| |
Effect of HIV and Interpersonal Trauma on Cortical Thickness, Cognition, and Daily Functioning
|
| |
| |
Effect of HIV and Interpersonal Trauma on Cortical
Thickness, Cognition, and Daily Functioning
JAIDS 2020 Kapetanovic, Suad MDa,b; Norato, Gina ScMc; Nair, Govind PhDc; Julnes, Peter Siyahhan MDc; Traino, Katherine A. BAb; Geannopoulos, Katrina BAc; Smith, Bryan R. MDc; Snow, Joseph PhDb; Nath, Avindra MDc
Abstract
Background:
Interpersonal trauma (IPT) is highly prevalent among HIV-positive (HIV+) individuals, but its relationship with brain morphology and function is poorly understood.
Setting:
This cross-sectional analysis evaluated the associations of IPT with cognitive task performance, daily functioning, magnetic resonance imaging (MRI) brain cortical thickness, and bilateral volumes of 4 selected basal ganglia regions in a US-based cohort of aviremic HIV+ individuals, with (HIV+ IPT+) and without IPT exposure (HIV+ IPT-), and sociodemographically matched HIV-negative controls with (HIV- IPT+) and without IPT exposure (HIV- IPT-).
Methods:
Enrollees completed brain MRI scans, a semistructured psychiatric interview, a neurocognitive battery, and 3 measures of daily functioning. Demographic and clinical characteristics of the 4 groups were described, and pairwise between-group comparisons performed using χ2 tests, analysis of variance, or t-tests. Linear or Poisson regressions evaluated relationships between group status and the outcomes of interest, in 6 pairwise comparisons, using Bonferroni correction for statistical significance.
Results:
Among 187 participants (mean age 50.0 years, 63% male, 64% non-white), 102 were HIV+ IPT+, 35 were HIV+ IPT-, 26 were HIV- IPT-, and 24 were HIV- IPT+.
Compared with the remaining 3 groups, the HIV+ IPT+ group had more activities of daily living declines, higher number of impaired Patient's Assessment of Own Functioning Inventory scores, and lower cortical thickness in multiple cerebral regions.
Attention/working memory test performances were significantly better in HIV- IPT- compared with the HIV+ IPT+ and HIV+ IPT- groups. Basal ganglia MRI volumes were not significantly different in any between-group comparisons.
Conclusion:
IPT exposure and HIV infection have a synergistic effect on daily functioning and cortical thickness in aviremic HIV+ individuals.
the experience of interpersonal trauma (IPT), defined as a "deliberate threat or injury in the context of an interpersonal interaction,"1 is highly prevalent among HIV-positive (HIV+) individuals. Evidence suggests high prevalence of intimate partner violence (55.3%), and childhood physical (39.3%) and sexual (42.7%) abuse among HIV+ women,2 and sexual (35.2%) and physical (53.9%) abuse in HIV+ men.3
In conclusion,in this US-based cohort of HIV+ individuals, we not only observed a high prevalence of IPT [interpersonal trauma], but also a significant combined effect of chronic HIV disease and IPT on daily functioning and cortical thickness despite viral suppression. We also observed independent effect of HIV on attention/working memory, regardless of IPT history. These results suggest that IPT exposure is associated with increased risk of NeuroHIV complications even among aviremic HIV+ individuals on ART, in addition to that of chronic HIV disease alone. Longitudinal and mechanistic studies are indicated to further elucidate the direction, causality, clinical implications, and underlying pathophysiology of the observed effect.
HIV infection in a virologically suppressed patient is also characterized by sustained chronic inflammation and elevated cytokines, including IL-6, CD14, CD163, TNFR1, TNFR2, IL2RA, KYN/TRP, and d-Dimer, which are associated with increased risk of non-AIDS adverse events,including cardiovascular, respiratory, gastrointestinal, and immune pathology.24,25 We have previously reported significant associations between post-traumatic stress disorder (one potential consequence of IPT) and markers of inflammation and immune activation in HIV+ individuals with controlled viremia, including higher percentages of memory CD8 T-cells, lower percentages of naïve CD8 T-cells, and higher rates of C -reactive protein >3 mg/L.26 The excess of circulating cytokines observed in both chronic conditions could hypothetically combine to cause cortical atrophy, possibly directly through chemokine interference with monoamine metabolism23 or with synaptic transmission,27 or indirectly (eg, through systemic vascular or immune pathology).23
The experience of interpersonal trauma (IPT), defined as a "deliberate threat or injury in the context of an interpersonal interaction,"1 is highly prevalent among HIV-positive (HIV+) individuals. Evidence suggests high prevalence of intimate partner violence (55.3%), and childhood physical (39.3%) and sexual (42.7%) abuse among HIV+ women,2 and sexual (35.2%) and physical (53.9%) abuse in HIV+ men.3
|
|
| |
| |
|
|
|
