The Hawaii AIDS Clinical Research Program (HACRP) has established a cohort of HIV-1 -infected individuals in Bangkok, Thailand to elucidate the mechanisms that induce HIV-1 associated dementia (HAD) in anti-retroviral naive individuals. This application will particularly focus on the role of cellular immune responses in the development of HAD using an expanded cohort of newly enrolled individuals and the established resources. This application is timely because The Thai Ministry of Public Health plans to provide anti-retroviral treatment for all HI V-1-infected individuals according to WHO guidelines. Thus, the opportunity to observe and study HAD before and after anti-retroviral therapy (ARV) within the same individual makes this cohort unique and invaluable. Moreover in contrast to most HIV-1 cohorts established in the US, the enrolled group will comprise of individuals with little to no exposure to illicit drugs, no hepatitis C exposure, and all starting the same ARVs. Therefore, fewer confounding factors exist to impact the HAD diagnosis. Increasing evidence links strong CD4+ T helper function with robust CD8+ CTL responses. HIV-1 - infected individuals who are able to maintain strong HIV-1 specific T cell responses have better clinical outcomes and rarely develop neurological symptoms. Monocyte/macrophage (M/M) infiltration into the white matter of the brain is a hallmark of HAD;yet the mechanisms by which these M/M are recruited to the brain are not clearly understood. We hypothesize that the loss of specific HIV-1 T cell responses results in activation/dysregulation of M/M leading to their accumulation in the brain. The mechanisms pertinent to this loss include: 1) the appearance of viral escape mutants that are no longer recognized by the T cells and 2) the loss of HIV specific CD4+ T cells by viral infection and cytolysis, both of which could results in increased blood M/M activation and infection and the development of HAD. To test this hypothesis we propose to enroll 20 HAD, 20 non-HAD, and 20 seronegative controls to be followed prospectively with neuropsychological data to: 1) define CD4+ and CDS T cell functions specifically by studying HIV-1 specific responses in HAD versus non-HAD individuals;2) correlate these responses simultaneously with M/M subpopulation cell number, percentage and immune function;3) correlate these responses with HIV-1 proviral load;and autologous viral sequences (viral escape sequences and HIV quasispecies) 4) correlate the impact of ARV on dementia with changes in immunological responses. The work described in this project will provide new insights into HIV-1 neuropathogenesis and its relationship to peripheral immune responses, thus opening exciting new areas for further investigation. The setting of this study in South East Asia will also provide novel information on how immunological responses correlate with HIV associated dementia in a population that is just starting anti retroviral drugs and is infected with clade E virus.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS053359-03
Application #
7692275
Study Section
NeuroAIDS and other End-Organ Diseases Study Section (NAED)
Program Officer
Wong, May
Project Start
2007-08-01
Project End
2012-07-31
Budget Start
2009-08-01
Budget End
2010-07-31
Support Year
3
Fiscal Year
2009
Total Cost
$327,334
Indirect Cost
Name
University of Hawaii
Department
Other Clinical Sciences
Type
Schools of Medicine
DUNS #
965088057
City
Honolulu
State
HI
Country
United States
Zip Code
96822
Ratto-Kim, Silvia; Schuetz, Alexandra; Sithinamsuwan, Pasiri et al. (2018) Characterization of Cellular Immune Responses in Thai Individuals With and Without HIV-Associated Neurocognitive Disorders. AIDS Res Hum Retroviruses 34:685-689
Agsalda-Garcia, Melissa A; Sithinamsuwan, Pasiri; Valcour, Victor G et al. (2017) Brief Report: CD14+ Enriched Peripheral Cells Secrete Cytokines Unique to HIV-Associated Neurocognitive Disorders. J Acquir Immune Defic Syndr 74:454-458
Sailasuta, Napapon; Ananworanich, Jintanat; Lerdlum, Sukalaya et al. (2016) Neuronal-Glia Markers by Magnetic Resonance Spectroscopy in HIV Before and After Combination Antiretroviral Therapy. J Acquir Immune Defic Syndr 71:24-30
Heaps, Jodi M; Sithinamsuwan, Pasiri; Paul, Robert et al. (2015) Association between brain volumes and HAND in cART-naïve HIV+ individuals from Thailand. J Neurovirol 21:105-12
Valcour, Victor G; Ananworanich, Jintanat; Agsalda, Melissa et al. (2013) HIV DNA reservoir increases risk for cognitive disorders in cART-naïve patients. PLoS One 8:e70164
Chalermchai, Thep; Valcour, Victor; Sithinamsuwan, Pasiri et al. (2013) Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND. J Neurovirol 19:137-43
Sailasuta, Napapon; Ross, William; Ananworanich, Jintanat et al. (2012) Change in brain magnetic resonance spectroscopy after treatment during acute HIV infection. PLoS One 7:e49272