Neuropsychological characterization of the AIDS dementia complex

Tross, Susan; Price, Richard W.; Navia, Bradford; Thaler, Howard T.; Gold, Jonathan W. M.; Hirsch, Dan Alan; Sidtis, John J.

doi:10.1097/00002030-198804000-00002

Cited by 209 publications

(65 citation statements)

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“…A standardized neurologic examination format was adapted from a widely used clinical classification system (24), incorporating history and examination data into scores for such individual parameters as mental status, cranial nerve, sensory, and motor or cognitive function, and into an overall summary rating for "neurotoxic complex staging" (Appendix). Neuropsychologic test results were converted to standard scores and percentiles using published normative data.…”

Section: Methodsmentioning

confidence: 99%

Estuary-associated syndrome in North Carolina: an occupational prevalence study.

Swinker

Koltai

Wilkins

et al. 2001

Environ Health Perspect

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Atlantic coast estuaries recently have experienced fish kills and fish with lesions attributed to Pfiesteria piscicida and related dinoflagellates. Human health effects have been reported from laboratory exposure and from a 1997 Maryland fish kill. North Carolina has recorded Pfiesteria-related fish kill events over the past decade, but human health effects from environmental exposure have not been systematically investigated or documented here. At the request of the state health agency, comprehensive examinations were conducted in a cross-sectional prevalence study of watermen working where Pfiesteria exposure may occur: waters where diseased or stressed fish were reported from June to September 1997, and where Pfiesteria had been identified in the past. Controls worked on unaffected waterways. The study was conducted 3 months after the last documented Pfiesteria-related fish kill. The goal was to document any persistent health effects from recent or remote contact with fish kills, fish with lesions, or affected waterways, using the 1997 U.S. Centers for Disease Control and Prevention case description for estuary-associated syndrome (EAS). Examinations included comprehensive medical, occupational, and environmental history, general medical, dermatologic, and neurologic examinations, vision testing, and neuropsychologic evaluations. Seventeen of 22 watermen working in affected waters and 11 of 21 in unaffected waters reported exposure to a fish kill or to fish with lesions. We found no pattern of abnormalities on medical, neurologic, neuropsychologic, or NES-2 evaluation. By history, one subject in each group met the EAS criteria, neither of whom had significant neuropsychological impairment when examined. Watermen from affected waterways had a significant reduction in visual contrast sensitivity (VCS) at the midspatial frequencies, but we did not identify a specific factor or exposure associated with this reduction. The cohorts did not differ in reported occupational exposure to solvents (qualitative) or to other neurotoxicants; however, exposure history was not sufficiently detailed to measure or control for solvent exposure. This small prevalence study in watermen, conducted 3 months after the last documented fish kill related to Pfiesteria, did not identify an increased risk of estuary-associated syndrome in those working on affected waterways. A significant difference between the estuary and ocean watermen was found on VCS, which could not be attributed to any specific factor or exposure. VCS may be affected by chemicals, drugs, alcohol, and several developmental and degenerative conditions; it has not been validated as being affected by known exposure to dinoflagellate secretions. VCS should be considered for inclusion in further studies, together with documentation or quantification of its potential confounders, to assess whether it has utility in relationship to dinoflagellate exposure.

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Section: Methodsmentioning

confidence: 99%

Estuary-associated syndrome in North Carolina: an occupational prevalence study.

Swinker

Koltai

Wilkins

et al. 2001

Environ Health Perspect

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“…However, significant improvements were detected, indicating that the battery was sensitive enough in this study. Although brief, these tests have been found to be sensitive 21,22 and specific 31 in detecting HIVrelated neurocognitive changes.…”

Section: (4%)mentioning

confidence: 99%

“…Neurocognitive assessments were conducted every 24 weeks. Subjects were eligible for step 2 if subject or provider desired to reinitiate ART, and were followed for at least 24 weeks, or 96 weeks from step 1 entry (whichever was longer 20 These tests are sensitive in detecting both HIV-related neurocognitive changes 21,22 and antiretroviral effects upon CNS functions. 13 The raw test score of each measurement was standardized using demographic-adjusted normative means, which adjust for gender, age, education, and ethnicity (Caucasian and African American).…”

mentioning

confidence: 99%

Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort

et al. 2010

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Objective: Prior studies have shown improved neurocognition with initiation of antiretroviral treatment (ART) in HIV. We hypothesized that stopping ART would be associated with poorer neurocognitive function. Methods:Neurocognitive function was assessed as part of ACTG 5170, a multicenter, prospective observational study of HIV-infected subjects who elected to discontinue ART. Eligible subjects had CD4 count Ͼ350 cells/mm 3 , had HIV RNA viral load Ͻ55,000 cp/mL, and were on ART (Ն2 drugs) for Ն6 months. Subjects stopped ART at study entry and were followed for 96 weeks with a neurocognitive examination.Results: A total of 167 subjects enrolled with a median nadir CD4 of 436 cells/mm 3 and 4.5 median years on ART. Significant improvements in mean neuropsychological scores of 0.22, 0.39, 0.53, and 0.74 were found at weeks 24, 48, 72, and 96 (all p Ͻ 0.001). In the 46 subjects who restarted ART prior to week 96, no significant changes in neurocognitive function were observed. Conclusion: Subjects with preserved immune function found that neurocognition improved signif-icantly following antiretroviral treatment (ART) discontinuation. The balance between the neurocognitive cost of untreated HIV viremia and the possible toxicities of ART require consideration. Classification of evidence:This study provides Class III evidence that discontinuing ART is associ- -1266GLOSSARY ACTG ϭ AIDS Clinical Trials Group; ART ϭ antiretroviral treatment; EFV ϭ efavirenz; HAART ϭ highly active antiretroviral therapy; HAD ϭ HIV-associated dementia; NP ϭ neuropsychological summary score; TI ϭ treatment interruption; VL ϭ viral load.

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“…It is able to provide data regarding visual search speed, scanning, speed of processing, mental flexibility, and executive functioning [93]. Additionally it is sensitive to detecting several cognitive impairments [93] and both tests in this study have been found to be sensitive and specific to detecting HAND [94,95]. The lack of observed further cognitive decline upon HAART reinitiation in these patients may be related to not following the cohort long enough for the chronic effects of HAART in the CNS to re-initiate.…”

Section: Aging Chronic Haart Administration and Development Of Cognimentioning

confidence: 68%

Development of 2′-Deoxy-4′-C-Ethynyl-2-Fluoroadenosine (EFdA) which has Supremely High Anti-HIV Activity and Low Toxicity and Prevents the Emergence of Resistant HIV Mutants, and Discovery of Different Substrate Selectivity between Viral and Human Nucleic Acid Polymerases

Ohrui¹

2013

J Antivir Antiretrovir

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Highly Active Antiretroviral Therapy (HAART) has significantly reduced AIDS-related morbidity and mortality. However the prevalence of HIV-1-Associated Neurocognitive Disorders (HAND) has been on the rise in the post-HAART era. A majority of the side effects of HAART can in part at least be attributed directly, or indirectly, to mitochondrial dysfunction. Indeed the rapid early clinical phase-in of HAART required dose de-escalations secondary to toxicities suggested to be related to drug side effects affecting mitochondria. Central to central nervous system (CNS) function is the amyloid precursor protein (APP), the parent protein from which amyloid-beta (Aβ) peptide is generated. Aβ generation and aggregation as plaques are well known in the age related dementia, Alzheimer's disease (AD). It has been demonstrated that Aβ is common feature of the HIV infected brain as well. Further, reactive oxygen species (ROS) production is upregulated by HAART. Importantly, ROS promote β-secretase expression; a mechanism by which HAART may promote cognitive dysfunction, even in immune-competent HIV infected individuals.

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Neuropsychological characterization of the AIDS dementia complex

Cited by 209 publications

References 0 publications

Estuary-associated syndrome in North Carolina: an occupational prevalence study.

Estuary-associated syndrome in North Carolina: an occupational prevalence study.

Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort

Development of 2′-Deoxy-4′-C-Ethynyl-2-Fluoroadenosine (EFdA) which has Supremely High Anti-HIV Activity and Low Toxicity and Prevents the Emergence of Resistant HIV Mutants, and Discovery of Different Substrate Selectivity between Viral and Human Nucleic Acid Polymerases

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