TY - JOUR
T1 - Effects of comorbidity burden and age on brain integrity in HIV
AU - Saloner, Rowan
AU - Heaton, Robert K.
AU - Campbell, Laura M.
AU - Chen, Anna
AU - Franklin, Donald
AU - Ellis, Ronald J.
AU - Collier, Ann C.
AU - Marra, Christina
AU - Clifford, David B.
AU - Gelman, Benjamin
AU - Sacktor, Ned
AU - Morgello, Susan
AU - Allen McCutchan, J.
AU - Letendre, Scott
AU - Grant, Igor
AU - Fennema-Notestine, Christine
N1 - Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
KW - HIV
KW - MRI
KW - aging
KW - brain
KW - comorbidity
KW - magnetic resonance spectroscopy
KW - neurocognitive disorders
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U2 - 10.1097/QAD.0000000000002192
DO - 10.1097/QAD.0000000000002192
M3 - Article
C2 - 30870195
AN - SCOPUS:85065510346
SN - 0269-9370
VL - 33
SP - 1175
EP - 1185
JO - AIDS
JF - AIDS
IS - 7
ER -