Neurological characteristics of HIV‐infected men and women seeking primary medical care

López, Oscar L.; Wess, Jeanne; Sánchez, Jorge; Dew, Mary Amanda; Becker, James T.

doi:10.1111/j.1468-1331.1999.tb00014.x

Cited by 18 publications

(11 citation statements)

References 13 publications

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“…Even so, cognitive impairment may also result from white matter atrophy (and associated cortical atrophy) which occurs in parallel with HIV-induced depletion of CD4 + cells (the rate of these two processes may not be connected, but both are caused by HIV). The CD4 + T-cell number reflects patients' neurological status (Lopez et al, 1999;, submitted for publication-b). White matter loss was greater in patients with CD4 + counts less than 200 cells/µl-relative to those with better immune function and CD4 + counts around 500 cells/µl (Stout et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

3D pattern of brain atrophy in HIV/AIDS visualized using tensor-based morphometry

Chiang¹,

Dutton²,

Hayashi³

et al. 2007

NeuroImage

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Abstract35% of HIV-infected patients have cognitive impairment, but the profile of HIV-induced brain damage is still not well understood. Here we used tensor-based morphometry (TBM) to visualize brain deficits and clinical/anatomical correlations in HIV/AIDS. To perform TBM, we developed a new MRI-based analysis technique that uses fluid image warping, and a new α-entropy-based information-theoretic measure of image correspondence, called the Jensen-Rényi divergence (JRD).Methods-3D T1-weighted brain MRIs of 26 AIDS patients (CDC stage C and/or 3 without HIV-associated dementia; 47.2 ± 9.8 years; 25M/1F; CD4 + T-cell count: 299.5 ± 175.7/µl; log 10 plasma viral load: 2.57 ± 1.28 RNA copies/ml) and 14 HIV-seronegative controls (37.6 ± 12.2 years; 8M/6F) were fluidly registered by applying forces throughout each deforming image to maximize the JRD between it and a target image (from a control subject). The 3D fluid registration was regularized using the linearized Cauchy-Navier operator. Fine-scale volumetric differences between diagnostic groups were mapped. Regions were identified where brain atrophy correlated with clinical measures.Results-Severe atrophy (~15-20% deficit) was detected bilaterally in the primary and association sensorimotor areas. Atrophy of these regions, particularly in the white matter, correlated with cognitive impairment (P=0.033) and CD4 + T-lymphocyte depletion (P=0.005).Conclusion-TBM facilitates 3D visualization of AIDS neuropathology in living patients scanned with MRI. Severe atrophy in frontoparietal and striatal areas may underlie early cognitive dysfunction in AIDS patients, and may signal the imminent onset of AIDS dementia complex.

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Section: Discussionmentioning

confidence: 99%

3D pattern of brain atrophy in HIV/AIDS visualized using tensor-based morphometry

Chiang¹,

Dutton²,

Hayashi³

et al. 2007

NeuroImage

Self Cite

164

152

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“…Similarly, a small study of 49 HIV-1-seropositive women living in Puerto Rico found that rates of cognitive impairment (77.6%), asymptomatic cognitive impairment (32.7%), minor cognitive motor disorders (16.3%), and HIV-associated dementia (28.6%) were similar to rates found among men in the United States, Europe, and Australia (Wojna et al 2006). It has been posited that earlier reports of a vulnerability to HIV-related dementia among women may reflect the lower education and higher proportion of injection drug use among HIV+ women than men and access to antiretroviral therapy (Lopez et al 1999). …”

Section: Neurological Function In Hiv+ Women Versus Menmentioning

confidence: 99%

HIV, Cognition and Women

Maki

Martin-Thormeyer

2009

Neuropsychol Rev

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Although the incidence of HIV in the United States is higher among men compared to women, the global proportion of women versus men who are infected has been approximately 50% since the late 1990s. Women have been under-represented in neuropsychological studies of HIV. A small number of studies have reported a significantly higher prevalence of neurocognitive impairment among HIV+ women compared to HIV− controls regardless of symptom status and with or without an AIDS diagnosis. Impairment was most evident on psychomotor tasks. The risk of neuropsychological impairment was increased among HIV+ women not on antiretroviral therapy. Age and depressive symptoms also increase neurocognitive risk. New neurocognitive studies of ovarian steroid hormones, PTSD and other psychiatric conditions are critical for addressing potential female-specific aspects of HIV-Associated Neurocognitive Disorder. Such studies will also address questions regarding involvement of the hippocampus and verbal memory, which may be of particular significance among HIV+ women.

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“…Relative to men, women living with HIV are more likely to reside in marginalized settings, be less educated, and have a greater frequency of substance use including intravenous drug use (IDU) [34]–[37]. Further, compared to HIV+ men, HIV+ women are less likely to receive recommended health care.…”

Section: Introductionmentioning

confidence: 99%

Select Neurocognitive Impairment in HIV-Infected Women: Associations with HIV Viral Load, Hepatitis C Virus, and Depression, but Not Leukocyte Telomere Length

et al. 2014

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BackgroundThrough implementation of combination antiretroviral therapy (cART) remarkable gains have been achieved in the management of HIV infection; nonetheless, the neurocognitive consequences of infection remain a pivotal concern in the cART era. Research has often employed norm-referenced neuropsychological scores, derived from healthy populations (excluding many seronegative individuals at high risk for HIV infection), to characterize impairments in predominately male HIV-infected populations.MethodsUsing matched-group methodology, we assessed 81 HIV-seropositive (HIV+) women with established neuropsychological measures validated for detection of HIV-related impairments, as well as additional detailed tests of executive function and decision-making from the Cambridge Neuropsychological Test Automated Battery (CANTAB).ResultsOn validated tests, the HIV+ women exhibited impairments that were limited to significantly slower information processing speed when compared with 45 HIV-seronegative (HIV−) women with very similar demographic backgrounds and illness comorbidities. Additionally, select executive impairments in shifting attention (i.e., reversal learning) and in decision-making quality were revealed in HIV+ participants. Modifiers of neurocognition in HIV-infected women included detectable HIV plasma viral load, active hepatitis C virus co-infection, and self-reported depression symptoms. In contrast, leukocyte telomere length (LTL), a marker of cellular aging, did not significantly differ between HIV+ and HIV− women, nor was LTL associated with overall neurocognition in the HIV+ group.ConclusionsThe findings suggest that well-managed HIV infection may entail a more circumscribed neurocognitive deficit pattern than that reported in many norm-referenced studies, and that common comorbidities make a secondary contribution to HIV-related neurocognitive impairments.

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Neurological characteristics of HIV‐infected men and women seeking primary medical care

Cited by 18 publications

References 13 publications

3D pattern of brain atrophy in HIV/AIDS visualized using tensor-based morphometry

3D pattern of brain atrophy in HIV/AIDS visualized using tensor-based morphometry

HIV, Cognition and Women

Select Neurocognitive Impairment in HIV-Infected Women: Associations with HIV Viral Load, Hepatitis C Virus, and Depression, but Not Leukocyte Telomere Length

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