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Keltner JR, Fennema-Notestine C, Vaida F, Wang D, Franklin DR, Dworkin RH, Sanders C, McCutchan JA, Archibald SL, Miller DJ, Kesidis G, Cushman C, Kim SM, Abramson I, Taylor MJ, Theilmann RJ, Julaton MD, Notestine RJ, Corkran S, Cherner M, Duarte NA, Alexander T, Robinson-Papp J, Gelman BB, Simpson DM, Collier AC, Marra CM, Morgello S, Brown G, Grant I, Atkinson JH, Jernigan TL, Ellis RJ. HIV-associated distal neuropathic pain is associated with smaller total cerebral cortical gray matter. J Neurovirol 2014; 20:209-18. [PMID: 24549970 DOI: 10.1007/s13365-014-0236-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/02/2014] [Accepted: 01/17/2014] [Indexed: 01/28/2023]
Abstract
Despite modern antiretroviral therapy, HIV-associated sensory neuropathy affects over 50 % of HIV patients. The clinical expression of HIV neuropathy is highly variable: many individuals report few symptoms, but about half report distal neuropathic pain (DNP), making it one of the most prevalent, disabling, and treatment-resistant complications of HIV disease. The presence and intensity of pain is not fully explained by the degree of peripheral nerve damage, making it unclear why some patients do, and others do not, report pain. To better understand central nervous system contributions to HIV DNP, we performed a cross-sectional analysis of structural magnetic resonance imaging volumes in 241 HIV-infected participants from an observational multi-site cohort study at five US sites (CNS HIV Anti-Retroviral Treatment Effects Research Study, CHARTER). The association between DNP and the structural imaging outcomes was investigated using both linear and nonlinear (Gaussian Kernel support vector) multivariable regression, controlling for key demographic and clinical variables. Severity of DNP symptoms was correlated with smaller total cerebral cortical gray matter volume (r = -0.24; p = 0.004). Understanding the mechanisms for this association between smaller total cortical volumes and DNP may provide insight into HIV DNP chronicity and treatment-resistance.
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Affiliation(s)
- John R Keltner
- Department of Psychiatry, University of California San Diego, 220 Dickinson St., San Diego, CA, 92103, USA,
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Marra CM, Deutsch R, Collier AC, Morgello S, Letendre S, Clifford D, Gelman B, McArthur J, McCutchan JA, Simpson DM, Duarte NA, Heaton RK, Grant I. Neurocognitive impairment in HIV-infected individuals with previous syphilis. Int J STD AIDS 2013; 24:351-5. [PMID: 23970701 DOI: 10.1177/0956462412472827] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is common in HIV-infected individuals, as is syphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in disease. We hypothesized that HIV-infected patients with a history of syphilis or neurosyphilis would have more cognitive impairment than HIV-infected individuals without these infections. Eighty-two of 1574 enrollees in CHARTER, a prospective, observational study, had reactive serum rapid plasma reagin (RPR) tests. They were matched to 84 controls with non-reactive RPR by age, gender, ethnicity and HIV risk factor. Participants underwent comprehensive neuropsychological (NP) evaluations. RPR results were confirmed and serum fluorescent treponemal antibody absorption (FTA-ABS) test reactivity determined at a central laboratory. Sera from 101 of 166 participants were FTA-ABS reactive, indicating past or current syphilis. Among the 136 individuals without confounding conditions, compared with patients who had never had syphilis, those with prior syphilis had a greater number of impaired NP test domains (1.90 SD [1.77] versus 1.25 [1.52], P = 0.03), a higher global deficit score (0.47 [0.46] versus 0.31 [0.33], P = 0.03), and more were impaired in the NP learning domain (36 [42.9%] of 84 versus 13 [25.0%] of 52, P = 0.04). These effects of prior syphilis remained after controlling for education and premorbid intelligence.
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Affiliation(s)
- C M Marra
- Department of Neurology, University of Washington, Seattle, WA, USA.
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Keltner JR, Vaida F, Ellis RJ, Moeller-Bertram T, Fitzsimmons C, Duarte NA, Robinson-Papp J, Dworkin RH, Clifford DB, McArthur JC, Simpson DM, Collier AC, Marra CM, Atkinson JH, Grant I. Health-related quality of life 'well-being' in HIV distal neuropathic pain is more strongly associated with depression severity than with pain intensity. Psychosomatics 2012; 53:380-6. [PMID: 22748751 DOI: 10.1016/j.psym.2012.05.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/27/2012] [Accepted: 04/30/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite modern antiretroviral treatment, HIV-associated distal neuropathic pain (DNP) remains one of the most prevalent and debilitating complications of HIV disease. Neuropathic pain is often accompanied by depressed mood, and both pain and depression have been associated with decreased health-related quality of life (HRQOL) well-being. The relative contribution of depression and pain to worse life quality has not been addressed, however, even though a better understanding might sharpen intervention strategies. METHODS We used the Medical Outcomes Study HIV (MOS-HIV) Health Survey and the Beck depression inventory-II and linear regression models to investigate HRQOL well-being in HIV-infected patients with DNP (n = 397) participating in an observational cohort study at six U.S. sites (CNS HIV Antiretroviral Treatment Effects Research Study, CHARTER). RESULTS For this sample of patients with HIV DNP, severity of depressed mood was more highly correlated with HRQOL well-being than was pain intensity. CONCLUSIONS These results suggest that interventions to improve HRQOL well-being in individuals with HIV-associated DNP may need to address not only pain intensity but mood state as well.
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Affiliation(s)
- John R Keltner
- Department of Psychiatry, University of California-San Diego, San Diego, CA 92117, USA.
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Duarte NA, Woods SP, Rooney A, Atkinson JH, Grant I. Working memory deficits affect risky decision-making in methamphetamine users with attention-deficit/hyperactivity disorder. J Psychiatr Res 2012; 46:492-9. [PMID: 22305489 PMCID: PMC3307875 DOI: 10.1016/j.jpsychires.2012.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/19/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
Abstract
Methamphetamine (MA) use and Attention-Deficit/Hyperactivity Disorder (ADHD) commonly co-occur and are independently associated with dysregulation of frontostriatal loops and risky decision-making; however, whether their comorbidity exacerbates risky decision-making is not known. This study evaluated 23 participants with histories of MA dependence and ADHD (MA+ADHD+), 25 subjects with MA dependence alone (MA+ADHD-), and 22 healthy adults (MA-ADHD-), who completed the Iowa Gambling Task (IGT) as part of a larger neuropsychiatric research evaluation. Results showed a significant interaction between ADHD, MA, and working memory, such that individuals with working memory deficits in the MA+ADHD+ cohort demonstrated the strongest propensity to select cards from "disadvantageous" versus "advantageous" decks on the IGT. This effect was not better explained by other psychiatric, substance use, neuromedical, or cognitive factors. Findings suggest that working memory deficits may moderate the expression of risky decision-making in MA users with ADHD.
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Affiliation(s)
| | | | | | - J. Hampton Atkinson
- Department of Psychiatry, University of California, San Diego,Psychiatry Service VA San Diego Healthcare System
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego
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Pottiez G, Jagadish T, Yu F, Letendre S, Ellis R, Duarte NA, Grant I, Gendelman HE, Fox HS, Ciborowski P. Plasma proteomic profiling in HIV-1 infected methamphetamine abusers. PLoS One 2012; 7:e31031. [PMID: 22359561 PMCID: PMC3281056 DOI: 10.1371/journal.pone.0031031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/29/2011] [Indexed: 12/21/2022] Open
Abstract
We wanted to determine whether methamphetamine use affects a subset of plasma proteins in HIV-infected persons. Plasma samples from two visits were identified for subjects from four groups: HIV+, ongoing, persistent METH use; HIV+, short-term METH abstinent; HIV+, long term METH abstinence; HIV negative, no history of METH use. Among 390 proteins identified, 28 showed significant changes in expression in the HIV+/persistent METH+ group over the two visits, which were not attributable to HIV itself. These proteins were involved in complement, coagulation pathways and oxidative stress. Continuous METH use is an unstable condition, altering levels of a number of plasma proteins.
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Affiliation(s)
- Gwenael Pottiez
- Department of Pharmacology and Experimental Neuroscience, Omaha, Nebraska, United States of America
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Byrd DA, Fellows RP, Morgello S, Franklin D, Heaton RK, Deutsch R, Atkinson JH, Clifford DB, Collier AC, Marra CM, Gelman B, McCutchan JA, Duarte NA, Simpson DM, McArthur J, Grant I. Neurocognitive impact of substance use in HIV infection. J Acquir Immune Defic Syndr 2011; 58:154-62. [PMID: 21725250 PMCID: PMC3183737 DOI: 10.1097/qai.0b013e318229ba41] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND : To determine how serious a confound substance use (SU) might be in studies on HIV-associated neurocognitive disorder (HAND), we examined the relationship of SU history to neurocognitive impairment (NCI) in participants enrolled in the Central Nervous System HIV Antiretroviral Therapy Effects Research study. METHODS : After excluding cases with behavioral evidence of acute intoxication and histories of factors that independently could account for NCI (eg, stroke), baseline demographic, medical, SU, and neurocognitive data were analyzed from 399 participants. Potential SU risk for NCI was determined by the following criteria: lifetime SU Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis, self-report of marked lifetime SU, or positive urine toxicology. Participants were divided into 3 groups as follows: no SU (n = 134), nonsyndromic SU (n = 131), syndromic SU (n = 134) and matched on literacy level, nadir CD4, and depressive symptoms. RESULTS : Although approximately 50% of the participants were diagnosed with HAND, a multivariate analysis of covariance of neurocogntive summary scores, covarying for urine toxicology, revealed no significant effect of SU status. Correlational analyses indicated weak associations between lifetime heroin dosage and poor recall and working memory and between cannabis and cocaine use and better verbal fluency. CONCLUSIONS : These data indicate that HIV neurocognitive effects are seen at about the same frequency in those with and without historic substance abuse in cases that are equated on other factors that might contribute to NCI. Therefore, studies on neuroAIDS and its treatment need not exclude such cases. However, the effects of acute SU and current SU disorders on HAND require further study.
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Affiliation(s)
- Desiree A Byrd
- Department of Pathology, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA.
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Atkinson JH, Jin H, Shi C, Yu X, Duarte NA, Casey CY, Franklin DR, Vigil O, Cysique L, Wolfson T, Riggs PK, Gupta S, Letendre S, Marcotte TD, Grant I, Wu Z, Heaton RK. Psychiatric context of human immunodeficiency virus infection among former plasma donors in rural China. J Affect Disord 2011; 130:421-8. [PMID: 21094530 PMCID: PMC3307799 DOI: 10.1016/j.jad.2010.10.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/15/2010] [Accepted: 10/23/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND China's HIV epidemic commenced in its agrarian provinces through contaminated commercial plasma donation centers and is now becoming a public health concern nationwide. Little is known of the psychiatric and substance use disorder characteristics of this population, or their impact on everyday function, employment, and life quality. METHODS HIV-infected (HIV+) former plasma donors (N=203) and HIV-negative (HIV-) donor controls (N=198) completed the World Mental Health Survey Composite International Diagnostic Interview to determine lifetime major depressive disorder (MDD), substance use disorders, and suicidality. Current mood and suicidality were assessed with the Beck Depression Inventory-II. Everyday function was measured by an Activity of Daily Living questionnaire; life quality was evaluated by the Medical Outcomes Study-HIV. RESULTS HIV+ participants had known their infected status for 2 years on average. Most were taking antiretroviral treatment and had frank AIDS. Rates of current MDD were similar across groups (1-2%), but HIV+ had a higher frequency of lifetime MDD (14% vs. 5%, p<.05). Its onset preceded date of known infection in one-third of cases. Alcoholism was the only substance use disorder detected; HIV+ had a higher proportion of lifetime substance use diagnoses (14% vs. 6%, p<.05). Depression and AIDS independently predicted worse daily functioning and life quality, and unemployment. LIMITATIONS The epicenter of China HIV has moved into urban injection drug users, limiting the representativeness of this sample. CONCLUSIONS High rates of MDD and its impact suggest that in China, as elsewhere, comprehensive care requires detection and treatment of mood disorder.
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Affiliation(s)
- J. Hampton Atkinson
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Hua Jin
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Chuan Shi
- The Institute of Mental Health at Peking University, Beijing, China
| | - Xin Yu
- The Institute of Mental Health at Peking University, Beijing, China
| | - Nichole A. Duarte
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Corinna Young Casey
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | | | - Ofilio Vigil
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Lucette Cysique
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Tanya Wolfson
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - P. Katie Riggs
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Saurabh Gupta
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Scott Letendre
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Thomas D. Marcotte
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Igor Grant
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
| | - Zunyou Wu
- China Center for Disease Control, Beijing, China
| | - Robert K. Heaton
- HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103 USA
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Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, LeBlanc S, Corkran SH, Duarte NA, Clifford DB, Woods SP, Collier AC, Marra CM, Morgello S, Mindt MR, Taylor MJ, Marcotte TD, Atkinson JH, Wolfson T, Gelman BB, McArthur JC, Simpson DM, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 2010; 17:3-16. [PMID: 21174240 PMCID: PMC3032197 DOI: 10.1007/s13365-010-0006-1] [Citation(s) in RCA: 1173] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 10/07/2010] [Accepted: 10/27/2010] [Indexed: 12/03/2022]
Abstract
Combination antiretroviral therapy (CART) has greatly reduced medical morbidity and mortality with HIV infection, but high rates of HIV-associated neurocognitive disorders (HAND) continue to be reported. Because large HIV-infected (HIV+) and uninfected (HIV−) groups have not been studied with similar methods in the pre-CART and CART eras, it is unclear whether CART has changed the prevalence, nature, and clinical correlates of HAND. We used comparable methods of subject screening and assessments to classify neurocognitive impairment (NCI) in large groups of HIV + and HIV − participants from the pre-CART era (1988–1995; N = 857) and CART era (2000–2007; N = 937). Impairment rate increased with successive disease stages (CDC stages A, B, and C) in both eras: 25%, 42%, and 52% in pre-CART era and 36%, 40%, and 45% in CART era. In the medically asymptomatic stage (CDC-A), NCI was significantly more common in the CART era. Low nadir CD4 predicted NCI in both eras, whereas degree of current immunosuppression, estimated duration of infection, and viral suppression in CSF (on treatment) were related to impairment only pre-CART. Pattern of NCI also differed: pre-CART had more impairment in motor skills, cognitive speed, and verbal fluency, whereas CART era involved more memory (learning) and executive function impairment. High rates of mild NCI persist at all stages of HIV infection, despite improved viral suppression and immune reconstitution with CART. The consistent association of NCI with nadir CD4 across eras suggests that earlier treatment to prevent severe immunosuppression may also help prevent HAND. Clinical trials targeting HAND prevention should specifically examine timing of ART initiation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Igor Grant
- University of California, San Diego, CA USA
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