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Use of Neuroimaging to Inform Optimal Neurocognitive Criteria for Detecting HIV-Associated Brain Abnormalities

Published online by Cambridge University Press:  02 October 2019

Laura M. Campbell
Affiliation:
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Christine Fennema-Notestine
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA Department of Radiology, University of California, San Diego, La Jolla, CA 92093, USA
Rowan Saloner
Affiliation:
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Mariam Hussain
Affiliation:
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Anna Chen
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Donald Franklin Jr.
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Anya Umlauf
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Ronald J. Ellis
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Ann C. Collier
Affiliation:
Department of Medicine, University of Washington, Seattle, WA 98195, USA
Christina M. Marra
Affiliation:
Department of Neurology, University of Washington, Seattle, WA 98195, USA
David B. Clifford
Affiliation:
Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
Benjamin B. Gelman
Affiliation:
Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
Ned Sacktor
Affiliation:
Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
Susan Morgello
Affiliation:
Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
J. Allen McCutchan
Affiliation:
Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
Scott Letendre
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
Igor Grant
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
Robert K. Heaton*
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
*
Correspondence and reprint requests to: Robert K. Heaton, Ph.D., Distinguished Professor of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, 220 Dickinson St, Suite B, MC8231, San Diego, CA 92103-8231. E-mail: rheaton@ucsd.edu

Abstract

Objective:

Frascati international research criteria for HIV-associated neurocognitive disorders (HAND) are controversial; some investigators have argued that Frascati criteria are too liberal, resulting in a high false positive rate. Meyer et al. recommended more conservative revisions to HAND criteria, including exploring other commonly used methodologies for neurocognitive impairment (NCI) in HIV including the global deficit score (GDS). This study compares NCI classifications by Frascati, Meyer, and GDS methods, in relation to neuroimaging markers of brain integrity in HIV.

Method:

Two hundred forty-one people living with HIV (PLWH) without current substance use disorder or severe (confounding) comorbid conditions underwent comprehensive neurocognitive testing and brain structural magnetic resonance imaging and magnetic resonance spectroscopy. Participants were classified using Frascati criteria versus Meyer criteria: concordant unimpaired [Frascati(Un)/Meyer(Un)], concordant impaired [Frascati(Imp)/Meyer(Imp)], or discordant [Frascati(Imp)/Meyer(Un)] which were impaired via Frascati criteria but unimpaired via Meyer criteria. To investigate the GDS versus Meyer criteria, the same groupings were utilized using GDS criteria instead of Frascati criteria.

Results:

When examining Frascati versus Meyer criteria, discordant Frascati(Imp)/Meyer(Un) individuals had less cortical gray matter, greater sulcal cerebrospinal fluid volume, and greater evidence of neuroinflammation (i.e., choline) than concordant Frascati(Un)/Meyer(Un) individuals. GDS versus Meyer comparisons indicated that discordant GDS(Imp)/Meyer(Un) individuals had less cortical gray matter and lower levels of energy metabolism (i.e., creatine) than concordant GDS(Un)/Meyer(Un) individuals. In both sets of analyses, the discordant group did not differ from the concordant impaired group on any neuroimaging measure.

Conclusions:

The Meyer criteria failed to capture a substantial portion of PLWH with brain abnormalities. These findings support continued use of Frascati or GDS criteria to detect HIV-associated CNS dysfunction.

Type
Regular Research
Copyright
Copyright © INS. Published by Cambridge University Press, 2019 

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Use of Neuroimaging to Inform Optimal Neurocognitive Criteria for Detecting HIV-Associated Brain Abnormalities
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