JAMA Netw Open: Are blood CD4 plus T cell counts and viral loads associated with cognitive impairment risk in HIV patients?

Despite the wider use of antiretroviral combination therapy (cART), HIV-1 infection remains a global public health challenge.
, even in chronically infected patients treated, neurocognitive disorders often persist, affecting quality of life.
prevalence of neurocognitive disorders in HIV-positive populations varies from study to study: In one review, nearly half of HIV-positive individuals had cognitive impairment, but other studies showed that less than 20 percent of those affected.
this variability may reflect the heterogeneity of the viral-cesothetic active forces and cART therapeutic states.
other factors may include cultural, socio-economic and educational differences in clinical environments and geographical areas, as well as neuropsychological testing methods, including the use of appropriate normative data, and the handling of neurological and psychiatric confuses.
another study using standard neuropsychological assessments and appropriate normative data found a close link between even minor neurocognitive impairment and interference with the ability to perform instrumental activities in everyday life.
neuroanatomical pathways associated with infections in the body can describe the neuropathological processes behind these defects.
, however, published neuroimaging results from relatively small heterogeneous queues are inconsistent, limiting the universality of the conclusions reached so far.
team explored the relationship between brain structure and the most commonly used clinical assessment of HIV burden (CD4-t cell count and viral load), the findings were published in the journal JAMA Netw Open.
cross-sectional study established the HIV Working Group to Strengthen Neuroimaging Genetics, which brings together and coordinates data from existing HIV neuroimaging studies through the Meta Analysis (ENIGMA) alliance.
, data from 1,295 hiv-positive adults in 13 studies in Africa, Asia, Australia, Europe and North America.
to extract regions and whole-brain segmentation from the data set on a rolling basis from 1 November 2014 to 31 December 2019.
researchers extracted volume estimates of eight sub-cortical regions of the cerebral cortical region from T1 weighted magnetic resonance images to determine the correlation between current immunosuppressed plasma markers (CD4 plus T cell count) or detectable plasma viral load (dVL) in HIV-positive participants.
1,203 HIV-positive individuals were collected after a quality assessment.
results showed that lower CD4-T cell counts were associated with smaller haima and hyalthesus volumes and larger brain chambers, while lower CD4-T cell counts were associated with smaller crustal nucleus volumes in participants who did not undercart therapy.
dVL is associated with a smaller sea mass (d s 0.17; P = .005); In participants treated with cART, dVL was also associated with a smaller amygdala volume (d s 0.23; P = 04)。
the relationship between cortical volume and CD4-T cell count and detectable viral load during scanning, this analysis demonstrates the feasibility and usefulness of a global cooperative initiative to understand the neurological characteristics of HIV infection.
Through greater collaboration, researchers will be able to assess in a robust analysis the factors that may regulate neurological outcomes, including cART treatment options, co-diseases, co-infections, drug use, socioeconomic and demographic factors, and the functional effects of this difference in brain structure.
understanding of neurobiological changes that can lead to neuropsychiatric and cognitive outcomes in HIV-positive individuals is critical to identifying individuals at risk of neurodegeneration, promoting new therapies that may protect the central nervous system, and monitoring treatment responses.
: Nir TM, Fouche J, Ananworanich J, et al. Association of Immunosuppression and Viral Load With Subcortical Brain Volume in an International Sample of People Living With HIV. JAMA Netw Open. 2021; 4(1):e2031190. doi:10.1001/jamanetworkopen.2020.31190MedSci Original Source: MedSci Original Copyright Notice: All noted on this website "Source: Met Medical" or "Source: MedSci Original" text, images and audio and video materials, copyrights are owned by Metz Medical, without authorization, no media, website or individual may reproduce, authorized to reproduce with the words "Source: Mets Medicine".
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