Antiretroviral Therapy in HIV Infection

Cysique, Lucette A.; Maruff, Paul; Brew, Bruce J.

doi:10.1001/archneur.61.11.1699

Cited by 86 publications

(17 citation statements)

References 20 publications

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“…However, HAART may not prevent HIV-induced neuronal damage even when viral load is low (28). Progressive CNS damage is now more common as patients live longer and is somewhat resistant even to therapeutic agents that cross the blood-brain barrier (29). The incidence of HIV-related neuropathology at autopsy also has increased since HAART therapy became more widely available (28).…”

Section: Discussionmentioning

confidence: 99%

Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 ⁺ T lymphocyte decline

Thompson

Dutton

Hayashi

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

287

273

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HIV͞AIDS infection is the fourth leading cause of death worldwide, and one in every 100 adults aged 15-49 years is HIV-infected. Forty percent of AIDS patients suffer from neurological symptoms, but the selective profile of damage caused by HIV in the brain is not well understood. Here, we report 3D maps revealing how AIDS affects the human cerebral cortex, identifying the most vulnerable regions and where deficits link with cognitive decline and immunesystem suppression. With high-resolution brain MRI scans, we created composite maps of cortical gray-matter thickness in 26 AIDS patients and 14 healthy controls to establish the selective pattern of brain deficits in AIDS. In AIDS, primary sensory, motor, and premotor cortices were 15% thinner. Thinner frontopolar and language cortex correlated with immune system deterioration measured through blood levels of CD4 ؉ T lymphocytes. Prefrontal and parietal tissue loss correlated with cognitive͞motor deficits. T cell depletion and cognitive impairment are, therefore, associated with specific 3D brain-deficit patterns visualized with MRI. These quantitative MRI-based maps reveal that HIV selectively damages the cortex. They provide an approach to gauge the impact of AIDS on the living brain and show that the brain is still vulnerable to infection even when patients are receiving antiretroviral therapy.brain ͉ MRI ͉ disease ͉ T cell ͉ immunity

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Section: Discussionmentioning

confidence: 99%

Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 ⁺ T lymphocyte decline

Thompson

Dutton

Hayashi

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

287

273

View full text Add to dashboard Cite

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“…Recently though, there has been an increasing number of studies showing the benefit of a CNS penetrating regimen (Cysique et al 2004b;Letendre et al 2004) in achieving a more favorable clinical outcome. The nature of a CNS penetrant regimen is the subject of ongoing studies but according to one group a central nervous system penetration effectiveness score of 3 or more is associated with a (Letendre et al 2008).…”

Section: Optimization Of Haartmentioning

confidence: 99%

Neurodegeneration and Ageing in the HAART Era

Brew

Crowe

Landay

et al. 2008

J Neuroimmune Pharmacol

Self Cite

188

151

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Cognitive impairment and neurodegeneration still occur despite highly active antiretroviral therapy (HAART). While there are many potential reasons for this, there is increasing evidence that such impairment occurs in the absence of a clear cause. Furthermore, there are data that some neurodegenerative diseases, especially Alzheimer's or an Alzheimer-like illness, are becoming more common in the context of HAART-treated human immunodeficiency virus (HIV) disease. This review will critically examine the evidence underpinning these observations. Potential mechanisms will be discussed with particular emphasis on the effect of ageing and how it overlaps with the effects of HIV disease itself thereby leading to neurodegeneration. The nature of this overlap will then be explored for its potential role in the facilitated expression and development of neurodegenerative diseases. Lastly, there will be a brief discussion of interventions to minimize such neurodegeneration including optimization of HAART for brain entry.

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“…For example, one study demonstrated a positive association between CPE scores and neurocognition limited to a subset of HIV+ participants with neurocognitive impairment at baseline (Cysique, Maruff & Brew, 2004), indicating that premorbid clinical status prior to initiation of cART may be an important determinant of the relationship between CPE and neurocognitive status. Similarly, Tozzi et al (2007) reported persistent neurocognitive deficits correlated with baseline neurocognitive impairment in a HIV+ cART-treated sample.…”

Section: Introductionmentioning

confidence: 99%

An investigation of the effects of antiretroviral central nervous system penetration effectiveness on procedural learning in HIV+ drug users

Wilson

Martin-Engel

Vassileva

et al. 2013

Journal of Clinical and Experimental Neuropsychology

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Treatment with combination antiretroviral therapy (cART) regimens with a high capacity to penetrate the blood-brain barrier has been associated with lower levels of human immunodeficiency virus (HIV) in the central nervous system (CNS). This study examined neurocognitive performance among a sample of 118 HIV+ substance dependent individuals (SDIs) and 310 HIV− SDIs. HIV+ participants were prescribed cART regimens with varying capacity to penetrate the CNS as indexed by the revised CNS penetration effectiveness (CPE) scale. Participants completed the Rotary Pursuit Task (RPT) and the Weather Prediction Task (WPT)--two measures of procedural learning (PL) with known sensitivity to HIV infection--and a control task of sustained attention. HIV+ SDIs prescribed cART with relatively high CNS penetrance performed significantly more poorly on both tasks than HIV− controls. Task performance of HIV+ SDIs prescribed cART with relatively low CNS penetrance did not differ significantly from either HIV− controls or the HIV+/High CPE group, although a trend towards lower RPT performance relative to HIV− participants was observed. Between-group differences were not seen on a control task of motor impulsivity (Immediate Memory Task), indicating that the observed deficits among HIV+/High CPE SDIs may have some specificity.

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Antiretroviral Therapy in HIV Infection

Cited by 86 publications

References 20 publications

Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 ⁺ T lymphocyte decline

Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 ⁺ T lymphocyte decline

Neurodegeneration and Ageing in the HAART Era

An investigation of the effects of antiretroviral central nervous system penetration effectiveness on procedural learning in HIV+ drug users

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Antiretroviral Therapy in HIV Infection

Cited by 86 publications

References 20 publications

Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 + T lymphocyte decline

Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 + T lymphocyte decline

Neurodegeneration and Ageing in the HAART Era

An investigation of the effects of antiretroviral central nervous system penetration effectiveness on procedural learning in HIV+ drug users

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Product

Resources

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Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 ⁺ T lymphocyte decline

Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 ⁺ T lymphocyte decline