HIV-related neurocognitive impairment in the HAART era.
ABSTRACT Neurocognitive impairment is common in people living with HIV and AIDS. Prior to highly active antiretroviral therapy (HAART), cognitive impairment primarily affected patients with advanced disease, and was a more rapidly progressive illness. With the use of HAART, cognitive impairment improved, along with the overall health of HIV-positive patients. However, it is still a prevalent problem, even in patients with desirable CD4+ count and undetectable plasma viral load. In this review, we address the nature of HIV-related neurocognitive impairment in the HAART era, including its etiology, pathology, appropriate diagnostic tools for clinical practice and research, and rational treatment approaches.
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ABSTRACT: Chronic systemic immune activation and inflammatory processes have been linked to brain dysfunction in medically stable HIV-infected people. We investigated the association between verbal memory performance and plasma concentrations of 13 cytokines measured using multiplexed bead array immunoassay in 74 HIV-seropositive individuals and 50 HIV-seronegative controls. Memory performance was positively related to levels of IL-8 and IFN-γ, and negatively related to IL-10 and IL-18 and to hepatitis C infection. Memory performance was not significantly related to HIV disease markers. The results indicate the importance of systemic immune and inflammatory markers to neurocognitive function in chronic and stable HIV disease.Journal of neuroimmunology 09/2013; · 2.84 Impact Factor
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ABSTRACT: HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65 %) and African American (68 %); and 41 % had cognitive impairment. On multivariate analysis, African American race (p = 2.21), older age (p = 1.03), high school education or less (p = 2.03) and depression (p = 1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV- populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.Journal of Neuroimmune Pharmacology 10/2013; 8(5). · 3.80 Impact Factor
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ABSTRACT: The purpose of this study is to characterize brain gray matter volumetric changes in HIV seropositive without neurocognitive impairment and seronegative men in Asia. We investigate 36 males with HIV seropositive (mean age 34.5±9.1 years) and 33 age- and gender-matched seronegative controls (mean age 31.4±7.6 years) in Asia. The cognitive competence of 36 males with HIV seropositive has no impaired based on performance in the international HIV dementia scale. High-resolution T1-weighted magnetic resonance imaging is performed on a 3.0 T MR system using a standard 32-channel birdcage head coil. Voxel-based morphometry is used to derive volumetric measurements at the level of the individual voxel (p < 0.001, none corrected for multiple comparisons). Compared to the control group, HIV seropositive male lower gray matter volumes are found in left inferior frontal gyrus triangular part and orbital part, left superior temporal gyrus, right middle frontal gyrus and ant cingulum; significant increases gray matter volumes can be seen in Periaqueductal gray and gray around lateral ventricle. HIV infection can change the gray matter volume early without cognitive competence impaired and MR can recognize that changes.International Journal of Clinical and Experimental Medicine 01/2014; 7(10):3362-3369. · 1.42 Impact Factor