Human immunodeficiency virus (HIV) infected patients are now living longer due to potent antiretroviral therapy (ART). Despite the effectiveness of ART for systemic viral suppression, up to half of chronically HIV infected (HIV+) individuals will develop HIV associated neurocognitive disorders (HAND). Increasing efforts have focused on understanding the early pathophysiologic changes within the central nervous system (CNS) initiated during primary HIV infection (PHI, defined as the first year after HIV transmission). It remains unknown if early initiation of ART during PHI could reduce the future incidence of developing HAND. It is imperative that early biomarkers (including cerebrospinal fluid (CSF) and neuroimaging) are developed for understanding the mechanisms of crucial early events that may influence the trajectory of damage in the CNS. Previous studies of PHI have primarily been cross sectional and have focused on a limited number of PHI participants assessed by single modality. We propose a longitudinal study to assess the effects of PHI and early ART on brain structure which integrates structural neuroimaging analyses with blood and CSF measures of infection, inflammation and neurodenegeration, as well as clinical data including exposure to stimulant drugs of abuse to investigate possible mechanisms of brain injury beginning during PHI. Specifically, this study will employ structural neuroimaging methods (diffusion tensor imaging (DTI) and brain volumetrics) to study the CNS mechanisms that underlie the natural history of PHI in the CNS as well as the effects of starting ART in the early stages of infection. Based on our preliminary cross sectional analyses, we hypothesize that structural neuroimaging (DTI and brain volumetrics) will reveal progressive injury in the brain during early infection prior to ART which may be halted in subjects that initiate ART soon after seroconversion. Subjects using methamphetamine may have increased vulnerability to HIV-associated structural injury, tied to inflammation in the brain. This proposal will:
(Aim 1) investigate the mechanisms of CNS injury in PHI prior to ART by temporally associating the emergence of abnormalities in structural imaging with laboratory biomarkers and neuropsychological performance. Additionally (Aim 2) we will explore the mechanisms of early ART effects in the CNS through assessment of white matter integrity and brain volumetrics over time in subjects both before and after starting ART. Our long term goal is to provide evidence for the appropriate timing of ART initiation and to evaluate the rationale of possible tailored adjunctive neuroprotective therapies to prevent HAND.
Antiretroviral therapy (ART) has changed the face of HIV but neurological complications still remain. The overall direct impact of our research will be: 1) an increase in our knowledge concerning the longitudinal effects of early HIV on brain structure, 2) a greater understanding of the correspondence between neuro-inflammation and brain injury during early HIV infection, 3) an increased comprehension of the effects of early initiation of ART on HIV associated pathology. Our long term goal is to provide evidence for the appropriate timing of ART initiation and to evaluate the rationale of possible tailored adjunctive neuroprotective therapies to prevent HAND.
|Guha, Anika; Brier, Matthew R; Ortega, Mario et al. (2016) Topographies of Cortical and Subcortical Volume Loss in HIV and Aging in the cART Era. J Acquir Immune Defic Syndr 73:374-383|
|Behrman-Lay, Ashley M; Paul, Robert H; Heaps-Woodruff, Jodi et al. (2016) Human immunodeficiency virus has similar effects on brain volumetrics and cognition in males and females. J Neurovirol 22:93-103|
|Wright, Patrick W; Pyakurel, Ashmit; Vaida, Florin F et al. (2016) Putamen volume and its clinical and neurological correlates in primary HIV infection. AIDS 30:1789-94|
|Ances, Beau M; Hoare, Jacqueline (2016) Perinatal HIV in the brain: Mission incomplete despite combination antiretroviral therapy. Neurology 86:13-4|
|Brier, Matthew R; McCarthy, John E; Benzinger, Tammie L S et al. (2016) Local and distributed PiB accumulation associated with development of preclinical Alzheimer's disease. Neurobiol Aging 38:104-11|
|Spudich, Serena S (2016) Immune activation in the central nervous system throughout the course of HIV infection. Curr Opin HIV AIDS 11:226-33|
|Ortega, Mario; Brier, Matthew R; Ances, Beau M (2015) Effects of HIV and combination antiretroviral therapy on cortico-striatal functional connectivity. AIDS 29:703-12|
|Thomas, Jewell B; Brier, Matthew R; Ortega, Mario et al. (2015) Weighted brain networks in disease: centrality and entropy in human immunodeficiency virus and aging. Neurobiol Aging 36:401-12|
|Wright, Patrick W; Vaida, Florin F; FernÃ¡ndez, Ricardo J et al. (2015) Cerebral white matter integrity during primary HIV infection. AIDS 29:433-42|
|Brier, Matthew R; Wu, Qian; Tanenbaum, Aaron B et al. (2015) Effect of HAART on Brain Organization and Function in HIV-Negative Subjects. J Neuroimmune Pharmacol 10:517-21|
Showing the most recent 10 out of 19 publications