NDLI: Relevance of lipopolysaccharide levels in HIV-associated neurocognitive impairment: the Neuradapt study

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Relevance of lipopolysaccharide levels in HIV-associated neurocognitive impairment: the Neuradapt study

Content Provider	Springer Nature Link
Author	Vassallo, Matteo Dunais, Brigitte Durant, Jacques Carsenti Dellamonica, Helene Harvey Langton, Alexandra Cottalorda, Jacqueline Ticchioni, Michel Laffon, Muriel Lebrun Frenay, Christine Dellamonica, Pierre Pradier, Christian
Copyright Year	2013
Abstract	Contributory factors to HIV-associated neurocognitive disorders (HAND) have been shown to include age, co-morbid infections, medication toxicity, virological, genetic and vascular mechanisms, as well as microbial translocation of lipopolysaccharide (LPS), which is suspected to trigger monocyte activation and increase trafficking of infected cells into the brain. In this study, our aim was to assess the degree of neurocognitive impairment in a group of randomly selected HIV-infected patients and investigate potential risk factors, including LPS plasma levels. Furthermore, we evaluated the relevance of LPS as a potential marker for screening patients with mild neurocognitive impairment. LPS plasma levels were compared among patients with HAND and those with no HAND. As LPS has also been shown to be elevated in hepatitis C co-infection, the analysis was stratified according to the presence or not of hepatitis C virus (HCV) co-infection. Differences between groups were evaluated using chi-square tests and Kruskal–Wallis non-parametric tests. Stepwise logistic regression was performed to identify independent risk factors for HAND in the subgroups of HCV-positive and negative patients. A p value <0.05 was considered significant. Analyses were conducted using SPSS® software. From December 2007 to July 2009, 179 patients were tested (mean age 44, 73 % male, 87 % on treatment, 30 % HCV co-infected, median CD4 504/ml and 67 % with viral load below 40 copies/ml). HAND was identified in 40/179 patients (22 %), the majority displaying asymptomatic neurocognitive impairment or mild neurocognitive disorder. Univariate analysis showed that age, illicit drug use, hepatitis C co-infection, prior AIDS-defining events, CD4/CD8 ratio and LPS plasma levels were significantly associated with HAND. The median LPS level was 98.2 pg/ml in the non-HAND group versus 116.1 pg/ml in the HAND group (p < 0.014). No differences were found in LPS values between subgroups of impairment. There was a clear association between LPS levels and HAND in the HCV-positive group (p = 0.036), while there was none in the HCV-negative group (p = 0.502). No difference in degree of hepatic fibrosis was found between the HAND and non-HAND groups. In conclusion, LPS levels were associated with HAND in the HCV-positive group, while, in the HCV-negative group, age and pro-viral DNA were the only variables independently associated with HAND. There was no difference in degree of liver disease as predicted by score of fibrosis between HAND and non-HAND groups. The role of HCV co-infection and higher LPS levels in the pathogenesis of HAND in patients with viral suppression on treatment requires further investigation.
Starting Page	376
Ending Page	382
Page Count	7
File Format	PDF
ISSN	13550284
Journal	Journal of NeuroVirology
Volume Number	19
Issue Number	4
e-ISSN	15382443
Language	English
Publisher	Springer US
Publisher Date	2013-07-12
Publisher Place	Boston
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Lipopolysaccharide HIV-associated neurocognitive disorders Antiretroviral therapy Neurosciences Virology Infectious Diseases Immunology Neurology
Content Type	Text
Resource Type	Article
Subject	Neurology Virology Neurology (clinical) Cellular and Molecular Neuroscience

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