Plasma viral load and CD4 lymphocytes predict HIV-associated dementia and sensory neuropathy

Childs, E. A.; Lyles, Robert H.; Selnes, Ola A.; Chen, B.; Miller, Eric N.; Cohen, Bruce A.; Becker, James T.; Mellors, John W.; McArthur, Justin C.

doi:10.1212/wnl.52.3.607

Cited by 288 publications

(192 citation statements)

References 29 publications

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“…HIV-associated dementia tends to develop when CD4 + T-lymphocyte number falls below 200 cells/µl (Childs et al, 1999;Dore et al, 1999), and in this study, CD4 + count correlated with the severity of cognitive impairment. This relationship may be partially ascribed to poor general condition or concurrent systemic opportunistic infections influencing neuropsychological performance in AIDS patients.…”

Section: Discussionsupporting

confidence: 58%

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

Chiang¹,

Dutton²,

Hayashi³

et al. 2007

NeuroImage

164

152

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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: Discussionsupporting

confidence: 58%

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

Chiang¹,

Dutton²,

Hayashi³

et al. 2007

NeuroImage

164

152

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“…Many risk factors have been listed for the peripheral neuropathy found in adults with AIDS. 9,10,18,19 A small trend of a higher prevalence for peripheral neuropathy occurring in children with encephalopathy or symptomatic AIDS (CDC classifications B and C) is shown in this study. However, none of the factors presently studied had a significant correlation with the presence of symptoms and signs of peripheral neuropathy in these children, which might have been attributable to a type 2 error.…”

Section: Discussionmentioning

confidence: 47%

Distal Sensory Polyneuropathy in a Cohort of HIV-Infected Children Over Five Years of Age

2000

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ABSTRACT. Background. Peripheral neuropathy in children with human immunodeficiency virus (HIV) infection has not been systematically studied.Objectives. To describe the symptoms and signs of peripheral neuropathy in HIV-infected children and to determine their frequency.Methods. A cross-sectional study was conducted on a convenience sample from a cohort of children older than 5 years of age at the pediatric HIV outpatient clinic of the Federal University of Rio de Janeiro. Those patients were interviewed and examined systematically for peripheral nerve symptoms and signs.Results. A total of 39 patients were clinically evaluated. Their ages ranged from 5 to 14 years, and 13 patients (34%) had symptoms and signs of peripheral nerve involvement. Distal paresthesia and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Symptoms were chronic and fluctuating, and pain was, in general, not severe. Nerve conduction studies primarily revealed axonal changes.Conclusions. Peripheral neuropathy occurs in one third of HIV-infected children, and, in general, has less severe features than the distal sensory polyneuropathy described in adults. Pediatrics 2000;106(3). URL: http:// www.pediatrics.org/cgi/content/full/106/3/e35; peripheral neuropathy, human immunodeficiency virus, children.ABBREVIATIONS. HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; CDC, Centers for Disease Control and Prevention; ddI, dideoxyinosine. W orldwide, children are still becoming infected with the human immunodeficiency virus (HIV). 1 Although pediatric acquired immunodeficiency syndrome (AIDS) cases have been reported since 1983 2,3 and, soon after, many authors started to highlight the central nervous system involvement in the course of the disease, 4,5 little is known concerning these patients' peripheral nervous system status. 6,7 Peripheral neuropathy is common in HIV-infected adults, 8 -10 either related to the disease or to its treatment. It may present as inflammatory demyelinating polyneuropathy, mononeuropathy, mononeuritis multiplex, polyradiculopathy, subclinical neuropathy, or, more frequently, as distal sensory polyneuropathy.In 1991, Raphael et al 6 reported the case of a 5-year-old boy with AIDS who had developed an inflammatory demyelinating polyneuropathy. In 1997, Floeter et al 7 described the electrophysiologic data of 50 HIV-infected patients under 18 years of age referred for evaluation of suspected neuropathy. A variety of abnormalities were described, including a probable distal sensory axonal neuropathy in 7 of the oldest children. Although biased by referral, this study suggested that at least some children eventually do develop peripheral neuropathy.The epidemiology of HIV infection is evolving. More children are becoming infected, and attributable to better management strategies, they are surviving longer. The paucity of reports on peripheral neuropathy in HIV-infected children may reflect agerelated differences in regenerative capacit...

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“…Some studies have examined viral load and CD4 cell counts, measures typically used to monitor immunologic function in patients with HIV infection, as potential markers of CNS injury and vulnerability to CNS complications. A study that followed viral loads and CD4 cell counts in a large cohort of HIV-infected men without AIDS found that relatively high plasma HIV RNA (> 3000 copies/ml) and low CD4 T-lymphocyte counts (< 500 x 106 cells/l) were predictive of both dementia and neuropathy (Childs et al, 1999).The authors suggested that effective suppression of HIV may reduce the risk of developing these neurological complications. Based on evidence of basal ganglia dysfunction in HIV-associated dementia (Berger & Nath, 1997), some researchers proposed that microvascular abnormalities would be found in the basal ganglia of patients with this condition (Berger, 2000).Using time-course magnetic resonance imaging, these investigators observed increased enhancement, both immediate and late, in the basal ganglia of individuals with HIV infection and moderate-to-severe dementia, relative to HIV patients without dementia.…”

Section: Impact Of Hiv On the Central Nervous System (Cns)mentioning

confidence: 99%

Neuropsychiatric Manifestations of HIV Infection and AIDS

Olisah¹

2011

HIV and AIDS - Updates on Biology, Immunology, Epidemiology and Treatment Strategies

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Plasma viral load and CD4 lymphocytes predict HIV-associated dementia and sensory neuropathy

Cited by 288 publications

References 29 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

Distal Sensory Polyneuropathy in a Cohort of HIV-Infected Children Over Five Years of Age

Neuropsychiatric Manifestations of HIV Infection and AIDS

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