls were compared for cognition and brain volumes from 10 regions of interest that are sensitive to HIV. Changes in cognition and brain volumes were examined in a subset of PLWH (n = 132) who completed a follow-up evaluation (mean interval = 28 months) and had no change in treatment regimen. RESULTS Significant differences in cognition and brain volumes were observed between the HIV-negative control and VS groups compared with those in the VF groups, with few differences observed between the 3 PLWH subgroups. Longitudinally, PLWH who continued to have VF exhibited a greater decline in cognition and brain volumes compared with PLWH who remained with VS. Observed longitudinal changes in cognition correlated with brain volume changes. CONCLUSION PLWH with continued VF (consecutive VL measurements of >200 copies/mL) represent a cause for clinical concern and may benefit from change in treatment in addition to consideration of other potential etiologies of VF to reduce loss of brain integrity.
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Affiliation(s)
- Sarah A. Cooley
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Jaimie Navid
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Julie K. Wisch
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Anna Boerwinkle
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - John Doyle
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Robert H. Paul
- Department of Psychology, University of Missouri, Saint Louis, Saint Louis, MO 63134, USA
| | - Beau M. Ances
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
- Department of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University in Saint Louis, Saint Louis, MO 63110, USA
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13
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Nir TM, Fouche JP, Ananworanich J, Ances BM, Boban J, Brew BJ, Chaganti JR, Chang L, Ching CRK, Cysique LA, Ernst T, Faskowitz J, Gupta V, Harezlak J, Heaps-Woodruff JM, Hinkin CH, Hoare J, Joska JA, Kallianpur KJ, Kuhn T, Lam HY, Law M, Lebrun-Frénay C, Levine AJ, Mondot L, Nakamoto BK, Navia BA, Pennec X, Porges EC, Salminen LE, Shikuma CM, Surento W, Thames AD, Valcour V, Vassallo M, Woods AJ, Thompson PM, Cohen RA, Paul R, Stein DJ, Jahanshad N. Association of Immunosuppression and Viral Load With Subcortical Brain Volume in an International Sample of People Living With HIV. JAMA Netw Open 2021; 4:e2031190. [PMID: 33449093 PMCID: PMC7811179 DOI: 10.1001/jamanetworkopen.2020.31190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022] Open
Abstract
Importance Despite more widely accessible combination antiretroviral therapy (cART), HIV-1 infection remains a global public health challenge. Even in treated patients with chronic HIV infection, neurocognitive impairment often persists, affecting quality of life. Identifying the neuroanatomical pathways associated with infection in vivo may delineate the neuropathologic processes underlying these deficits. However, published neuroimaging findings from relatively small, heterogeneous cohorts are inconsistent, limiting the generalizability of the conclusions drawn to date. Objective To examine structural brain associations with the most commonly collected clinical assessments of HIV burden (CD4+ T-cell count and viral load), which are generalizable across demographically and clinically diverse HIV-infected individuals worldwide. Design, Setting, and Participants This cross-sectional study established the HIV Working Group within the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) consortium to pool and harmonize data from existing HIV neuroimaging studies. In total, data from 1295 HIV-positive adults were contributed from 13 studies across Africa, Asia, Australia, Europe, and North America. Regional and whole brain segmentations were extracted from data sets as contributing studies joined the consortium on a rolling basis from November 1, 2014, to December 31, 2019. Main Outcomes and Measures Volume estimates for 8 subcortical brain regions were extracted from T1-weighted magnetic resonance images to identify associations with blood plasma markers of current immunosuppression (CD4+ T-cell counts) or detectable plasma viral load (dVL) in HIV-positive participants. Post hoc sensitivity analyses stratified data by cART status. Results After quality assurance, data from 1203 HIV-positive individuals (mean [SD] age, 45.7 [11.5] years; 880 [73.2%] male; 897 [74.6%] taking cART) remained. Lower current CD4+ cell counts were associated with smaller hippocampal (mean [SE] β = 16.66 [4.72] mm3 per 100 cells/mm3; P < .001) and thalamic (mean [SE] β = 32.24 [8.96] mm3 per 100 cells/mm3; P < .001) volumes and larger ventricles (mean [SE] β = -391.50 [122.58] mm3 per 100 cells/mm3; P = .001); in participants not taking cART, however, lower current CD4+ cell counts were associated with smaller putamen volumes (mean [SE] β = 57.34 [18.78] mm3 per 100 cells/mm3; P = .003). A dVL was associated with smaller hippocampal volumes (d = -0.17; P = .005); in participants taking cART, dVL was also associated with smaller amygdala volumes (d = -0.23; P = .004). Conclusions and Relevance In a large-scale international population of HIV-positive individuals, volumes of structures in the limbic system were consistently associated with current plasma markers. Our findings extend beyond the classically implicated regions of the basal ganglia and may represent a generalizable brain signature of HIV infection in the cART era.
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Affiliation(s)
- Talia M. Nir
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jean-Paul Fouche
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jintanat Ananworanich
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- South East Asian Research Collaboration in HIV, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- AIGHD, University of Amsterdam, Amsterdam, the Netherlands
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Jasmina Boban
- Faculty of Medicine, Department of Radiology, University of Novi Sad, Novi Sad, Serbia
| | - Bruce J. Brew
- Department of Neurology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Department of Immunology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Peter Duncan Neurosciences Unit, St Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia
| | - Joga R. Chaganti
- Department of Medical Imaging, St Vincent’s Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Chang
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Neurology, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Lucette A. Cysique
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ernst
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Faskowitz
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Vikash Gupta
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington
| | | | - Charles H. Hinkin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Jacqueline Hoare
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kalpana J. Kallianpur
- Hawaii Center for AIDS, University of Hawaii, Honolulu
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii, Honolulu
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Hei Y. Lam
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Meng Law
- Department of Radiology, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Christine Lebrun-Frénay
- Neurology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | | | - Lydiane Mondot
- Department of Radiology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | - Beau K. Nakamoto
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
| | - Bradford A. Navia
- Infection Unit, School of Public Health, Tufts University Medical School, Boston, Massachusetts
| | - Xavier Pennec
- Cote d’Azur University, Sophia Antipolis, France
- Epione Team, Inria, Sophia Antipolis Mediterrannee, Sophia Antipolis, France
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Lauren E. Salminen
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | | | - Wesley Surento
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - April D. Thames
- Department of Psychology, University of Southern California, Los Angeles
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, San Francisco, California
| | - Matteo Vassallo
- Internal Medicine/Infectious Diseases, Centre Hospitalier de Cannes, Cannes, France
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Ronald A. Cohen
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Robert Paul
- Psychological Sciences, Missouri Institute of Mental Health, University of Missouri, St Louis
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
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Thurman M, Johnson S, Acharya A, Pallikkuth S, Mahesh M, Byrareddy SN. Biomarkers of Activation and Inflammation to Track Disparity in Chronological and Physiological Age of People Living With HIV on Combination Antiretroviral Therapy. Front Immunol 2020; 11:583934. [PMID: 33162998 PMCID: PMC7581935 DOI: 10.3389/fimmu.2020.583934] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
With advancement, prompt use, and increasing accessibility of antiretroviral therapy, people with HIV are living longer and have comparable lifespans to those negative for HIV. However, people living with HIV experience tradeoffs with quality of life often developing age-associated co-morbid conditions such as cancers, cardiovascular diseases, or neurodegeneration due to chronic immune activation and inflammation. This creates a discrepancy in chronological and physiological age, with HIV-infected individuals appearing older than they are, and in some contexts ART-associated toxicity exacerbates this gap. The complexity of the accelerated aging process in the context of HIV-infection highlights the need for greater understanding of biomarkers involved. In this review, we discuss markers identified in different anatomical sites of the body including periphery, brain, and gut, as well as markers related to DNA that may serve as reliable predictors of accelerated aging in HIV infected individuals as it relates to inflammatory state and immune activation.
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Affiliation(s)
- Michellie Thurman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Samuel Johnson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Suresh Pallikkuth
- Department of Microbiology and Immunology, University of Miami School of Medicine, Miami, FL, United States
| | - Mohan Mahesh
- Southwest National Primate Research Institute, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
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15
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Bell RP, Towe SL, Lalee Z, Huettel SA, Meade CS. Neural sensitivity to risk in adults with co-occurring HIV infection and cocaine use disorder. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:859-872. [PMID: 32648056 PMCID: PMC7773226 DOI: 10.3758/s13415-020-00806-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Persons with co-occurring HIV infection and cocaine use disorder tend to engage in riskier decision-making. However, the neural correlates of sensitivity to risk are not well-characterized in this population. The purpose of this study was to examine the neural interaction effects of HIV infection and cocaine use disorder to sensitivity to risk. The sample included 79 adults who differed on HIV status and cocaine use disorder. During functional magnetic resonance imaging (fMRI), participants completed a Wheel of Fortune (WoF) task that assessed neural activation in response to variations of monetary risk (i.e., lower probability of winning a larger reward). Across groups, neural activation to increasing risk was in cortical and subcortical regions similar to previous investigations using the WoF in nondrug-using populations. Our analyses showed that there was a synergistic effect between HIV infection and cocaine use in the left precuneus/posterior cingulate cortex and hippocampus, and right postcentral gyrus, lateral occipital cortex, cerebellum, and posterior parietal cortex. HIV+ individuals with cocaine use disorder displayed neural hyperactivation to increasing risk that was not observed in the other groups. These results support a synergistic effect of co-occurring HIV infection and cocaine dependence in neural processing of risk probability that may reflect compensation. Future studies can further investigate and validate how neural activation to increasing risk is associated with risk-taking behavior.
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Affiliation(s)
- Ryan P Bell
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27708, USA
| | - Sheri L Towe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27708, USA
| | - Zahra Lalee
- Duke University Department of Psychology and Neuroscience, Durham, NC, 27708, USA
| | - Scott A Huettel
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27708, USA
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27708, USA
- Duke University Department of Psychology and Neuroscience, Durham, NC, 27708, USA
| | - Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27708, USA.
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27708, USA.
- Duke University Department of Psychology and Neuroscience, Durham, NC, 27708, USA.
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16
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The association of peripheral immune markers with brain cortical thickness and surface area in South African people living with HIV. J Neurovirol 2020; 26:908-919. [PMID: 32661895 DOI: 10.1007/s13365-020-00873-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/01/2020] [Accepted: 06/15/2020] [Indexed: 12/22/2022]
Abstract
A spectrum of cognitive impairments known as HIV-associated neurocognitive disorders (HAND) are consequences of the effects of HIV-1 within the central nervous system. Regardless of treatment status, an aberrant chronic neuro-immune regulation is a crucial contributor to the development of HAND. However, the extent to which inflammation affects brain structures critical for cognitive status remains unclear. The present study aimed to determine associations of peripheral immune markers with cortical thickness and surface area. Participants included 65 treatment-naïve HIV-positive individuals and 26 HIV-negative controls. Thickness and surface area of all cortical regions were derived using automated parcellation of T1-weighted images acquired at 3 T. Peripheral immune markers included C-C motif ligand 2 (CCL2), matrix metalloproteinase 9 (MMP9), neutrophil gelatinase-associated lipocalin (NGAL), thymidine phosphorylase (TYMP), transforming growth factor (TGF)-β1, and vascular endothelial growth factor (VEGF), which were measured using enzyme-linked immunosorbent assays. Associations of these markers with thickness and surface area of cortical regions were evaluated. A mediation analysis examined whether associations of inflammatory markers with cognitive functioning were mediated by brain cortical thickness and surface area. After controlling for multiple comparisons, higher NGAL was associated with reduced thickness of the bilateral orbitofrontal cortex in HIV-positive participants. The association of NGAL with worse motor function was mediated by cortical thickness of the bilateral orbitofrontal region. Taken together, this study suggests that NGAL plays a potential role in the neuropathophysiology of neurocognitive impairments of HIV.
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17
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Omeragic A, Kayode O, Hoque MT, Bendayan R. Potential pharmacological approaches for the treatment of HIV-1 associated neurocognitive disorders. Fluids Barriers CNS 2020; 17:42. [PMID: 32650790 PMCID: PMC7350632 DOI: 10.1186/s12987-020-00204-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
HIV associated neurocognitive disorders (HAND) are the spectrum of cognitive impairments present in patients infected with human immunodeficiency virus type 1 (HIV-1). The number of patients affected with HAND ranges from 30 to 50% of HIV infected individuals and although the development of combinational antiretroviral therapy (cART) has improved longevity, HAND continues to pose a significant clinical problem as the current standard of care does not alleviate or prevent HAND symptoms. At present, the pathological mechanisms contributing to HAND remain unclear, but evidence suggests that it stems from neuronal injury due to chronic release of neurotoxins, chemokines, viral proteins, and proinflammatory cytokines secreted by HIV-1 activated microglia, macrophages and astrocytes in the central nervous system (CNS). Furthermore, the blood-brain barrier (BBB) not only serves as a route for HIV-1 entry into the brain but also prevents cART therapy from reaching HIV-1 brain reservoirs, and therefore could play an important role in HAND. The goal of this review is to discuss the current data on the epidemiology, pathology and research models of HAND as well as address the potential pharmacological treatment approaches that are being investigated.
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Affiliation(s)
- Amila Omeragic
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Room 1001, Toronto, ON, M5S 3M2, Canada
| | - Olanre Kayode
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Room 1001, Toronto, ON, M5S 3M2, Canada
| | - Md Tozammel Hoque
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Room 1001, Toronto, ON, M5S 3M2, Canada
| | - Reina Bendayan
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Room 1001, Toronto, ON, M5S 3M2, Canada.
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Adeli E, Li X, Kwon D, Zhang Y, Pohl KM. Logistic Regression Confined by Cardinality-Constrained Sample and Feature Selection. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2020; 42:1713-1728. [PMID: 30835210 PMCID: PMC7331794 DOI: 10.1109/tpami.2019.2901688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Many vision-based applications rely on logistic regression for embedding classification within a probabilistic context, such as recognition in images and videos or identifying disease-specific image phenotypes from neuroimages. Logistic regression, however, often performs poorly when trained on data that is noisy, has irrelevant features, or when the samples are distributed across the classes in an imbalanced setting; a common occurrence in visual recognition tasks. To deal with those issues, researchers generally rely on ad-hoc regularization techniques or model a subset of these issues. We instead propose a mathematically sound logistic regression model that selects a subset of (relevant) features and (informative and balanced) set of samples during the training process. The model does so by applying cardinality constraints (via l0-'norm' sparsity) on the features and samples. l0 defines sparsity in mathematical settings but in practice has mostly been approximated (e.g., via l1 or its variations) for computational simplicity. We prove that a local minimum to the non-convex optimization problems induced by cardinality constraints can be computed by combining block coordinate descent with penalty decomposition. On synthetic, image recognition, and neuroimaging datasets, we show that the accuracy of the method is higher than alternative methods and classifiers commonly used in the literature.
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Affiliation(s)
| | | | - Dongjin Kwon
- Center for Health Sciences, SRI International, Menlo Park, CA, 94025
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305
| | - Yong Zhang
- Vancouver Research Center, Huawei, Burnaby, BC, Canada V5C 6S7
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Popov M, Molsberry SA, Lecci F, Junker B, Kingsley LA, Levine A, Martin E, Miller E, Munro CA, Ragin A, Seaberg E, Sacktor N, Becker JT. Brain structural correlates of trajectories to cognitive impairment in men with and without HIV disease. Brain Imaging Behav 2020; 14:821-829. [PMID: 30623289 PMCID: PMC6616021 DOI: 10.1007/s11682-018-0026-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There are distinct trajectories to cognitive impairment among participants in the Multicenter AIDS Cohort Study (MACS). Here we analyzed the relationship between regional brain volumes and the individual trajectories to impairment in a subsample (n = 302) of the cohort. 302 (167 HIV-infected; mean age = 55.7 yrs.; mean education: 16.2 yrs.) of the men enrolled in the MACS MRI study contributed data to this analysis. We used voxel-based morphometry (VBM) to segment the brain images to analyze gray and white matter volume at the voxel-level. A Mixed Membership Trajectory Model had previously identified three distinct profiles, and each study participant had a membership weight for each of these three trajectories. We estimated VBM model parameters for 100 imputations, manually performed the post-hoc contrasts, and pooled the results. We examined the associations between brain volume at the voxel level and the MMTM membership weights for two profiles: one considered "unhealthy" and the other considered "Premature aging." The unhealthy profile was linked to the volume of the posterior cingulate gyrus/precuneus, the inferior frontal cortex, and the insula, whereas the premature aging profile was independently associated with the integrity of a portion of the precuneus. Trajectories to cognitive impairment are the result, in part, of atrophy in cortical regions linked to normal and pathological aging. These data suggest the possibility of predicting cognitive morbidity based on patterns of CNS atrophy.
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Affiliation(s)
- Mikhail Popov
- Department of Psychiatry, University of Pittsburgh, Suite 830, 3501 Forbes Avenue, Pittsburgh, PA, 15213, USA
- Wikimedia Foundation, San Francisco, CA, USA
| | - Samantha A Molsberry
- Department of Psychiatry, University of Pittsburgh, Suite 830, 3501 Forbes Avenue, Pittsburgh, PA, 15213, USA
- Population Health Sciences, Harvard University, Cambridge, MA, USA
| | - Fabrizio Lecci
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA, USA
- Uber, New York, NY, USA
| | - Brian Junker
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lawrence A Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew Levine
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Eileen Martin
- Department of Psychiatry, Rush Medical School, Chicago, IL, USA
| | - Eric Miller
- Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
| | - Cynthia A Munro
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Ragin
- Department of Radiology, Northwestern University, Evanston, IL, USA
| | - Eric Seaberg
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ned Sacktor
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James T Becker
- Department of Psychiatry, University of Pittsburgh, Suite 830, 3501 Forbes Avenue, Pittsburgh, PA, 15213, USA.
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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Regional brain volumetric changes despite 2 years of treatment initiated during acute HIV infection. AIDS 2020; 34:415-426. [PMID: 31725432 DOI: 10.1097/qad.0000000000002436] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess changes in regional brain volumes after 24 months among individuals who initiated combination antiretroviral therapy (cART) within weeks of HIV exposure. DESIGN Prospective cohort study of Thai participants in the earliest stages of HIV-1infection. METHODS Thirty-four acutely HIV-infected individuals (AHI; Fiebig I-V) underwent brain magnetic resonance (MR) imaging and MR spectroscopy at 1.5 T and immediately initiated cART. Imaging was repeated at 24 months. Regional brain volumes were quantified using FreeSurfer's longitudinal pipeline. Voxel-wise analyses using tensor-based morphometry (TBM) were conducted to verify regional assessments. Baseline brain metabolite levels, blood and cerebrospinal fluid biomarkers assessed by ELISA, and peripheral blood monocyte phenotypes measured by flow cytometry were examined as predictors of significant volumetric change. RESULTS Participants were 31 ± 8 years old. The estimated mean duration of infection at cART initiation was 15 days. Longitudinal analyses revealed reductions in volumes of putamen (P < 0.001) and caudate (P = 0.006). TBM confirmed significant atrophy in the putamen and caudate, and also in thalamic and hippocampal regions. In exploratory post-hoc analyses, higher baseline frequency of P-selectin glycoprotein ligand-1 (PSGL-1)-expressing total monocytes correlated with greater caudate volumetric decrease (ρ = 0.67, P = 0.017), whereas the baseline density of PSGL-1-expressing inflammatory (CD14CD16) monocytes correlated with putamen atrophy (ρ = 0.65, P = 0.022). CONCLUSION Suppressive cART initiated during AHI may not prevent brain atrophy. Volumetric decrease appears greater than expected age-related decline, although examination of longitudinal change in demographically similar HIV-uninfected Thai individuals is needed. Mechanisms underlying progressive HIV-related atrophy may include early activation and enhanced adhesive and migratory capacity of circulating monocyte populations.
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Use of Neuroimaging to Inform Optimal Neurocognitive Criteria for Detecting HIV-Associated Brain Abnormalities. J Int Neuropsychol Soc 2020; 26:147-162. [PMID: 31576785 PMCID: PMC7015796 DOI: 10.1017/s1355617719000985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Frascati international research criteria for HIV-associated neurocognitive disorders (HAND) are controversial; some investigators have argued that Frascati criteria are too liberal, resulting in a high false positive rate. Meyer et al. recommended more conservative revisions to HAND criteria, including exploring other commonly used methodologies for neurocognitive impairment (NCI) in HIV including the global deficit score (GDS). This study compares NCI classifications by Frascati, Meyer, and GDS methods, in relation to neuroimaging markers of brain integrity in HIV. METHOD Two hundred forty-one people living with HIV (PLWH) without current substance use disorder or severe (confounding) comorbid conditions underwent comprehensive neurocognitive testing and brain structural magnetic resonance imaging and magnetic resonance spectroscopy. Participants were classified using Frascati criteria versus Meyer criteria: concordant unimpaired [Frascati(Un)/Meyer(Un)], concordant impaired [Frascati(Imp)/Meyer(Imp)], or discordant [Frascati(Imp)/Meyer(Un)] which were impaired via Frascati criteria but unimpaired via Meyer criteria. To investigate the GDS versus Meyer criteria, the same groupings were utilized using GDS criteria instead of Frascati criteria. RESULTS When examining Frascati versus Meyer criteria, discordant Frascati(Imp)/Meyer(Un) individuals had less cortical gray matter, greater sulcal cerebrospinal fluid volume, and greater evidence of neuroinflammation (i.e., choline) than concordant Frascati(Un)/Meyer(Un) individuals. GDS versus Meyer comparisons indicated that discordant GDS(Imp)/Meyer(Un) individuals had less cortical gray matter and lower levels of energy metabolism (i.e., creatine) than concordant GDS(Un)/Meyer(Un) individuals. In both sets of analyses, the discordant group did not differ from the concordant impaired group on any neuroimaging measure. CONCLUSIONS The Meyer criteria failed to capture a substantial portion of PLWH with brain abnormalities. These findings support continued use of Frascati or GDS criteria to detect HIV-associated CNS dysfunction.
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Kallianpur KJ, Walker M, Gerschenson M, Shikuma CM, Gangcuangco LMA, Kohorn L, Libutti DE, Nir TM, Jahanshad N, Thompson PM, Paul R. Systemic Mitochondrial Oxidative Phosphorylation Protein Levels Correlate with Neuroimaging Measures in Chronically HIV-Infected Individuals. AIDS Res Hum Retroviruses 2019; 36:83-91. [PMID: 31617381 DOI: 10.1089/aid.2019.0240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Few studies have examined systemic mitochondrial function in conjunction with brain imaging in human immunodeficiency virus (HIV) disease. Oxidative phosphorylation enzyme protein levels of peripheral blood mononuclear cells were measured in association with neuroimaging indices in 28 HIV+ individuals. T1-weighted magnetic resonance imaging yielded volumes of seven brain regions of interest; diffusion tensor imaging determined fractional anisotropy (FA) and mean diffusivity (MD) in the corpus callosum (CC). Higher nicotinamide adenine dinucleotide dehydrogenase levels correlated with lower volumes of thalamus (p = .005) and cerebral white matter (p = .049) and, in the CC, with lower FA (p = .011, body; p = .005, genu; p = .009, total CC) and higher MD (p = .023, body; p = .035, genu; p = .019, splenium; p = .014, total CC). Greater cytochrome c oxidase levels correlated with lower thalamic (p = .034) and cerebellar gray matter (p = .021) volumes. The results indicate that systemic mitochondrial cellular bioenergetics are associated with brain health in HIV.
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Affiliation(s)
- Kalpana J. Kallianpur
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
- Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii
| | - Maegen Walker
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Mariana Gerschenson
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Cecilia M. Shikuma
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Louie Mar A. Gangcuangco
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Lindsay Kohorn
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Daniel E. Libutti
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Talia M. Nir
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck USC School of Medicine, Marina del Rey, California
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck USC School of Medicine, Marina del Rey, California
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck USC School of Medicine, Marina del Rey, California
| | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri
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23
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Sanford R, Fellows LK, Ances BM, Collins DL. Association of Brain Structure Changes and Cognitive Function With Combination Antiretroviral Therapy in HIV-Positive Individuals. JAMA Neurol 2019; 75:72-79. [PMID: 29131878 DOI: 10.1001/jamaneurol.2017.3036] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Despite the introduction of combination antiretroviral therapy (cART), HIV-associated neurocognitive disorders continue to be a problem for treated HIV-positive individuals. The cause of this impairment remains unclear. Objective To determine if detectable brain changes occur during a 2-year period in HIV-positive individuals who were aviremic and treated with cART. Design, Setting, and Participants In this longitudinal case-control study, participants underwent neuroimaging and neuropsychological assessment approximately 2 years apart. Data were collected from October 26, 2011, to March 1, 2016. Data from 92 HIV-positive individuals were acquired at Washington University in St Louis from ongoing studies conducted in the infectious disease clinic and AIDS Clinical Trial Unit. A total of 55 HIV-negative control participants were recruited from the St Louis community and a research participant registry. A total of 48 HIV-positive individuals who were aviremic and treated with cART and 31 demographically similar HIV-negative controls met the study requirements and were included in the analyses. Main Outcomes and Measures Brain volumes were extracted with tensor-based and voxel-based morphometry and cortical modeling. Raw scores from neuropsychological tests quantified cognitive performance. Multivariable mixed-effects models assessed the effect of HIV serostatus on brain volumes and cognitive performance, and determined if HIV serostatus affected how these measures changed over time. With HIV-positive participants, linear regression models tested whether brain volumes and cognitive performance were associated with measures of infection severity and duration of infection. Results The 2 groups were demographically similar (HIV-positive group: 23 women and 25 men; mean [SD] age, 47.7 [13.2] years; mean [SD] educational level, 13.3 [3.4] years; and HIV-negative group, 16 women and 15 men; mean [SD] age, 51.2 [12.9] years; mean [SD] educational level, 14.5 [2.1] years). The HIV-positive participants had poorer neuropsychological test scores compared with controls on the Trail Making Test Part A (5.9 seconds; 95% CI, 1.5-10.3; P = .01), Trail Making Test Part B (27.3 seconds; 95% CI, 15.0-39.6; P < .001), Digit Symbol Substitution Task (-12.5 marks; 95% CI, -18.9 to -6.0; P < .001), Letter-Number Sequencing (-2.5 marks; 95% CI, -3.7 to -1.3; P < .001), Letter Fluency (-6.6 words; 95% CI, -11.5 to -1.6; P = .01), and Hopkins Verbal Learning Test-Revised immediate recall (-2.4 words; 95% CI, -4.4 to -0.4; P = .05), after adjusting for age, sex, and educational level. Only changes in Trail Making Test Part A significantly differed between the groups. Cortical thickness and subcortical volumes were smaller in HIV-positive individuals compared with controls. However, changes in brain volume over time were similar between the groups. Conclusions and Relevance These findings are consistent with the idea that cognitive and structural brain changes may occur early after seroconversion, and argue that maintaining aviremia with cART can prevent or minimize progressive brain injury.
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Affiliation(s)
- Ryan Sanford
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Beau M Ances
- Department of Neurology, Washington University, St Louis, Missouri
| | - D Louis Collins
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
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O'Connor E, Zeffiro T. Is treated HIV infection still toxic to the brain? PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:259-284. [PMID: 31481166 DOI: 10.1016/bs.pmbts.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clinically apparent HIV infection, accompanied by CNS opportunistic infections and HIV encephalopathy, was often associated with profound structural and functional brain effects prior to the introduction of anti-retroviral therapy (ART). With treatment, HIV structural and functional brain effects are smaller and have not been as easily detected. With near complete elimination of CNS opportunistic infections, the HIV neuroimaging research community now grapples with the problem of detecting subtler structural and functional changes against a background of persisting confounds, such as comorbidities and clinical features common in the HIV infected population. This situation also raises the question of whether imaging measure changes that are reported as HIV brain effects are purely related to viral infection, rather than originating from confounding effects that might include age, substance use, hepatitis C coinfection, cerebrovascular risk factors, ART, premorbid cognitive skills and illness duration. In addition to cohort characteristics, variation in image acquisition and analysis techniques may also contribute to study outcome heterogeneity. We review the potential effects of these confounds on detection of HIV infection effects and discuss strategies to avoid or mitigate the effects of these confounds. We then present a systematic approach to measurement, design and analysis in HIV neuroimaging studies, combining both experimental and statistical control techniques to determine if HIV infection effects persist, fluctuate or worsen in groups achieving viral suppression from ART.
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Affiliation(s)
- Erin O'Connor
- University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Thomas Zeffiro
- University of Maryland School of Medicine, Baltimore, MD, United States.
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25
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Israel SM, Hassanzadeh-Behbahani S, Turkeltaub PE, Moore DJ, Ellis RJ, Jiang X. Different roles of frontal versus striatal atrophy in HIV-associated neurocognitive disorders. Hum Brain Mapp 2019; 40:3010-3026. [PMID: 30921494 DOI: 10.1002/hbm.24577] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 01/26/2023] Open
Abstract
Gray matter (GM) atrophy is frequently detected in persons living with HIV, even in the era of combination antiretroviral therapy (cART), but the specificity of regions affected remains elusive. For instance, which regions are consistently affected in HIV? In addition, atrophy at which regions is frequently associated with neurocognitive impairment in HIV? Resolving these questions can potentially help to establish the possible neural profiles of HIV-associated neurocognitive disorders (HAND) severity, which currently is solely defined by neurobehavioral assessments. Here, we addressed these questions using a novel meta-analysis technique, the colocalization-likelihood estimation (CLE) technique, to quantitatively synthesize the findings of GM atrophy in HIV+ adults. Twenty-one of 386 studies published between 1988 and November 2017 and identified in PubMed were selected, plus four identified in other resources. In the end, 25 studies (1,370 HIV+ adults, 889 HIV- controls) were included in the meta-analysis. This technique revealed that GM atrophy in HIV+ adults was dominated by two distinct but nonexclusive profiles: frontal (including anterior cingulate cortex, [ACC]) atrophy, which was associated withHIV-disease and consistently differentiated HIV+ adults from HIV- controls; and caudate/striatum atrophy, which was associated with neurocognitive impairment. The critical role of caudate/striatum atrophy in neurocognitive impairment was further supported by a separate data analysis, which examined the findings of correlation analyses between GM and neurocognitive performance. These results suggest that the frontal lobe and the striatum play critical but differential roles in HAND. A neural model of HAND severity was proposed with several testable predictions.
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Affiliation(s)
- Sarah M Israel
- Department of Neuroscience, Georgetown University Medical Center, Washington, District of Columbia
| | | | - Peter E Turkeltaub
- Department of Neurology, Georgetown University Medical Center, Washington, District of Columbia
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, California
| | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California, San Diego, California
| | - Xiong Jiang
- Department of Neuroscience, Georgetown University Medical Center, Washington, District of Columbia
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26
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Atrophic brain signatures of mild forms of neurocognitive impairment in virally suppressed HIV infection. AIDS 2019; 33:55-66. [PMID: 30325766 DOI: 10.1097/qad.0000000000002042] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE There is a lack of evidence for the neurobiological underpinning of asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorders (MNDs) in virally suppressed HIV-positive persons. We hypothesized that such mild impairment would be associated with focal brain atrophy. DESIGN A cross-sectional observational study. METHODS Eighty-five virally suppressed HIV-positive and 44 geographically, demographically and lifestyle comparable HIV-negative men underwent anatomical MRI, neuropsychological evaluation and HIV laboratory tests. Volumes of interest (VOI) from magnetic resonance (MR) images were extracted using FreeSurfer to yield grey and white matter volumes in regions associated with HIV-related brain injury. HIV-associated neurocognitive disorder (HAND) [ANI = 38%, MND = 13%, HIV-associated dementia (HAD) = 3% vs. neuropsychologically-normal] was classified using Global Deficit Score (GDS ≥0.5) and functional decline. Effects of HIV status on VOI were assessed with multivariate analyses controlling for family-wise error. HAND categories and HIV biomarker effects on VOI were assessed with multiple regression. RESULTS Relative to the HIV-negative group, the HIV-positive group demonstrated subcortical grey (d = 0.50-0.60) and white matter (d = 0.43-0.69) atrophy, with relative cortical sparing (d = 0.23). ANI showed reduced medial-orbitofrontal white matter compared with NP-normal cases (P = 0.04). MND showed enlarged lateral ventricles (P = 0.02) and reduced caudal-middle-frontal white matter (P = 0.04), caudal-anterior-cingulate white matter (P = 0.006) and inferior-parietal white matter (P = 0.04) compared with neuropsychologically normal. Across the HIV-positive group, lower CD4+/CD8 ratio was the strongest predictor of atrophy in subcortical regions. Across HAND categories, HIV disease duration uniquely predicted greater medial-orbitofrontal white matter atrophy only in ANI (P = 0.002). CONCLUSION ANI shows specific frontal white matter atrophy to which HIV disease duration is a unique contributor. MND is characterized by more widespread subcortical atrophy.
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Adeli E, Kwon D, Zhao Q, Pfefferbaum A, Zahr NM, Sullivan EV, Pohl KM. Chained regularization for identifying brain patterns specific to HIV infection. Neuroimage 2018; 183:425-437. [PMID: 30138676 PMCID: PMC6197908 DOI: 10.1016/j.neuroimage.2018.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 12/21/2022] Open
Abstract
Human Immunodeficiency Virus (HIV) infection continues to have major adverse public health and clinical consequences despite the effectiveness of combination Antiretroviral Therapy (cART) in reducing HIV viral load and improving immune function. As successfully treated individuals with HIV infection age, their cognition declines faster than reported for normal aging. This phenomenon underlines the importance of improving long-term care, which requires a better understanding of the impact of HIV on the brain. In this paper, automated identification of patients and brain regions affected by HIV infection are modeled as a classification problem, whose solution is determined in two steps within our proposed Chained-Regularization framework. The first step focuses on selecting the HIV pattern (i.e., the most informative constellation of brain region measurements for distinguishing HIV infected subjects from healthy controls) by constraining the search for the optimal parameter setting of the classifier via group sparsity (ℓ2,1-norm). The second step improves classification accuracy by constraining the parameterization with respect to the selected measurements and the Euclidean regularization (ℓ2-norm). When applied to the cortical and subcortical structural Magnetic Resonance Images (MRI) measurements of 65 controls and 65 HIV infected individuals, this approach is more accurate in distinguishing the two cohorts than more common models. Finally, the brain regions of the identified HIV pattern concur with the HIV literature that uses traditional group analysis models.
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Affiliation(s)
- Ehsan Adeli
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Dongjin Kwon
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA; Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Qingyu Zhao
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA; Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA; Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Kilian M Pohl
- Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA.
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28
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Sanford R, Ances BM, Meyerhoff DJ, Price RW, Fuchs D, Zetterberg H, Spudich S, Collins DL. Longitudinal Trajectories of Brain Volume and Cortical Thickness in Treated and Untreated Primary Human Immunodeficiency Virus Infection. Clin Infect Dis 2018; 67:1697-1704. [PMID: 29697762 PMCID: PMC6233681 DOI: 10.1093/cid/ciy362] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) penetrates the brain in early infection. We used neuroimaging to longitudinally examine the impact of HIV and combination antiretroviral therapy (cART) on the brain in treated and untreated HIV-infected participants, starting in primary HIV infection (PHI). Methods Sixty-five participants, enrolled during PHI, underwent longitudinal magnetic resonance imaging, 30 of whom commenced cART during follow-up. Cross-sectional data from 16 patients with chronic HIV infection (CHI) and 19 HIV-uninfected participants were included for comparison. Brain volume and cortical thickness were estimated using tensor-based morphometry and cortical modeling, respectively. Mixed-effects models longitudinally mapped structural brain changes before and after cART. The relationship between brain morphometry estimates and blood and cerebrospinal fluid (CSF) biomarkers were also tested. Region-of-interest analyses were performed to compare brain morphometry estimates between the groups. Results Prior to cART, longer duration of untreated infection in PHI correlated with volume loss in the thalamus, caudate, and cerebellum, and with cortical thinning in the frontal and temporal lobes and cingulate cortex. After cART, no further volume loss was observed. However, small increases of cortical thickness in the frontal and temporal lobe correlated with longer cART duration. No correlations were observed with blood or CSF measures. The PHI group did not have different brain morphometric measures compared to the HIV-uninfected group, but had larger volumes in the thalamus, caudate, putamen, and cortical gray matter compared with CHI participants. Conclusions Subcortical atrophy and cortical thinning occur during untreated infection but may be arrested by cART. These findings emphasize the importance of early cART.
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Affiliation(s)
- Ryan Sanford
- Department of Biological and Biomedical Engineering, Montreal Neurological Institute, Quebec, Canada
| | - Beau M Ances
- Department of Neurology, University of Washington, St Louis, Missouri
| | | | - Richard W Price
- Department of Neurology, University of California, San Francisco School of Medicine, Austria
| | - Dietmar Fuchs
- Division of Biological Chemistry, Innsbruck Medical University, Austria
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, Institute of Neurology, United Kingdom
- UK Dementia Research Institute, University College London, United Kingdom
| | - Serena Spudich
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - D Louis Collins
- Department of Biological and Biomedical Engineering, Montreal Neurological Institute, Quebec, Canada
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Abstract
: Abnormalities in cerebral MRI are frequently reported in persons living with HIV (PLWH). We compared clinical cerebral MRI reports in 59 PLWH and 29 lifestyle matched controls. Although clinical abnormalities were highly prevalent (47.7%), and included white-matter lesions (46.6%), microvascular disease (22.7%) and cerebral volume loss (11.4%), no differences were apparent between PLWH and controls, with abnormalities being associated with age and hypertension rather than HIV serostatus.
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Bell RP, Barnes LL, Towe SL, Chen NK, Song AW, Meade CS. Structural connectome differences in HIV infection: brain network segregation associated with nadir CD4 cell count. J Neurovirol 2018; 24:454-463. [PMID: 29687404 PMCID: PMC6105458 DOI: 10.1007/s13365-018-0634-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 01/21/2023]
Abstract
This study investigated structural brain organization using diffusion tensor imaging (DTI) in 35 HIV-positive and 35 HIV-negative individuals. We used global and nodal graph theory metrics to investigate whether HIV was associated with differences in brain network organization based on fractional anisotropy (FA) and mean diffusivity (MD). Participants also completed a comprehensive neuropsychological testing battery. For global network metrics, HIV-positive individuals displayed a lower FA clustering coefficient relative to HIV-negative individuals. For nodal network metrics, HIV-positive individuals had less MD nodal degree in the left thalamus. Within HIV-positive individuals, the FA global clustering coefficient was positively correlated with nadir CD4 cell count. Across the sample, cognitive performance was negatively correlated with characteristic path length and positively correlated with global efficiency for FA. These results suggest that, despite management with combination antiretroviral therapy, HIV infection is associated with altered structural brain network segregation and thalamic centrality and that low nadir CD4 cell count may be a risk factor. These graph theory metrics may serve as neural biomarkers to identify individuals at risk for HIV-related neurological complications.
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Affiliation(s)
- Ryan P Bell
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Laura L Barnes
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Sheri L Towe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Nan-Kuei Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Allen W Song
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA.
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA.
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Pfefferbaum A, Zahr NM, Sassoon SA, Kwon D, Pohl KM, Sullivan EV. Accelerated and Premature Aging Characterizing Regional Cortical Volume Loss in Human Immunodeficiency Virus Infection: Contributions From Alcohol, Substance Use, and Hepatitis C Coinfection. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:844-859. [PMID: 30093343 DOI: 10.1016/j.bpsc.2018.06.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/16/2018] [Accepted: 06/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Life expectancy of successfully treated human immunodeficiency virus (HIV)-infected individuals is approaching normal longevity. The growing HIV population ≥50 years of age is now at risk of developing HIV-associated neurocognitive disorder, acquiring coinfection with the hepatitis C virus (HCV), and engaging in hazardous drinking or drug consumption that can adversely affect trajectories of the healthy aging of brain structures. METHODS This cross-sectional/longitudinal study quantified regional brain volumes from 1101 magnetic resonance imaging scans collected over 14 years in 549 participants (25 to 75 years of age): 68 HIV-infected individuals without alcohol dependence, 60 HIV-infected individuals with alcohol dependence, 222 alcohol-dependent individuals, and 199 control subjects. We tested 1) whether localized brain regions in HIV-infected individuals exhibited accelerated aging, or alternatively, nonaccelerated premature aging deficits; and 2) the extent to which alcohol or substance dependence or HCV coinfection altered brain aging trajectories. RESULTS The HIV-infected cohort exhibited steeper declining volume trajectories than control subjects, consistently in the frontal cortex. Nonaccelerated volume deficits occurred in the temporal, parietal, insular, and cingulate regions of all three diagnostic groups. Alcohol and drug dependence comorbidities and HCV coinfection exacerbated HIV-related volume deficits. Accelerated age interactions in frontal and posterior parietal volumes endured in HIV-infected individuals free of alcohol or substance dependence and HCV infection comorbidities. Functionally, poorer HIV-associated neurocognitive disorder scores and Veterans Aging Cohort Study indices correlated with smaller regional brain volumes in the HIV-infected individuals without alcohol dependence and alcohol-dependent groups. CONCLUSIONS HIV infection itself may confer a heightened risk of accelerated brain aging, potentially exacerbated by HCV coinfection and substance dependency. Confirmation would require a prospective study with a preinfection baseline.
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Affiliation(s)
- Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Natalie M Zahr
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Dongjin Kwon
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Kilian M Pohl
- Center for Health Sciences, SRI International, Menlo Park, California
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
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Fleischman DA, Arfanakis K, Leurgans S, Keating SM, Lamar M, Bennett DA, Adeyemi OM, Barnes LL. Neopterin is associated with hippocampal subfield volumes and cognition in HIV. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e467. [PMID: 29904644 PMCID: PMC5999345 DOI: 10.1212/nxi.0000000000000467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/04/2018] [Indexed: 11/27/2022]
Abstract
Objective HIV infection sets off an immediate immune response and inflammatory cascade that can lead to neuronal injury and cognitive impairment, but the relationship between immune markers, regional brain volumes, and cognition remains understudied in HIV-infected adults. Methods Cross-sectional associations were examined between serum immune markers of activation (neopterin) and inflammation (interleukin [IL]-1β, IL-6, tumor necrosis factor alpha, and C-reactive protein) with regional brain volumes (cortical, subcortical, total gray matter, hippocampus, and subfields) and cognition in 66 HIV-infected, virally suppressed, adults who underwent 3.0-T MRI as part of the Research Core of the Rush Center of Excellence on Disparities in HIV and Aging. Immune markers were assayed from frozen plasma, values were entered into linear regression models as predictors of regional brain volumes, and interactive effects of immune response and regional brain volumes on cognition were examined. Results No inflammatory marker was associated with any regional brain volume. Higher neopterin level was associated with lower total hippocampal, presubiculum, and cornu ammonis (CA) subfield volumes. Higher neopterin level and lower total hippocampal volume were independently associated with lower episodic memory, and neopterin level fully mediated the effect of hippocampal atrophy on episodic memory. Higher neopterin levels were associated with lower presubiculum, CA1, and CA4/dentate volumes and lower semantic memory, working memory, and global cognition. Conclusion Immune activation in response to HIV infection, measured by neopterin, has a deleterious and targeted effect on regional brain structure, which can be visualized with clinically available MRI measures of hippocampus and its subfields, and this effect is associated with lower cognitive function.
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Affiliation(s)
- Debra A Fleischman
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
| | - Sue Leurgans
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
| | - Sheila M Keating
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
| | - Melissa Lamar
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
| | - David A Bennett
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
| | - Oluwatoyin M Adeyemi
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center (D.A.F., K.A., S.L., M.L., D.A.B., L.L.B.), Rush University Medical Center; the Department of Neurological Sciences (D.A.F., S.L., M.L., D.A.B., L.L.B.), the Department of Behavioral Sciences (D.A.F., M.L., L.L.B.), the Department of Preventive Medicine (S.L.), the Department of Diagnostic Radiology and Nuclear Medicine (K.A.), Rush University Medical Center; Ruth M. Rothstein CORE Center (O.M.A.); the Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago; the Blood Systems Research Institute (S.M.K.), San Francisco, CA; and the University of California at San Francisco (S.M.K.), Laboratory Medicine
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Lu Z, Jiao Y, Li J, Lan G, Lu C, Li X, Tang Z, Wang N. After 18 months of antiretroviral therapy, total HIV DNA decreases more pronouncedly in patients infected by CRF01_AE than in those infected by subtype B and CRF07_BC. Microbiol Immunol 2018; 62:248-254. [PMID: 29377267 DOI: 10.1111/1348-0421.12578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 12/19/2022]
Abstract
Whether the amount of HIV DNA is associated with the subtype of HIV-1 after antiretroviral therapy (ART) has not been reported. In the present study, the amount of HIV DNA and RNA and CD4+T counts in blood and semen prior to and after 18 months of ART were compared in 48 patients infected by CRF01_AE, subtype B or CRF07_BC of HIV-1. Viral RNA was suppressed and CD4 cell count recovery achieved in all patients. The level of HIV DNA were similar before ART; however, patients with CRF01_AE had less HIV DNA after ART than those with subtype B and CRF07_BC infection. According to prediction of co-receptor usage by Geno2Pheno and PSSM in combination, more than 35.6% of clones for CRF01_AE were predicted as CXCR4-using before ART, whereas less than 6% of those for subtype B and CRF07_BC were predicted as CXCR4-using. After 18 months of ART, no CXCR4-using clones were predicted in any of the subtypes. Despite more HIV RNA and fewer CD4 + T cells in patients with CRF01_AE before therapy, no significant differences (P > 0.05) in viral RNA or CD4 cell counts were observed between the subtypes after 18 months of ART. Thus, 18 months of antiretroviral therapy was more efficient in patients with CRF01_AE. Considering that successful ART dramatically reduces the viral load in both blood and semen, risks of sexual transmission of HIV were reduced, contributing to prevention of rapid spread of HIV among men who have sex with men in the region.
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Affiliation(s)
- Zhenzhen Lu
- Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China.,Department of Infectious Diseases, Beijing 302 Hospital, Beijing 100069, China
| | - Yanmei Jiao
- AIDS Antiviral Treatment Clinic, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Jianjun Li
- Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Guanghua Lan
- Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Chunyan Lu
- AIDS Research Center, Ruikang Hospital affiliated to Guangxi University of Chinese Medicine, Nanning, 530011, China
| | - Xuan Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Zhenzhu Tang
- Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Ning Wang
- Department of Infectious Diseases, Beijing 302 Hospital, Beijing 100069, China
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Zahr NM. The Aging Brain With HIV Infection: Effects of Alcoholism or Hepatitis C Comorbidity. Front Aging Neurosci 2018; 10:56. [PMID: 29623036 PMCID: PMC5874324 DOI: 10.3389/fnagi.2018.00056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
As successfully treated individuals with Human Immunodeficiency Virus (HIV)-infected age, cognitive and health challenges of normal aging ensue, burdened by HIV, treatment side effects, and high prevalence comorbidities, notably, Alcohol Use Disorders (AUD) and Hepatitis C virus (HCV) infection. In 2013, people over 55 years old accounted for 26% of the estimated number of people living with HIV (~1.2 million). The aging brain is increasingly vulnerable to endogenous and exogenous insult which, coupled with HIV infection and comorbid risk factors, can lead to additive or synergistic effects on cognitive and motor function. This paper reviews the literature on neuropsychological and in vivo Magnetic Resonance Imaging (MRI) evaluation of the aging HIV brain, while also considering the effects of comorbidity for AUD and HCV.
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Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
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Milanini B, Valcour V. Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer's Disease: an Emerging Issue in Geriatric NeuroHIV. Curr HIV/AIDS Rep 2018; 14:123-132. [PMID: 28779301 DOI: 10.1007/s11904-017-0361-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to examine characteristics that may distinguish HIV-associated neurocognitive disorder (HAND) from early Alzheimer's disease (AD). RECENT FINDINGS Cerebrospinal fluid (CSF) AD biomarkers are perturbed in HIV, yet these alterations may be limited to settings of advanced dementia or unsuppressed plasma HIV RNA. Neuropsychological testing will require extensive batteries to maximize utility. Structural imaging is limited for early AD detection in the setting of HIV, but proper studies are absent. While positron-emission tomography (PET) amyloid imaging has altered the landscape of differential diagnosis for age-associated neurodegenerative disorders, costs are prohibitive. Risk for delayed AD diagnosis in the aging HIV-infected population is now among the most pressing issues in geriatric neuroHIV. While clinical, imaging, and biomarker characterizations of AD are extensively defined, fewer data define characteristics of HIV-associated neurocognitive disorder in the setting of suppressed plasma HIV RNA. Data needed to inform the phenotype of AD in the setting of HIV are equally few.
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Affiliation(s)
- Benedetta Milanini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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Structural Covariance of Gray Matter Volume in HIV Vertically Infected Adolescents. Sci Rep 2018; 8:1182. [PMID: 29352127 PMCID: PMC5775353 DOI: 10.1038/s41598-018-19290-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/19/2017] [Indexed: 02/06/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection significantly affect neurodevelopmental and behavioral outcomes. We investigated whether alterations of gray matter organization and structural covariance networks with vertical HIV infection adolescents exist, by using the GAT toolbox. MRI data were analysed from 25 HIV vertically infected adolescents and 33 HIV-exposed-uninfected control participants. The gray matter volume (GMV) was calculated, and structural brain networks were reconstructed from gray matter co-variance. Gray matter losses were pronounced in anterior cingulate cortex (ACC), right pallidum, right occipital lobe, inferior parietal lobe, and bilateral cerebellum crus. The global brain network measures were not significantly different between the groups; however, the nodal alterations were most pronounced in frontal, temporal, basal ganglia, cerebellum, and temporal lobes. Brain hubs in the HIV-infected subjects increased in number and tended to shift to sensorimotor and temporal areas. In the HIV-infected subjects, decreased GMVs in ACC and bilateral cerebellum were related to lower Mini-Mental State Examination scores; the CD4 counts were positively related to the GMVs in ACC and sensorimotor areas. These findings suggest that focally reduced gray matter, disrupted nodal profiles of structural wirings, and a shift in hub distribution may represent neuroanatomical biomarkers of HIV infection on the developing brain.
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Casas R, Muthusamy S, Wakim PG, Sinharay S, Lentz MR, Reid WC, Hammoud DA. MR brain volumetric measurements are predictive of neurobehavioral impairment in the HIV-1 transgenic rat. NEUROIMAGE-CLINICAL 2017; 17:659-666. [PMID: 29204344 PMCID: PMC5705794 DOI: 10.1016/j.nicl.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/11/2017] [Accepted: 11/18/2017] [Indexed: 01/18/2023]
Abstract
Introduction HIV infection is known to be associated with brain volume loss, even in optimally treated patients. In this study, we assessed whether dynamic brain volume changes over time are predictive of neurobehavorial performance in the HIV-1 transgenic (Tg) rat, a model of treated HIV-positive patients. Materials and methods Cross-sectional brain MRI imaging was first performed comparing Tg and wild type (WT) rats at 3 and 19 months of age. Longitudinal MRI and neurobehavioral testing of another group of Tg and WT rats was then performed from 5 to 23 weeks of age. Whole brain and subregional image segmentation was used to assess the rate of brain growth over time. We used repeated-measures mixed models to assess differences in brain volumes and to establish how predictive the volume differences are of specific neurobehavioral deficits. Results Cross-sectional imaging showed smaller whole brain volumes in Tg compared to WT rats at 3 and at 19 months of age. Longitudinally, Tg brain volumes were smaller than age-matched WT rats at all time points, starting as early as 5 weeks of age. The Tg striatal growth rate delay between 5 and 9 weeks of age was greater than that of the whole brain. Striatal volume in combination with genotype was the most predictive of rota-rod scores and in combination with genotype and age was the most predictive of total exploratory activity scores in the Tg rats. Conclusion The disproportionately delayed striatal growth compared to whole brain between 5 and 9 weeks of age and the role of striatal volume in predicting neurobehavioral deficits suggest an important role of the dopaminergic system in HIV associated neuropathology. This might explain problems with motor coordination and executive decisions in this animal model. Smaller brain and subregional volumes and neurobehavioral deficits were seen as early as 5 weeks of age, suggesting an early brain insult in the Tg rat. Neuroprotective therapy testing in this model should thus target this early stage of development, before brain damage becomes irreversible. HIV infection is known to be associated with brain volume loss. HIV transgenic rats showed smaller brain volumes than wild type rats. Tg rats showed disproportionate loss of volume in the striatum compared to brain. Tg striatal volume loss along with genotype/age predict neurobehavioral deficits.
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Affiliation(s)
- Rafael Casas
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Siva Muthusamy
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Paul G Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Sanhita Sinharay
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Margaret R Lentz
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States
| | - William C Reid
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Dima A Hammoud
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States.
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Progressive Brain Atrophy Despite Persistent Viral Suppression in HIV Patients Older Than 60 Years. J Acquir Immune Defic Syndr 2017. [PMID: 28650401 DOI: 10.1097/qai.0000000000001489] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Current HIV treatments are successful at suppressing plasma HIV RNA to undetectable levels for most adherent patients. Yet, emerging evidence suggests that viral suppression will inadequately control inflammation and mitigate risk for progressive brain injury. We sought to quantify differences in longitudinal brain atrophy rates among older virally suppressed HIV-infected participants compared with that of healthy aging participants. METHODS We examined longitudinal structural brain magnetic resonance imaging atrophy rates using region of interest assessments and voxel-wise tensor-based morphometry in HIV-infected participants older than 60 years (n = 38) compared with age-matched HIV-uninfected healthy and cognitively normal controls (n = 24). RESULTS The mean age of participants was 63 years, the mean estimated duration of infection was 21 years, and the median duration of documented viral suppression was 3.2 years. Average proximal and nadir CD4 counts were 550 and 166, respectively; 15/38 (39%) met criteria for HIV-associated neurocognitive disorder. In models adjusting for age and sex, HIV serostatus was associated with more rapid average annualized rates of atrophy in the cerebellum (0.42% vs. 0.02%, P = 0.016), caudate (0.74% vs. 0.03%, P = 0.012), frontal lobe (0.48% vs. 0.01%, P = 0.034), total cortical gray matter (0.65% vs. 0.16%, P = 0.027), brainstem (0.31% vs. 0.01%, P = 0.026), and pallidum (0.73% vs. 0.39%, P = 0.046). Among those with HIV, atrophy rates did not differ statistically by cognitive status. CONCLUSIONS Despite persistent control of plasma viremia, these older HIV-infected participants demonstrate more rapid progressive brain atrophy when compared with healthy aging. Either HIV or other factors that differ between older HIV-infected participants and healthy controls could be responsible for these differences.
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Motor-related brain abnormalities in HIV-infected patients: a multimodal MRI study. Neuroradiology 2017; 59:1133-1142. [PMID: 28889255 DOI: 10.1007/s00234-017-1912-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/22/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE It is generally believed that HIV infection could cause HIV-associated neurocognitive disorders (HAND) across a broad range of functional domains. Some of the most common findings are deficits in motor control. However, to date no neuroimaging studies have evaluated basic motor control in HIV-infected patients using a multimodal approach. METHODS In this study, we utilized high-resolution structural imaging and task-state functional magnetic resonance imaging (fMRI) to assess brain structure and motor function in a homogeneous cohort of HIV-infected patients. RESULTS We found that HIV-infected patients had significantly reduced gray matter (GM) volume in cortical regions, which are involved in motor control, including the bilateral posterior insula cortex, premotor cortex, and supramarginal gyrus. Increased activation in bilateral posterior insula cortices was also demonstrated by patients during hand movement tasks compared with healthy controls. More importantly, the reduced GM in bilateral posterior insula cortices was spatially coincident with abnormal brain activation in HIV-infected patients. In addition, the results of partial correlation analysis indicated that GM reduction in bilateral posterior insula cortices and premotor cortices was significantly correlated with immune system deterioration. CONCLUSION This study is the first to demonstrate spatially coincident GM reduction and abnormal activation during motor performance in HIV-infected patients. Although it remains unknown whether the brain deficits can be recovered, our findings may yield new insights into neurologic injury underlying motor dysfunction in HAND.
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Eggers C, Arendt G, Hahn K, Husstedt IW, Maschke M, Neuen-Jacob E, Obermann M, Rosenkranz T, Schielke E, Straube E. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol 2017; 264:1715-1727. [PMID: 28567537 PMCID: PMC5533849 DOI: 10.1007/s00415-017-8503-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023]
Abstract
The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus-brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
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Affiliation(s)
- Christian Eggers
- Department of Neurology, Krankenhaus Barmherzige Brüder, Seilerstätte 2, 4021, Linz, Austria.
| | - Gabriele Arendt
- Neurologische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Katrin Hahn
- Neurologische Klinik, Charité, Berlin, Germany
| | - Ingo W Husstedt
- Klinik für Neurologie, Universitätsklinikum Münster, Münster, Germany
| | - Matthias Maschke
- Neurologische Abteilung, Brüderkrankenhaus Trier, Trier, Germany
| | - Eva Neuen-Jacob
- Institut für Neuropathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Mark Obermann
- Direktor des Zentrums für Neurologie, Asklepios Kliniken Schildautal, Seesen, Germany
| | - Thorsten Rosenkranz
- Neurologische Abteilung, Asklepios-Klinik Hamburg-St. Georg, Hamburg, Germany
| | - Eva Schielke
- Praxis für Neurologie Berlin-Mitte, 10117, Berlin, Germany
| | - Elmar Straube
- HIV-Schwerpunktpraxis, 30890, Barsinghausen, Germany
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Regionally Specific Brain Volumetric and Cortical Thickness Changes in HIV-Infected Patients in the HAART Era. J Acquir Immune Defic Syndr 2017; 74:563-570. [PMID: 28129254 DOI: 10.1097/qai.0000000000001294] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cognitive impairment still occurs in a substantial subset of HIV-infected patients, despite effective viral suppression with highly active antiretroviral therapy (HAART). Structural brain changes may provide clues about the underlying pathophysiology. This study provides a detailed spatial characterization of the pattern and extent of brain volume changes associated with HIV and relates these brain measures to cognitive ability and clinical variables. METHODS Multiple novel neuroimaging techniques (deformation-based morphometry, voxel-based morphometry, and cortical modeling) were used to assess regional brain volumes in 125 HIV-infected patients and 62 HIV-uninfected individuals. Ninety percent of the HIV-infected patients were on stable HAART with most of them (75%) having plasma viral suppression. Brain volumetrics and cortical thickness estimates were compared between the HIV-infected and uninfected groups, and the relationships between these measures of brain volume and indices of current and past infection severity, central nervous system penetration of HAART, and cognitive performance were assessed. RESULTS Regionally specific patterns of reduced thalamic and brainstem volumes and reduced cortical thickness in the orbitofrontal cortex, cingulate gyrus, primary motor and sensory cortex, temporal, and frontal lobes were seen in HIV-infected patients compared to HIV-uninfected participants. Observed white matter loss and subcortical atrophy were associated with lower nadir CD4 cell counts, while reduction in cortical thickness was related to worse cognitive performance. CONCLUSIONS Our findings suggest that distinct mechanisms may underlie cortical and subcortical injury in people with HIV and argues for the potential importance of early initiation of HAART to protect long-term brain health.
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ApoE ε4 Is Associated With Cognition, Brain Integrity, and Atrophy in HIV Over Age 60. J Acquir Immune Defic Syndr 2017; 73:426-432. [PMID: 27228100 DOI: 10.1097/qai.0000000000001091] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are contradicting reports on the associations between Apolipoprotein E4 (ApoE ε4) and brain outcomes in HIV with some evidence that relationships may be greatest in older age groups. METHODS We assessed cognition in 76 clinically stable HIV-infected participants over age 60 and genotyped ApoE. Sixty-one of these subjects underwent structural brain magnetic resonance imaging and diffusion tensor imaging. RESULTS The median age of the participants was 64 years (range: 60-84) and the median estimated duration of HIV infection was 22 years. Apo ε4 carriers (n = 19) were similar to noncarriers (n = 57) in sex (95% vs. 96% male), and education (16.0 vs. 16.2 years) ApoE ε4 carriers demonstrated greater deficits in cognitive performance in the executive domain (P = 0.045) and had reduced fractional anisotropy and increased mean diffusivity throughout large white matter tracts within the brain compared with noncarriers. Tensor-based morphometry analyses revealed ventricular expansion and atrophy in the posterior corpus callosum, thalamus, and brainstem among HIV-infected ApoE ε4 carriers compared with ε4 noncarriers. CONCLUSIONS In this sample of older HIV-infected individuals, having at least 1 ApoE ε4 allele was associated with decreased cognitive performance in the executive functioning domain, reduced brain white matter integrity, and brain atrophy. Brain atrophy was most prominent in the posterior corpus callosum, thalamus, and brainstem. This pattern of cognitive deficit, atrophy, and damage to white matter integrity was similar to that described in HIV, suggesting an exacerbation of HIV-related pathology; although emergence of other age-associated neurodegenerative disorders cannot be excluded.
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ANGELES CPLEWISDELOS, WILLIAMS PL, HUO Y, WANG SD, UBAN KA, HERTING MM, MALEE K, YOGEV R, CSERNANSKY JG, NICHOLS S, VAN DYKE RB, SOWELL ER, WANG L. Lower total and regional grey matter brain volumes in youth with perinatally-acquired HIV infection: Associations with HIV disease severity, substance use, and cognition. Brain Behav Immun 2017; 62:100-109. [PMID: 28089557 PMCID: PMC5373952 DOI: 10.1016/j.bbi.2017.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 12/21/2022] Open
Abstract
Despite improved survival due to combination antiretroviral therapy (cART), youth with perinatally-acquired HIV (PHIV) show cognitive deficits and developmental delay at increased rates. HIV affects the brain during critical periods of development, and the brain may be a persistent reservoir for HIV due to suboptimal blood brain barrier penetration of cART. We conducted structural magnetic resonance imaging (sMRI) and cognitive testing in 40 PHIV youth (mean age=16.7years) recruited from the NIH Pediatric HIV/AIDS Cohort Study (PHACS) who are part of the first generation of PHIV youth surviving into adulthood. Historical and current HIV disease severity and substance use measures were also collected. Total and regional cortical grey matter brain volumes were compared to a group of 334 typically-developing, HIV-unexposed and uninfected youth (frequency-matched for age and sex) from the Pediatric Imaging, Neurocognition, and Genetics (PING) study (mean age=16.1years). PHIV youth had smaller (2.8-5.1%) total and regional grey matter volumes than HIV-unexposed and uninfected youth, with smallest volumes seen among PHIV youth with higher past peak viral load (VL) and recent unsuppressed VL. In PHIV youth, worse cognitive performance correlated with smaller volumes. This pattern of smaller grey matter volumes suggests that PHIV infection may influence brain development and underlie cognitive dysfunction seen in this population. Among PHIV youth, smaller volumes were also linked to substance use (alcohol use: 9.0-13.4%; marijuana use: 10.1-16.0%). In this study, collection of substance use information was limited to the PHIV cohort; future studies should also collect substance use information in controls to further address interactions between HIV and substance use on brain volume.
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Affiliation(s)
- C. Paula LEWIS-DE LOS ANGELES
- Northwestern University Interdepartmental Neuroscience Program, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Paige L. WILLIAMS
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Yanling HUO
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Shirlene D. WANG
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kristina A. UBAN
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Megan M. HERTING
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Kathleen MALEE
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ram YOGEV
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - John G. CSERNANSKY
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sharon NICHOLS
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Russell B. VAN DYKE
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA
| | - Elizabeth R. SOWELL
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lei WANG
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Abstract
Combination antiretroviral treatment is associated with clear benefits in HIV-positive subjects, and is also effective in the central nervous system (CNS), meaning HIV-associated dementia is now an uncommon event. Nevertheless, a significant number of patients show symptoms of neurocognitive impairment which may negatively affect their quality of life. Although several risk factors for HIV-associated neurocognitive disorders have been identified, there is no clear recommendation for their prevention and management. In this review, the penetration of drugs into the cerebrospinal fluid/CNS is discussed as well as the viral and clinical consequences associated with higher/lower compartmental exposure. We also review the potential interventions according to the currently identified underlying mechanisms, including persistent CNS immune activation, legacy effects, low-level viral replication and escape, co-morbidities, and antiretroviral-associated direct and indirect 'neurotoxicity'. Adjunctive therapies and interventions (including neuro-rehabilitation) are then briefly discussed. The treatment of HIV infection in the CNS is a complex area of therapeutics requiring multidisciplinary interventions and further study.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy.
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
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45
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Vocal emotion processing deficits in HIV-infected individuals. J Neurovirol 2016; 23:304-312. [PMID: 27943048 DOI: 10.1007/s13365-016-0501-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/28/2016] [Accepted: 11/14/2016] [Indexed: 01/24/2023]
Abstract
We aimed to explore the brain imaging correlates of vocal emotion processing in a group of HIV+ individuals and to compare the vocal emotion processing of HIV+ individuals with a group of healthy adults. We conducted multiple linear regressions to determine the cerebral correlates of a newly designed vocal emotion processing test in a sub-group of HIV+ individuals who completed the cerebral magnetic resonance scan (n = 36). Separately, we test whether the association between our test scores and each cerebral measure persisted regardless of the presence of neurocognitive impairment. We also calculated differences in average test scores between the total HIV+ group (n = 100) and a healthy adult group (n = 46). We found a positive association between the test scores and several brain area volumes: right frontal, temporal and parietal lobes, bilateral thalamus, and left hippocampus. We found a negative association between inflammatory markers in frontal white matter and the test scores. After controlling by neurocognitive impairment, several brain area volumes remained positively associated to the prosody test scores. Moreover, the whole HIV+ sample had significantly poorer test scores than healthy adults, but only in the subset of HIV+ individuals with neurocognitive impairment. For the first time, our results suggest that cerebral dysfunctions in particular brain areas involved in the processing of emotional auditory stimuli may occur in HIV+ individuals. These results highlight the need for broad characterization of the neuropsychological consequence of HIV brain damages.
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46
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Paul RH, Phillips S, Hoare J, Laidlaw DH, Cabeen R, Olbricht GR, Su Y, Stein DJ, Engelbrecht S, Seedat S, Salminen LE, Baker LM, Heaps J, Joska J. Neuroimaging abnormalities in clade C HIV are independent of Tat genetic diversity. J Neurovirol 2016; 23:319-328. [PMID: 27913960 DOI: 10.1007/s13365-016-0503-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 01/13/2023]
Abstract
Controversy remains regarding the neurotoxicity of clade C human immunodeficiency virus (HIV-C). When examined in preclinical studies, a cysteine to serine substitution in the C31 dicysteine motif of the HIV-C Tat protein (C31S) results in less severe brain injury compared to other viral clades. By contrast, patient cohort studies identify significant neuropsychological impairment among HIV-C individuals independent of Tat variability. The present study clarified this discrepancy by examining neuroimaging markers of brain integrity among HIV-C individuals with and without the Tat substitution. Thirty-seven HIV-C individuals with the Tat C31S substitution, 109 HIV-C individuals without the Tat substitution (C31C), and 34 HIV- controls underwent 3T structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Volumes were determined for the caudate, putamen, thalamus, corpus callosum, total gray matter, and total white matter. DTI metrics included fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). Tracts of interest included the anterior thalamic radiation (ATR), cingulum bundle (CING), uncinate fasciculus (UNC), and corpus callosum (CC). HIV+ individuals exhibited smaller volumes in subcortical gray matter, total gray matter and total white matter compared to HIV- controls. HIV+ individuals also exhibited DTI abnormalities across multiple tracts compared to HIV- controls. By contrast, neither volumetric nor diffusion indices differed significantly between the Tat C31S and C31C groups. Tat C31S status is not a sufficient biomarker of HIV-related brain integrity in patient populations. Clinical attention directed at brain health is warranted for all HIV+ individuals, independent of Tat C31S or clade C status.
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Affiliation(s)
- Robert H Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA.
| | - Sarah Phillips
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700, South Africa
| | - David H Laidlaw
- Department of Computer Science, Brown University, Providence, RI, 02912, USA
| | - Ryan Cabeen
- Department of Computer Science, Brown University, Providence, RI, 02912, USA
| | - Gayla R Olbricht
- Department of Mathematics and Statistics, Missouri University of Science and Technology, Rolla, MO, 65409, USA
| | - Yuqing Su
- Department of Mathematics and Statistics, Missouri University of Science and Technology, Rolla, MO, 65409, USA
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Services (NHLS), Cape Town, South Africa
| | - Soraya Seedat
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, 7599, South Africa
| | - Lauren E Salminen
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, 90007, USA
| | - Laurie M Baker
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Jodi Heaps
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - John Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700, South Africa
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Lewis-de los Angeles CP, Alpert KI, Williams PL, Malee K, Huo Y, Csernansky JG, Yogev R, Van Dyke RB, Sowell ER, Wang L. Deformed Subcortical Structures Are Related to Past HIV Disease Severity in Youth With Perinatally Acquired HIV Infection. J Pediatric Infect Dis Soc 2016; 5:S6-S14. [PMID: 27856671 PMCID: PMC5181545 DOI: 10.1093/jpids/piw051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/25/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Combination antiretroviral therapy has led to increased survival among youth with perinatally acquired HIV (PHIV). However, cognitive deficits continue to be common. Histopathological studies in adults have found HIV concentrated in subcortical structures, which are involved in sensory processing, movement, and higher-order cognition that emerges with development. METHODS We conducted magnetic resonance imaging and cognitive testing in 40 youth with PHIV at one site of the Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study. We collected HIV disease-severity measures and substance-use reports. Subcortical volume and shape deformation were generated with FreeSurfer-Initiated Large Deformation Diffeomorphic Metric Mapping. Inward shape deformation was defined as negative displacement. We evaluated associations of subcortical shape deformation with past HIV severity after adjustment for sex, age at neuroimaging, age at HIV severity marker, and substance use. We examined associations between subcortical deformation and cognitive function. RESULTS Negative correlations between shape deformation and peak HIV viral load (VL) were found in clusters in the caudate tail, globus pallidus, lateral putamen, and anterior and medial thalamus. Positive correlations between shape deformation and nadir CD4-positive T-lymphocyte percentage (CD4%) were found in clusters in the medial and posterior thalamus. Inward deformation in caudate and thalamic clusters correlated with worse cognition. CONCLUSIONS Youth with PHIV have demonstrable subcortical shape deformation related to past HIV severity and cognition; inward deformation was associated with higher peak VL, lower nadir CD4%, and worse cognition. Identifying subcortical deformation may inform clinical practice for early intervention to help improve cognitive outcomes and assess the neuroefficacy of combination antiretroviral therapy in youth with PHIV.
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Affiliation(s)
| | | | - Paige L. Williams
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Yanling Huo
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ram Yogev
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Russell B. Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Elizabeth R. Sowell
- Department of Pediatrics, Children's Hospital Los Angeles
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, and
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Kallianpur KJ, Sakoda M, Gangcuangco LMA, Ndhlovu LC, Umaki T, Chow D, Wongjittraporn S, Shikuma CM. Frailty Characteristics in Chronic HIV Patients are Markers of White Matter Atrophy Independently of Age and Depressive Symptoms: A Pilot Study. ACTA ACUST UNITED AC 2016; 3:138-152. [PMID: 27721908 PMCID: PMC5051693 DOI: 10.2174/1874220301603010138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Chronic HIV disease is associated with neurocognitive impairment and age-related conditions such as frailty. Objective To determine whether regional brain volumetric changes correlate with frailty parameters in older (≥ 40 years) HIV+ patients on stable combination antiretroviral therapy. Method Thirty-five HIV-infected participants in the Hawaii Aging with HIV Cohort - Cardiovascular Disease study underwent T1-weighted brain magnetic resonance imaging, frailty assessment and neuropsychological testing. Five physical frailty traits were assessed: low physical activity; exhaustion; unintentional weight loss; weak hand grip strength; slow walking speed. Linear regression quantified cross-sectional relationships of 12 brain regions to walking times and hand grip strength. Results Participants were 50.6 ± 6.8 years old and 77% had undetectable plasma viral load. One subject was frail (possessing ≥ 3 frailty traits); 23% were pre-frail (1–2 frailty traits) and had worse composite learning and memory z-scores than did non-frail individuals (p=0.06). Pre-frail or frail subjects had reduced hand grip strength relative to the non-frail group (p=0.001). Longer walking times (slower gait) related independently to lower volumes of cerebellar white matter (p<0.001, β=−0.6) and subcortical gray matter (p<0.05, β=−0.30). Reduced thalamus volume was linked to weaker grip strength (p < 0.05, β=0.4). Caudate volume was negatively associated with grip strength (p<0.01, β=−0.5). Conclusion Volumetric changes in cerebellar white matter and subcortical gray matter, brain regions involved in motor control and cognition, may be connected to frailty development in well-controlled HIV. Gait speed is particularly sensitive to white matter alterations and should be investigated as a predictor of frailty and brain atrophy in chronically infected patients.
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Affiliation(s)
- Kalpana J Kallianpur
- Department of Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Marissa Sakoda
- Department of Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Louie Mar A Gangcuangco
- Department of Internal Medicine, Bridgeport Hospital-Yale New Haven Health, Bridgeport, CT, USA
| | - Lishomwa C Ndhlovu
- Department of Tropical Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Tracie Umaki
- Department of Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Dominic Chow
- Department of Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | | | - Cecilia M Shikuma
- Department of Medicine, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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Williams DW, Engle EL, Shirk EN, Queen SE, Gama L, Mankowski JL, Zink MC, Clements JE. Splenic Damage during SIV Infection: Role of T-Cell Depletion and Macrophage Polarization and Infection. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:2068-2087. [PMID: 27322772 DOI: 10.1016/j.ajpath.2016.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/04/2016] [Accepted: 03/25/2016] [Indexed: 12/31/2022]
Abstract
The effects of HIV infection on spleen and its cellular subsets have not been fully characterized, particularly for macrophages in which diverse populations exist. We used an accelerated SIV-infected macaque model to examine longitudinal effects on T-cell and macrophage populations and their susceptibilities to infection. Substantial lymphoid depletion occurred, characterized by follicular burn out and a loss of CD3 T lymphocytes, which was associated with cellular activation and transient dysregulations in CD4/CD8 ratios and memory effector populations. In contrast, the loss of CD68 and CD163(+)CD68(+) macrophages and increase in CD163 cells was irreversible, which began during acute infection and persisted until terminal disease. Mac387 macrophages and monocytes were transiently recruited into spleen, but were not sufficient to mitigate the changes in macrophage subsets. Type I interferon, M2 polarizing genes, and chemokine-chemokine receptor signaling were up-regulated in spleen and drove macrophage alterations. SIV-infected T cells were numerous within the white pulp during acute infection, but were rarely observed thereafter. CD68, CD163, and Mac387 macrophages were highly infected, which primarily occurred in the red pulp independent of T cells. Few macrophages underwent apoptosis, indicating that they are a long-lasting target for HIV/SIV. Our results identify macrophages as an important contributor to HIV/SIV infection in spleen and in promoting morphologic changes through the loss of specific macrophage subsets that mediate splenic organization.
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Affiliation(s)
- Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth L Engle
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin N Shirk
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Suzanne E Queen
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lucio Gama
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph L Mankowski
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Christine Zink
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janice E Clements
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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50
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Kallianpur KJ, Gerschenson M, Mitchell BI, LiButti DE, Umaki TM, Ndhlovu LC, Nakamoto BK, Chow DC, Shikuma CM. Oxidative mitochondrial DNA damage in peripheral blood mononuclear cells is associated with reduced volumes of hippocampus and subcortical gray matter in chronically HIV-infected patients. Mitochondrion 2016; 28:8-15. [PMID: 26923169 DOI: 10.1016/j.mito.2016.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 01/20/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
Cross-sectional relationships were examined between regional brain volumes and mitochondrial DNA (mtDNA) 8-hydroxy-2-deoxyguanosine (8-oxo-dG) in peripheral blood mononuclear cells (PBMCs) of 47 HIV patients [mean age 51years; 81% with HIV RNA ≤50copies/mL] on combination antiretroviral therapy. The gene-specific DNA damage and repair assay measured mtDNA 8-oxo-dG break frequency. Magnetic resonance imaging was performed at 3T. Higher mtDNA 8-oxo-dG was associated with lateral ventricular enlargement and with decreased volumes of hippocampus, pallidum, and total subcortical gray matter, suggesting the involvement of systemic mitochondrial-specific oxidative stress in chronic HIV-related structural brain changes and cognitive difficulties. Clarification of the mechanism may provide potential therapeutic targets.
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Affiliation(s)
- Kalpana J Kallianpur
- Hawaii Center for AIDS, Department of Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States.
| | - Mariana Gerschenson
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, Honolulu HI 96813, United States
| | - Brooks I Mitchell
- Department of Tropical Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States
| | - Daniel E LiButti
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, Honolulu HI 96813, United States
| | - Tracie M Umaki
- Hawaii Center for AIDS, Department of Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States
| | - Lishomwa C Ndhlovu
- Hawaii Center for AIDS, Department of Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States; Department of Tropical Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States
| | - Beau K Nakamoto
- Hawaii Center for AIDS, Department of Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States; Straub Clinics and Hospital, Honolulu HI 96813, United States
| | - Dominic C Chow
- Hawaii Center for AIDS, Department of Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States
| | - Cecilia M Shikuma
- Hawaii Center for AIDS, Department of Medicine, John A. Burns School of Medicine, Honolulu HI 96813, United States
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