HIV subtype is not associated with dementia among individuals with moderate and advanced immunosuppression in Kampala, Uganda

Abstract

Background HIV-associated neurocognitive disorders (HAND) are a common neurological manifestation of HIV infection. A previous study suggested that HIV dementia may be more common among patients with subtype D virus than among those with subtype A virus among HIV+ individuals with advanced immunosuppression. We conducted a study to evaluate the frequency of HIV dementia, and the association of HIV dementia with HIV subtype and compartmentalization among HIV+ individuals with moderate and advanced immunosuppression (CD4 lymphocyte count >150 cells/μL and < 250 cells/μL). Methods The study enrolled 117 antiretroviral naïve HIV+ individuals in Kampala, Uganda. HIV+ individuals received neurological, neuropsychological testing, and functional assessments, and gag and gp41 regions were subtyped. Subjects were considered infected with a specific subtype if both regions analyzed were from the same subtype. Results 41% of the HIV+ individuals had HIV dementia (mean CD4 lymphocyte count= 233 cells/μL). 67 individuals had subtype A, 25 individuals had subtype D, 24 individuals were classified as A/D recombinants, and one individual had subtype C. There was no difference in the frequency of HIV dementia when stratified by HIV subtype A and D and no association with compartmentalization between the cerebrospinal fluid and peripheral blood. Conclusions These results suggest that HIV dementia is common in HIV+ individuals in Uganda. There was no association between HIV subtype and dementia among HIV+ individuals with moderate and advanced immunosuppression. Future studies should be performed to confirm these results.

Absence of neurocognitive disadvantage associated with paediatric HIV subtype A infection in children on antiretroviral therapy

“…Another study by Sacktor el al. found no differences by subtype in adults with moderate immune suppression [11].…”

Neuroimaging abnormalities in clade C HIV are independent of Tat genetic diversity

“…A possible exception to the influence of clade on brain integrity is clade D (HIV-D) in Africa, which is associated with rapid immune depletion (Kiwanuka et al 2010), early utilization of CXCR4 co-receptor tropism (Huang et al 2007; Kaleebu et al 2007), and faster disease progression (Kaleebu et al 2002; Kiwanuka et al 2008; Vasan et al 2006). It remains unclear whether HIV-D individuals exhibit disproportional brain dysfunction compared to other clades and to what extent overall disease severity mediates brain outcomes in this population (Sacktor et al 2009; Sacktor et al 2014; Boivin et al 2010). …”

Suicide risk and prevalence of major depressive disorder (MDD) among individuals infected with HIV-1 subtype C versus B in Southern Brazil

“…HIV-1 subtypes present many structural and functional differences, which may influence cellular tropism and organ involvement, including central nervous system (CNS) involvement and cognitive impairment. It was previously thought that different subtypes might account for variation in the incidence of cognitive impairment in distinct geographic regions of the world (Kanki et al, 1999; Kaleebu et al, 2002; Sacktor et al, 2009), although this hypothesis has not been supported by recent studies (de Almeida et al, 2013; Sacktor et al, 2014). …”