Neurocognitive Dysfunction With Neuronal Injury in People With HIV on Long-Duration Antiretroviral Therapy

McMahan, Cynthia; Dietrich, Devon K; Horne, Elizabeth; Kelly, Erin; Geannopoulos, Katrina; Julnes, Peter Selim Siyahhan; Ham, Lillian; Santamaria, Ulisses; Lau, Chuen-Yen; Wu, Tianxia; Hsieh, Hsing-Chuan; Ganesan, Anuradha; Berjohn, Catherine M; Kapetanovic, Suad; Reich, Daniel S.; Nair, Govind; Snow, Joseph; Agan, Brian K.; Nath, Avindra; Smith, Bryan

doi:10.1212/wnl.0000000000207339

Cited by 7 publications

(3 citation statements)

References 47 publications

(61 reference statements)

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“…Regarding the other results, no previous studies have shown a clear association with ALT: in all fairness, the association we found is indeed statistically significant but with an OR of 1.02, which is a clinically insignificant increase. Another inconsistency with the literature—yet a controversial issue—[ 87 ] was the inverse relationship between cognitive impairment and duration of HIV infection (OR: 0.96), which is again statistically significant but almost clinically insignificant. In general, all the associations obtained, except for age and depression, failed to show ORs higher than ±10%.…”

Section: Discussionmentioning

confidence: 92%

Cognitive Impairment in People Living with HIV and the Impact of Mood: Results from a Cross-Sectional Study

Salis,

Belfiori,

Bellisai

et al. 2024

JCM

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Background: Human Immunodeficiency Virus (HIV) infection represents a significant public health concern and, consequently, the incidence of HIV-Associated Neurocognitive Disorder (HAND) has grown over the years. The present study aims to assess HAND with the Montreal Cognitive Assessment (MoCA) in People Living With HIV/AIDS (PLWHA) to find significant associations with cognitive impairment. Methods: The study included 210 PLWHA, aged from 30 to 81 years, of whom, 137 (65.2%) were males. They were assessed at the Immunology Service of the University Hospital of Monserrato, Cagliari, Italy, between November 2022 and April 2023. Results: The sample showed an overall optimal response to antiretroviral therapy, as shown by the excellent levels of CD4+ lymphocytes and HIV RNA copies. A sum of 115 subjects (54.8%) were considered cognitively impaired and the multivariate analysis demonstrated that it was independently associated with duration of infection (OR: 0.96), age (OR: 1.12), alanine aminotransferase (ALT) (OR: 1.02), and depression (OR: 1.33). By dichotomizing the variables, the significance of the association was confirmed for age (65-year threshold) (χ2: 5.142, p = 0.0233) and depression (χ2: 7.834, p = 0.0051). Conclusions: Our study demonstrates that it is hard to find both statistically and clinically significantly associated variables with cognitive impairment in PLWHA, and that the strongest independent association is with depressed mood.

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Section: Discussionmentioning

confidence: 92%

Cognitive Impairment in People Living with HIV and the Impact of Mood: Results from a Cross-Sectional Study

Salis,

Belfiori,

Bellisai

et al. 2024

JCM

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“…Chemokines IP-10/CXCL10 and RANTES/CCL5 in plasma have been found to correlate with and strongly predict NP performance, as measured by the GDS, in treatment-naïve PLWH [187,188]. Moreover, CSF TNFα levels remain increased even in PLWH on long-duration cART compared to matched controls [20]. Whether this pro-inflammatory milieu is directly involved in HIV neuropathogenesis or it is mediated by other comorbidities is an area of active research, with studies identifying a complex immune interplay between HIV infection and metabolic abnormalities, substance use, and even depression [42,189,190].…”

Section: Biomarkers Of Inflammationmentioning

confidence: 99%

“…To be able to delve into the diagnostic methodologies, it is crucial to understand the nature of HIV-associated NCI. The common pattern of cognitive impairment, reported by numerous studies both before and after the cART era, has played a major role in guideline development for appropriate neuropsychological batteries [17][18][19][20]. NCI in PLWH is often referred to as having a "subcortical" pattern, with deficits predominately affecting executive functions, attention/working memory, speed of information processing, motor speed, episodic memory, and learning, while semantic memory, language, and visuospatial abilities are relatively preserved [12,18].…”

Section: Neuropsychological Assessments 21 Understanding Neurocogniti...mentioning

confidence: 99%

Multimodal Approach to Neurocognitive Function in People Living with HIV in the cART Era: A Comprehensive Review

Moschopoulos,

Stanitsa,

Protopapas

et al. 2024

Life

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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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Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross‐sectional study

Mergenova,

Davis,

Gilbert

et al. 2024

J Int AIDS Soc.

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IntroductionThere is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.MethodsWe randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June−November 2019) into a cross‐sectional study. We examined associations between self‐reported ART adherence for the last 1 and 2 weeks; the Adherence Self‐Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire‐9 [PHQ‐9]), anxiety (Generalized Anxiety Disorder tool [GAD‐7]), post‐traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ‐9 and GAD‐7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.ResultsParticipants’ median age was 40.0 (IQR: 34−47) with 40.9% (n = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22–9.11, p < 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20–8.92, p < 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15–14.21, p < 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31–45.7, p < 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24–140.33, p < 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36–80.84, p < 0.005) symptoms. Participants with better cognitive function had lower odds of non‐adherence over the last week (aOR = 0.88, 95% CI: 0.81–0.96, p < 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13–0.40, p < 0.005). Poor memory was associated with higher odds of non‐adherence over the last week (aOR = 4.64, 95% CI: 1.76–12.24, p < 0.005) and lower ASES score (β = −0.31, 95% CI: −0.45 to 0.16, p < 0.005). Those who had at least mild depression (β = −0.21, 95% CI: −0.35 to −0.07, p < 0.005); moderate anxiety (β = −0.21, 95% CI: −0.34 to −0.07, p < 0.005) and PTSD (β = −0.19, 95% CI: −0.33 to −0.05, p < 0.005) symptoms had lower ASES scores.ConclusionsDepression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness were associated with poorer ART adherence and worse adherence self‐efficacy. It is crucial to assess and treat mental illness and provide support for PLWH with worsened cognition to enhance ART adherence.

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Neurocognitive Dysfunction With Neuronal Injury in People With HIV on Long-Duration Antiretroviral Therapy

Cited by 7 publications

References 47 publications

Cognitive Impairment in People Living with HIV and the Impact of Mood: Results from a Cross-Sectional Study

Cognitive Impairment in People Living with HIV and the Impact of Mood: Results from a Cross-Sectional Study

Multimodal Approach to Neurocognitive Function in People Living with HIV in the cART Era: A Comprehensive Review

Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross‐sectional study

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