Persistence of HIV-associated cognitive impairment, inflammation, and neuronal injury in era of highly active antiretroviral treatment
Year: 2011
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To determine whether cognitive impairment and brain injury as measured by proton magnetic resonance spectroscopy (MRS) persist in the setting of HAART. DESIGN: This study is an observational cohort study. METHODS: MRS was performed in 268 patients: HIV-negative controls (N = 28), HIV-positive neuroasymptomatic individuals (N = 124), and individuals with AIDS dementia complex (ADC; N = 50) on stable antiretroviral therapy (ART) with a mean duration of infection of 12 years and CD4 cell count of 309 cells/μl. Four metabolites were measured over creatine: N-acetyl aspartate (NAA), marker of neuronal integrity; choline (Cho), myoinositol, markers of inflammation, and glutamate and glutamine (Glx) in the basal ganglia, frontal white matter (FWM), and mid-frontal cortex. Analyses included analysis of variance, analysis of covariance, linear, and nonparametric regression models. RESULTS: Cognitive impairment was found in 48% of HIV-infected individuals. Both HIV-positive groups showed significant increases in myoinositol/creatine or Cho/creatine in all brain regions when compared to controls; a significant decrease in Glx/creatine in the FWM was observed in the neuroasymptomatic group; and only individuals with ADC showed a significant reduction in NAA/creatine, although a significant trend for decreasing NAA/creatine in the basal ganglia was found across the groups. Effects related to aging and duration of infection, but not central nervous system penetration effectiveness were observed. CONCLUSION: Brain inflammatory changes remain ubiquitous among HIV-infected individuals, whereas neuronal injury occurs predominantly in those with cognitive impairment. Together these findings indicate that despite the widespread use of HAART, HIV-associated cognitive impairment and brain injury persist in the setting of chronic and stable disease.
Source: AIDS
Institutions: Indiana University School of Medicine, University of Hawaiʻi at Mānoa, University of Hawaii System, University of California San Diego, University of California San Diego Medical Center, University of Rochester Medicine, University of Rochester, University of California, Los Angeles, The Lundquist Institute, Harbor–UCLA Medical Center, University of Colorado Denver, Brown University, Miriam Hospital, Tufts University
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: green
Funders: National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: G1050281965, California NeuroAIDS Tissue Network (CNTN), G136028817, UCLA Clinical and Translational Science Institute, National Neurological AIDS Bank, G4559771646, G475936976, G6803312306, In vivo proton MRS studies:cerebral injury in HIV infection, G8162860740, G939674998, G961682679, Colorado Clinical and Translational Science Institute (UL1)
OpenAlex ID: W2109169003