HIV-Associated Neurocognitive Impairment in the Modern ART Era: Are We Close to Discovering Reliable Biomarkers in the Setting of Virological Suppression?
The prevalence of the most severe forms of HIV-associated neurocognitive disorders (HAND) is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical conc...
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| Published in: | Frontiers in aging neuroscience Vol. 11; p. 187 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
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02.08.2019
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| ISSN: | 1663-4365, 1663-4365 |
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| Abstract | The prevalence of the most severe forms of HIV-associated neurocognitive disorders (HAND) is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical concern for people with HIV (PWH). The pathogenesis of these cognitive impairments has yet to be fully understood and probably multifactorial. In PWH with undetectable peripheral HIV-RNA, the presence of viral escapes in cerebrospinal fluid (CSF) might explain a proportion of cases, but not all. Many other mechanisms have been hypothesized to be involved in disease progression, in order to identify possible therapeutic targets. As potential indicators of disease staging and progression, numerous biomarkers have been used to characterize and implicate chronic inflammation in the pathogenesis of neuronal injuries, such as certain phenotypes of activated monocytes/macrophages, in the context of persistent immune activation. Despite none of them being disease-specific, the correlation of several CSF cellular biomarkers to HIV-induced neuronal damage has been investigated. Furthermore, recent studies have been evaluating specific microRNA (miRNA) profiles in the CSF of PWH with neurocognitive impairment (NCI). The aim of the present study is to review the body of evidence on different biomarkers use in research and clinical settings, focusing on PWH on ART with undetectable plasma HIV-RNA. |
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| AbstractList | The prevalence of the most severe forms of HIV-associated neurocognitive disorders (HAND) is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical concern for people with HIV (PWH). The pathogenesis of these cognitive impairments has yet to be fully understood and probably multifactorial. In PWH with undetectable peripheral HIV-RNA, the presence of viral escapes in cerebrospinal fluid (CSF) might explain a proportion of cases, but not all. Many other mechanisms have been hypothesized to be involved in disease progression, in order to identify possible therapeutic targets. As potential indicators of disease staging and progression, numerous biomarkers have been used to characterize and implicate chronic inflammation in the pathogenesis of neuronal injuries, such as certain phenotypes of activated monocytes/macrophages, in the context of persistent immune activation. Despite none of them being disease-specific, the correlation of several CSF cellular biomarkers to HIV-induced neuronal damage has been investigated. Furthermore, recent studies have been evaluating specific microRNA (miRNA) profiles in the CSF of PWH with neurocognitive impairment (NCI). The aim of the present study is to review the body of evidence on different biomarkers use in research and clinical settings, focusing on PWH on ART with undetectable plasma HIV-RNA. The prevalence of the most severe forms of HIV-associated neurocognitive disorders is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical concern for people with HIV. The pathogenesis of these cognitive impairments has yet to be fully understood and probably multifactorial. In people with HIV (PWH) with undetectable peripheral HIV-RNA, the presence of viral escapes in cerebrospinal fluid (CSF) might explain a proportion of cases, but not all. Many other mechanisms have been hypothesized to be involved in disease progression, in order to identify possible therapeutic targets. As potential indicators of disease staging and progression, numerous biomarkers have been used to characterize and implicate chronic inflammation in the pathogenesis of neuronal injury, such as certain phenotypes of activated monocytes/macrophages, in the context of persistent immune-activation. Despite none of them being disease-specific, the correlation of several CSF cellular biomarkers to HIV-induced neuronal damage have been investigated. Furthermore, recent studies have been evaluating specific microRNA profiles in the CSF of PWH with neurocognitive impairment. The aim of the present study is to review the body of evidence on different biomarkers use in research and clinical settings, focusing on PWH on ART with undetectable plasma HIV-RNA. The prevalence of the most severe forms of HIV-associated neurocognitive disorders (HAND) is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical concern for people with HIV (PWH). The pathogenesis of these cognitive impairments has yet to be fully understood and probably multifactorial. In PWH with undetectable peripheral HIV-RNA, the presence of viral escapes in cerebrospinal fluid (CSF) might explain a proportion of cases, but not all. Many other mechanisms have been hypothesized to be involved in disease progression, in order to identify possible therapeutic targets. As potential indicators of disease staging and progression, numerous biomarkers have been used to characterize and implicate chronic inflammation in the pathogenesis of neuronal injuries, such as certain phenotypes of activated monocytes/macrophages, in the context of persistent immune activation. Despite none of them being disease-specific, the correlation of several CSF cellular biomarkers to HIV-induced neuronal damage has been investigated. Furthermore, recent studies have been evaluating specific microRNA (miRNA) profiles in the CSF of PWH with neurocognitive impairment (NCI). The aim of the present study is to review the body of evidence on different biomarkers use in research and clinical settings, focusing on PWH on ART with undetectable plasma HIV-RNA.The prevalence of the most severe forms of HIV-associated neurocognitive disorders (HAND) is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical concern for people with HIV (PWH). The pathogenesis of these cognitive impairments has yet to be fully understood and probably multifactorial. In PWH with undetectable peripheral HIV-RNA, the presence of viral escapes in cerebrospinal fluid (CSF) might explain a proportion of cases, but not all. Many other mechanisms have been hypothesized to be involved in disease progression, in order to identify possible therapeutic targets. As potential indicators of disease staging and progression, numerous biomarkers have been used to characterize and implicate chronic inflammation in the pathogenesis of neuronal injuries, such as certain phenotypes of activated monocytes/macrophages, in the context of persistent immune activation. Despite none of them being disease-specific, the correlation of several CSF cellular biomarkers to HIV-induced neuronal damage has been investigated. Furthermore, recent studies have been evaluating specific microRNA (miRNA) profiles in the CSF of PWH with neurocognitive impairment (NCI). The aim of the present study is to review the body of evidence on different biomarkers use in research and clinical settings, focusing on PWH on ART with undetectable plasma HIV-RNA. |
| Author | Muscatello, Antonio Taramasso, Lucia Bandera, Alessandra Bozzi, Giorgio Burdo, Tricia H. Gori, Andrea Robinson, Jake A. |
| AuthorAffiliation | 1 Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy 4 Department of Neuroscience, Lewis Katz School of Medicine at Temple University , Philadelphia, PA , United States 2 Department of Pathophysiology and Transplantation, University of Milano , Milan , Italy 3 Infectious Diseases Clinic, Department of Health Sciences, School of Medical and Pharmaceutical Sciences, Policlinico Hospital San Martino, University of Genova (DISSAL) , Genova , Italy |
| AuthorAffiliation_xml | – name: 3 Infectious Diseases Clinic, Department of Health Sciences, School of Medical and Pharmaceutical Sciences, Policlinico Hospital San Martino, University of Genova (DISSAL) , Genova , Italy – name: 2 Department of Pathophysiology and Transplantation, University of Milano , Milan , Italy – name: 4 Department of Neuroscience, Lewis Katz School of Medicine at Temple University , Philadelphia, PA , United States – name: 1 Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy |
| Author_xml | – sequence: 1 givenname: Alessandra surname: Bandera fullname: Bandera, Alessandra – sequence: 2 givenname: Lucia surname: Taramasso fullname: Taramasso, Lucia – sequence: 3 givenname: Giorgio surname: Bozzi fullname: Bozzi, Giorgio – sequence: 4 givenname: Antonio surname: Muscatello fullname: Muscatello, Antonio – sequence: 5 givenname: Jake A. surname: Robinson fullname: Robinson, Jake A. – sequence: 6 givenname: Tricia H. surname: Burdo fullname: Burdo, Tricia H. – sequence: 7 givenname: Andrea surname: Gori fullname: Gori, Andrea |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31427955$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2019. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright © 2019 Bandera, Taramasso, Bozzi, Muscatello, Robinson, Burdo and Gori. 2019 Bandera, Taramasso, Bozzi, Muscatello, Robinson, Burdo and Gori |
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| SubjectTerms | Acquired immune deficiency syndrome AIDS ANI Antiretroviral drugs Antiretroviral therapy Biomarkers Cell activation Cerebrospinal fluid Cognition Cognitive ability Cytokines Disease HAND HIV Human immunodeficiency virus Infections Macrophages marker miRNA Monocytes neurocognitive impairment Neuroscience Phenotypes Proteins Therapeutic applications |
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