cni » projects » neurological disorders » HIV/AIDS
HIV/AIDS
There are approximately 1.2 million people living with HIV in the United States, and nearly 33 million worldwide. While HIV/AIDS has been widely studied, the effect of the virus on the central nervous system (CNS) is still being elucidated - particularly its effect in the era of antiretroviral treatments.
HIV is observed to enter the brain quickly after initial infection. Before the advent of highly active antiretroviral treatment (HAART) the emphasis in patient care was on survival, and cognitive testing and neuroimaging only played a minor role in patient care and treatment. Among these early patients, dementia was a common cognitive outcome (as many as 50% of HIV patients) and was often associated with increased morbidity risk. Since 1996, HAART therapies have become the standard treatment to reduce HIV viral loads and have been largely successful in reducing the occurrence of dementia. However, the prevalence of mild-to-moderate cognitive impairment in HIV-infected patients has increased due to longer life expectancy and the general inability of the treatment drugs to penetrate the blood brain barrier and enter the CNS. This HIV-related cognitive impairment affects psychomotor speed, executive functioning, and verbal fluency and leads to a decreased quality of life and difficulty in adhering to medication schedules. Thus, as the patient's life expectancy has been prolonged with better treatment, there has been a growing interest in understanding the nature, extent, and severity of cognitive change and the associated neuroimaging correlates.
The mission of the HIV lab is to generate scholarship on the neuropathological and cognitive consequences of HIV in the era of HAART using magnetic resonance imaging techniques combined with neuropsychological testing.
The specific projects that we are working on are:
K-Award:
The purpose of the grant is to investigate the relationship between white matter changes as measured by diffusion tensor imaging (DTI) and cognitive outcome. Each participant will receive an extensive neuropsychological battery and undergo DTI. The relationships between various subcortical white matter pathways and cognition will be investigated.
Navia Study:
This is a multi-site prospective study of HIV associated CNS injury. We will examine the longitudinal structural change of the whole brain, the basal ganglia, white matter signal abnormalities, and hippocampus using quantitative MRI (qMRI) methods for 300 participants reassessed every six to eight months. We will then examine the temporal associations between qMRI variables and magnetic resonance spectroscopy (MRS), neuropsychological, and clinical variables being collected by the parent study in the hopes that we will understand the evolution and progression of CNS injury typical of HIV infected patient populations.
Paul Study:
The purpose of this grant is to examine the relationship between novel neuroimaging markers based on DTI fiber tracking models, structural morphology, genetic polymorphisms of vascular disease and inflammation, and age-related cognitive decline in healthy individuals. Our lab is responsible for processing all the structural imaging data associated with this grant which is being conducted at the University of Missouri St. Louis campus in St. Louis, MO.
CFAR Developmental Grant:
The purpose of this grant is to obtain pilot data examining the variability of white matter change in patients infected with HIV. We will collect prospective neuroimaging data on a subset of patients with identifiable white matter abnormalities. Using time series image analyses, we will then examine the white matter abnormalities for changes that might provide evidence of waxing and waning HIV encephalitis.
BU ADC Grant:
The purpose of this grant is to obtain pilot data examining the association between cardiovascular health as examined by cardiac MRI and multimodal MRI of the brain among patients with mild cognitive impairment. Using these imaging methods, we hope to examine the effect of systemic cardiac function on the evolution/progression of CNS abnormalities and cognitive worsening among patients at risk for developing Alzheimer's disease.
Current members of the group working on quantitative imaging of HIV at CNI are:
- David F. Tate (Principal Investigator: dtate1@partners.org)
- Istvan Csapo
- Kinga Kertesz
- Jared Price
- Troy Russell
- Kelsey Rae Han
- Stella Barth
- Molly Siegel
Recent alumni of the HIV group include:
- Jared Conley
- Soumya Rangarajan