Cingulate transcranial direct current stimulation in adults with HIV

Abstract

Background Neuronal dysfunction plays an important role in the high prevalence of HIV-associated neurocognitive disorders (HAND) in people with HIV (PWH). Transcranial direct current stimulation (tDCS)—with its capability to improve neuronal function—may have the potential to serve as an alternative therapeutic approach for HAND. Brain imaging and neurobehavioral studies provide converging evidence that injury to the anterior cingulate cortex (ACC) is highly prevalent and contributes to HAND in PWH, suggesting that ACC may serve as a potential neuromodulation target for HAND. Here we conducted a randomized, double-blind, placebo-controlled, partial crossover pilot study to test the safety, tolerability, and potential efficacy of anodal tDCS over cingulate cortex in adults with HIV, with a focus on the dorsal ACC (dACC). Methods Eleven PWH (47–69 years old, 2 females, 100% African Americans, disease duration 16–36 years) participated in the study, which had two phases, Phase 1 and Phase 2. During Phase 1, participants were randomized to receive ten sessions of sham (n = 4) or cingulate tDCS (n = 7) over the course of 2–3 weeks. Treatment assignments were unknown to the participants and the technicians. Neuropsychology and MRI data were collected from four additional study visits to assess treatment effects, including one baseline visit (BL, prior to treatment) and three follow-up visits (FU1, FU2, and FU3, approximately 1 week, 3 weeks, and 3 months after treatment, respectively). Treatment assignment was unblinded after FU3. Participants in the sham group repeated the study with open-label cingulate tDCS during Phase 2. Statistical analysis was limited to data from Phase 1. Results Compared to sham tDCS, cingulate tDCS led to a decrease in Perseverative Errors in Wisconsin Card Sorting Test (WCST), but not Non-Perseverative Errors, as well as a decrease in the ratio score of Trail Making Test—Part B (TMT-B) to TMT—Part A (TMT-A). Seed-to-voxel analysis with resting state functional MRI data revealed an increase in functional connectivity between the bilateral dACC and a cluster in the right dorsal striatum after cingulate tDCS. There were no differences in self-reported discomfort ratings between sham and cingulate tDCS. Conclusions Cingulate tDCS is safe and well-tolerated in PWH, and may have the potential to improve cognitive performance and brain function. A future study with a larger sample is warranted.

The Effects of Transcranial Direct Current Stimulation (tDCS) in HIV Patients—A Review

“…In the other studies, a monopolar montage was utilized, where one electrode was placed on the scalp, and the other was positioned extracerebrally, such as on the arm. The studies [43][44][45][46][47][48] found were published between 2012 and 2022. Among the included studies, three adopted parallel designs, and one adopted a crossover design.…”

“…The studies [ 43 , 44 , 45 , 46 , 47 , 48 ] found were published between 2012 and 2022. Among the included studies, three adopted parallel designs, and one adopted a crossover design.…”

“…Random assignment occurred in all controlled clinical trials; all trials used sham stimulation for the control group. In studies [ 43 , 44 , 46 ], the investigators who conducted the participant assessments were blinded, and in one study [ 48 ], the technician who performed the intervention was blinded. A current of 1.5 or 2 mA was used.…”

“…The objective of the study conducted by Jiang et al [ 48 ] was to investigate the effects of tDCS applied to the dorsal anterior cingulate cortex (dACC) and posterior cingulate cortex (PCC) in individuals living with HIV (PWH). Eleven PWH participated in the study, which consisted of two phases.…”

Prefrontal Cortex Neuromodulation Improve Gait Parameters in Latinx People Living with HIV

“…Recent studies have shown that tDCS has excellent potential to enhance cognitive and motor impairments in those living with H.I.V. A study conducted by Jiang et al, (2022) revealed that participants with H.I.V. who underwent tDCS demonstrated enhanced preservation errors in the Wisconsin card sorting test, a measure of executive functioning, as well as improved scores in the ratio score of the trail making test, which assesses cognitive impairment.…”