Gray and White Matter Abnormalities in Treated Human Immunodeficiency Virus Disease and Their Relationship to Cognitive Function

Underwood, Jonathan; Cole, James R.; Caan, Matthan W.A.; Francesco, Davide De; Leech, Robert; Zoest, Rosan A van; Su, Tanja; Geurtsen, Gert J.; Schmand, Ben; Portegies, Peter; Prins, Maria; Wit, Ferdinand W. N. M.; Sabin, Caroline; Majoie, Charles B. L. M.; Reiss, Peter; Winston, Alan; Sharp, David J.

doi:10.1093/cid/cix301

“…This may reflect the more appropriate selection of an HIVnegative control group with similar lifestyles to the PLWH. Of note, our findings are consistent with those from the comorbidity in relation to HIV/AIDS study [32,33] in which baseline differences between PLWH and comparable controls did not increase with longer follow-up. The link between HIV infection and depression is likely to be bi-directional and multifactorial, involving both biological and psychosocial/social factors [7].…”

Section: Discussionsupporting

confidence: 90%

“…This may reflect the more appropriate selection of an HIV‐negative control group with similar lifestyles to the PLWH. Of note, our findings are consistent with those from the co‐morbidity in relation to HIV/AIDS study in which baseline differences between PLWH and comparable controls did not increase with longer follow‐up.…”

Section: Discussionsupporting

confidence: 89%

Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV‐negative controls

Francesco

¹

,

Underwood

²

,

Bagkeris

³

et al. 2019

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Objectives We investigated whether differences in cognitive performance between people living with HIV ( PLWH ) and comparable HIV ‐negative people were mediated or moderated by depressive symptoms and lifestyle factors. Methods A cross‐sectional study of 637 ‘older’ PLWH aged ≥ 50 years, 340 ‘younger’ PLWH aged < 50 years and 276 demographically matched HIV ‐negative controls aged ≥ 50 years enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty ( POPPY ) study was performed. Cognitive function was assessed using a computerized battery (CogState). Scores were standardized into Z ‐scores [mean = 0; standard deviation ( SD ) = 1] and averaged to obtain a global Z ‐score. Depressive symptoms were evaluated via the Patient Health Questionnaire ( PHQ ‐9). Differences between the three groups and the effects of depression, sociodemographic factors and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education. Results After adjustment for sociodemographic factors, older and younger PLWH had poorer overall cognitive scores than older HIV ‐negative controls ( P < 0.001 and P = 0.006, respectively). Moderate or severe depressive symptoms were more prevalent in both older (27%; P < 0.001) and younger (21%; P < 0.001) PLWH compared with controls (8%). Depressive symptoms ( P < 0.001) and use of hashish ( P = 0.01) were associated with lower cognitive function; alcohol consumption ( P = 0.02) was associated with better cognitive scores. After further adjustment for these factors, the difference between older PLWH and HIV ‐negative controls was no longer significant ( P = 0.08), while that between younger PLWH and older HIV ‐negative controls remained significant ( P = 0.01). Conclusions Poorer cognitive performances in PLWH compared with HIV ‐negative individuals were, in part, mediated by the greater prevalence of depressive symptoms and recreational drug use reported by PLWH .

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“…Another main strength is the participation of SHM and the ATHENA cohort in regional, national and international scientific research collaborations. There is close collaboration with the Academic Medical Center of the University of Amsterdam, the Public Health Service Amsterdam through the Amsterdam Cohort Studies (ACS) 36 ; the MSM Observational Study of Acute Infection with Hepatitis C (MOSAIC) 32 ; Co-morbidity and Ageing with HIV (AGE h IV) cohort study 37 ; EU-funded Co-morbidity in Relation to AIDS (COBRA) programme 38 ; and the HIV Transmission Elimination Amsterdam (H-TEAM) initiative. 39 ATHENA collaborates with other research groups and observational cohorts in western Europe, the USA and Canada.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

AIDS Therapy Evaluation in the Netherlands (ATHENA) national observational HIV cohort: cohort profile

Boender

¹

,

Smit

²

,

Sighem

³

et al. 2018

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PurposeIn 1998, the AIDS Therapy Evaluation in the Netherlands (ATHENA) national observational HIV cohort was established to demonstrate the lifesaving effectiveness of triple combination antiretroviral therapy, including HIV-protease inhibitors, that had recently been made available for clinical use. Subsequently, the HIV Monitoring Foundation was established by the Dutch Ministry of Health, Welfare and Sport to continue ATHENA as an open cohort in order to continue the registration and monitoring of all HIV-positive people as an integral part of HIV care in all 26 HIV treatment centres in the Netherlands.ParticipantsTo date, a total of 25 036 participants have been enrolled in the cohort, with 263 600 person-years of follow-up. As of 1 January 2017, 19 035 HIV-1-positive participants were known to be in care: 18 824 adults (81% men and 19% women) and 211 children (47% boys and 53% girls). The remaining 6001 participants had either died (46%), were lost to care (29%) or had moved abroad (25%).Findings to dateToday, with over 20 years of follow-up, the ATHENA cohort has provided extensive knowledge on HIV treatment, comorbidities and coinfections and created insight into the transmission dynamics of the HIV epidemic.Future plansATHENA continues to enrol and monitor HIV positive people entering HIV care in the Netherlands. Future research will continue to provide tangible input into HIV care and prevention policies in the Netherlands and internationally.

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“…[41, 85-88] One study found widespread white matter abnormalities that correlated with cognitive impairment. [88] In contrast, cardiovascular risk factors and duration of past immune deficiency but not cognitive impairment were found to be associated with white matter injury among men with well controlled HIV infection.…”

Section: Neuroimagingmentioning

confidence: 99%

“…[41, 85-88] One study found widespread white matter abnormalities that correlated with cognitive impairment. [88] In contrast, cardiovascular risk factors and duration of past immune deficiency but not cognitive impairment were found to be associated with white matter injury among men with well controlled HIV infection. [87] Another study investigated white matter abnormalities in 56 HIV-infected elders compared to 31 matched controls reporting widespread fractional anisotropy (FA) decreases and increased mean diffusivity (MD) in areas including the corpus callosum, splenium, body of the genu, tapetum of the corpus callosum, as well as the anterior, superior and posterior corona radiata.…”

Section: Neuroimagingmentioning

confidence: 99%

Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer’s Disease: an Emerging Issue in Geriatric NeuroHIV

Milanini

¹

,

Valcour

²

2017

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Purpose of Review To examine characteristics that may distinguish HIV-associated Neurocognitive Disorder (HAND) from early Alzheimer's disease (AD) Recent Findings 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. Summary Risk for delayed AD diagnosis in the aging HIV-infected population is now among the most pressing issues in geriatric neuro HIV. While clinical, imaging, and biomarker characterization of AD is extensively defined, fewer data define characteristics of HAND 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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Gray and White Matter Abnormalities in Treated Human Immunodeficiency Virus Disease and Their Relationship to Cognitive Function

Cited by 71 publications

References 40 publications

Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV‐negative controls

Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV‐negative controls

AIDS Therapy Evaluation in the Netherlands (ATHENA) national observational HIV cohort: cohort profile

Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer’s Disease: an Emerging Issue in Geriatric NeuroHIV

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