Untangling the Gordian knot of HIV, stress, and cognitive impairment

• Type of Material: Article
• Authors: Arielle N. Valdez, Emory University; Leah H. Rubin, University of Illinois at Chicago; Gretchen Neigh, Emory University
• Language: English
• Date: 2016-10-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2016 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ynstr.2016.02.005
• Title of Journal or Parent Work: Neurobiology of Stress
• Volume: 4
• Start Page: 44
• End Page: 54
• Grant/Funding Information: L.H.R. was supported by 1K01MH098798-01 from the National Institute of Mental Health.; This work was partially supported by funding from a 2015 HIV and Aging Pilot Award to G.N.N. (R24 AG044325 sponsored by Wake Forest University) and Emory University's CFAR (P30AI050409).; G.N.N. also received support from K18MH105098 from the National Institute of Mental Health.
• Keywords: NRTIs, Nucleoside reverse transcriptase inhibitors; CD4; PTSD, Posttraumatic stress disorder; LPS, Lipopolysaccharide; MND, Mild neurocognitive disorder; HANA, HIV-associated, Non-AIDS; ANI, Asymptomatic neurocognitive impairment; Stress; AIDS, Acquired immune deficiency syndrome; PIs, Protease inhibitors; HPA, Hypothalamic–Pituitary Adrenal; hsCRP, High-sensitivity C-reactive protein; NNRTIs, Non-nucleoside reverse transcriptase inhibitors; IL-2, Interleukin-2; HAD, HIV-associated dementia; IL-1β, Interleukin-1β; Cognition; INSTIs, Integrase strand transfer inhibitors; CNS, Central Nervous System; CRP, C-reactive protein; HAND, HIV-associated neurocognitive disorders; IL-12, Interleukin-12; ART, Antiretroviral therapy; GR, Glucocorticoid receptor; PLWH, People living with HIV; GALT, Gut-associated lymphoid tissue; HRV, Heart rate variability; Inflammation; PFC, Prefrontal cortex; HIV; IL-18, Interleukin-18; LTP, Long-term potentiation; ACTH, Adrenocorticotropic hormone; Vpr, Viral protein r; TNFα, Tumor necrosis factor alpha; CBSM, Cognitive behavioral stress management; WIHS, Women's Interagency HIV Study; ROS, Reactive oxygen species; IL-6, Interleukin-6
• Research Categories: Health Sciences, Immunology; Biology, Neuroscience

Abstract

As individuals live longer with HIV, this “graying of the HIV epidemic” has introduced a new set of challenges including a growing number of age and inflammation-related diseases such as cardiovascular disease, type II diabetes, cancer, and dementia. The biological underpinnings of these complex and co-morbid diseases are not fully understood and become very difficult to disentangle in the context of HIV and aging. In the current review we examine the contributions and interactions of HIV, stress, and cognitive impairment and query the extent to which inflammation is the linchpin in these dynamic interactions. Given the inter-relatedness of stress, inflammatory mechanisms, HIV, and cognitive impairment, future work will either need to address multiple dimensions simultaneously or embrace the philosophy that breaking the aberrant cycle at any one point will subsequently remedy the other related systems and processes. Such a single-point intervention may be effective in early disease states, but after perpetuation of an aberrant cycle, adaptations in an attempt to internally resolve the issue will likely lead to the need for multifaceted interventions. Acknowledging that HIV, inflammation, and stress may interact with one another and collectively impact cognitive ability is an important step in fully understanding an individual's complete clinical picture and moving towards personalized medicine.