Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Jun 1;33(7):1175-1185.
doi: 10.1097/QAD.0000000000002192.

Effects of comorbidity burden and age on brain integrity in HIV

Rowan Saloner  1   2 , Robert K Heaton  1 , Laura M Campbell  1   2 , Anna Chen  1 , Donald Franklin Jr  1 , Ronald J Ellis  1 , Ann C Collier  3 , Christina Marra  3 , David B Clifford  4 , Benjamin Gelman  5 , Ned Sacktor  6 , Susan Morgello  7 , J Allen McCutchan  1 , Scott Letendre  1 , Igor Grant  1 , Christine Fennema-Notestine  1 ; CHARTER Study Group
Affiliations
Observational Study

Effects of comorbidity burden and age on brain integrity in HIV

Rowan Saloner et al. AIDS. .

Abstract

Objective: The influence of confounding neurocognitive comorbidities in people living with HIV (PLWH) on neuroimaging has not been systematically evaluated. We determined associations between comorbidity burden and brain integrity and examined the moderating effect of age on these relationships.

Design: Observational, cross-sectional substudy of the CNS HIV Antiretroviral Therapy Effects Research cohort.

Methods: A total of 288 PLWH (mean age = 44.2) underwent structural MRI and magnetic resonance spectroscopy as well as neurocognitive and neuromedical assessments. Consistent with Frascati criteria for HIV-associated neurocognitive disorders (HAND), neuromedical and neuropsychiatric comorbidity burden was classified as incidental (mild), contributing (moderate), or confounding (severe-exclusionary) to a diagnosis of HAND. Multiple regression modeling predicted neuroimaging outcomes as a function of comorbidity classification, age, and their interaction.

Results: Comorbidity classifications were 176 incidental, 77 contributing, and 35 confounded; groups did not differ in HIV disease characteristics. Relative to incidental and contributing participants, confounded participants had less cortical gray matter and more abnormal white matter and ventricular cerebrospinal fluid, alongside more neuroinflammation (choline, myo-inositol) and less neuronal integrity (N-acetylaspartate). Older age exacerbated the impact of comorbidity burden: to a greater extent in the confounded group, older age was associated with more abnormal white matter (P = 0.017), less total white matter (P = 0.015), and less subcortical gray matter (P = 0.014).

Conclusion: Neuroimaging in PLWH reveals signatures associated with confounding neurocognitive conditions, emphasizing the importance of evaluating these among individuals with suspected HAND. Older age amplifies subcortical and white matter tissue injury, especially in PLWH with severe comorbidity burden, warranting increased attention to this population as it ages.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Age moderates the relationships between comorbidity burden and brain structure.
Interaction between age and comorbidity group predicting (A) abnormal white matter, (B) total white matter, (C) subcortical gray matter, and (D) cortical gray matter. All structural volumes are log-transformed.
See this image and copyright information in PMC

References

    1. Heaton R, Clifford D, Franklin D, Woods S, Ake C, Vaida F, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology 2010; 75(23):2087–2096. - PMC - PubMed
    1. Centers for Disease Control and Prevention. HIV Among People Aged 50 and Over. In: Centers for Disease Control and Prevention; 2018.
    1. Tozzi V, Balestra P, Bellagamba R, Corpolongo A, Salvatori MF, Visco-Comandini U, et al. Persistence of neuropsychologic deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment: prevalence and risk factors. JAIDS Journal of Acquired Immune Deficiency Syndromes 2007; 45(2):174–182. - PubMed
    1. Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, LeBlanc S, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. In: Journal of Neurovirology; 2011. pp. 3–16. - PMC - PubMed
    1. Masters MC, Ances BM. Role of Neuroimaging in HIV Associated Neurocognitive Disorders (HAND). Seminars in neurology 2014; 34(1):89–102. - PMC - PubMed

Publication types

MeSH terms

Substances