Clinical and neuroimaging correlates of cognition in HIV

Olubanke Davies,Mervi Pitkanen,Michael D Kopelman,Ranjababu Kulasegaram,Sarah J Casey,Sofia Gerbase,Gareth J Barker,Becky I Haynes

doi:10.1007/s13365-019-00763-w

Abstract

This study investigated whether HIV-positive participants, stable on combined antiretroviral therapy (cART), showed cognitive impairments relative to HIV-negative controls; and whether clinical and neuroimaging factors correlated with cognitive function in the HIV-positive participants. One hundred and twenty-six white men who have sex with men, of whom 78 were HIV-positive and stable on cART and 48 were HIV negative, were recruited to this cross-sectional study. The median age of HIV-positive participants in this study was 47. They underwent clinical and neuropsychological evaluation and magnetic resonance imaging of the brain, including diffusion tensor imaging (DTI). Cognitive scores for both groups were compared, and regression models were run to explore the influence of clinical, psychiatric, lifestyle, and neuroimaging variables on cognition. The prevalence of neurocognitive impairment, using the multivariate normative comparison criteria, was 28% in HIV-positive participants and 5% in HIV-negative participants. After covarying for age, years of education, and non-English speaking background, there were significant differences between the HIV group and the controls across four cognitive domains. The HIV group showed significantly higher mean diffusivity (MD) and lower fractional anisotropy (FA) than the control group on DTI. Although anxiety levels were clinically low, anxiety and DTI measures were the only variables to show significant correlations with cognitive function. In the HIV group, poorer cognitive performance was associated with higher MD and lower FA on DTI and higher (albeit clinically mild) levels of anxiety. Our findings suggest that white matter changes and subtle anxiety levels contribute independently to cognitive impairment in HIV.

Highlights

The introduction of combined antiretroviral therapy has led to a dramatic decline in HIV-associated mortality and morbidity
All analyses controlled for age, years in education, and non-English speaking background CNS penetration effectiveness (CPE), central nervous system (CNS) penetration efficiency; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; MD, mean diffusivity; FA, fractional anisotropy single model
Both anxiety and the imaging parameters remained significant predictors of cognition, suggesting they were independently associated with cognitive performance. This cross-sectional study investigated whether HIV-positive participants, stable on combined antiretroviral therapy (cART), showed cognitive impairments, relative to HIV-negative controls

Summary

Introduction

The introduction of combined antiretroviral therapy (cART) has led to a dramatic decline in HIV-associated mortality and morbidity. Since the advent of cART, these cognitive deficits have taken a milder form (Heaton et al 2010; Antinori 2007; Pfefferbaum et al 2014; Janssen et al 2015, 2017; Cole et al 2018), but continue to impact negatively on quality of life (Heaton et al 2004) with marked effects on patients and their families and significant cost implications for health and social services. Cognitive decline in HIV may, relate to the insufficient CNS penetrance of some antiretroviral drugs (Robertson et al 2004; Fiandra et al 2017)

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