Purpose of Review
To examine characteristics that may distinguish HIV-associated Neurocognitive Disorder (HAND) from early Alzheimer's disease (AD)
Recent Findings
CSF AD biomarkers are perturbed in HIV, yet these alterations may be limited to settings of advanced dementia or unsuppressed plasma HIV RNA. Neuropsychological testing will require extensive batteries to maximize utility. Structural imaging is limited for early AD detection in the setting of HIV, but proper studies are absent. While positron emission tomography (PET) amyloid imaging has altered the landscape of differential diagnosis for age-associated neurodegenerative disorders, costs are prohibitive.
Summary
Risk for delayed AD diagnosis in the aging HIV-infected population is now among the most pressing issues in geriatric neuro HIV. While clinical, imaging, and biomarker characterization of AD is extensively defined, fewer data define characteristics of HAND in the setting of suppressed plasma HIV RNA. Data needed to inform the phenotype of AD in the setting of HIV are equally few.
Progress in HIV treatments has led to HIV-infected patients living into
their 60s and older. Since HIV-associated Neurocognitive Disorder (HAND) in
older age is associated with more executive dysfunction, cognitive screening
instruments tapping this domain may be optimal. We examined the Montreal
Cognitive Assessment (MoCA) to identify HAND in 67 HIV-infected patients over
age 60, of which 40% were diagnosed with HAND. Receiver operator
characteristics (ROC) curve identified an optimized cut-off ≤25/30
identified HAND with a sensitivity of 72% and specificity of
67%. We conclude that the MoCA has only moderate performance
characteristics for cognitive screening of HIV-infected elders.
Our aim was to examine the clinical relevance of white matter hyperintensities (WMH) in HIV. We used an automated approach to quantify WMH volume in HIV seropositive (HIV+; n = 65) and HIV seronegative (HIV−; n = 29) adults over age 60. We compared WMH volumes between HIV+ and HIV− groups in cross-sectional and multiple time-point analyses. We also assessed correlations between WMH volumes and cardiovascular, HIV severity, cognitive scores, and diffusion tensor imaging variables. Serostatus groups did not differ in WMH volume, but HIV+ participants had less cerebral white matter (mean: 470.95 [43.24] vs. 497.63 [49.42] mL, p = 0.010). The distribution of WMH volume was skewed in HIV+ with a high proportion (23%) falling above the 95th percentile of WMH volume defined by the HIV− group. Serostatus groups had similar amount of WMH volume growth over time. Total WMH volume directly correlated with measures of hypertension and inversely correlated with measures of global cognition, particularly in executive functioning, and psychomotor speed. Greater WMH volume was associated with poorer brain integrity measured from diffusion tensor imaging (DTI) in the corpus callosum and sagittal stratum. In this group of HIV+ individuals over 60, WMH burden was associated with cardiovascular risk and both worse diffusion MRI and cognition. The median total burden did not differ by serostatus; however, a subset of HIV+ individuals had high WMH burden.
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