| Publication Abstract Display | | Type: Poster | | Title: Use of neuroimaging to inform optimal neurocognitive criteria for detecting HIV associated brain abnormalities. | | Authors: Campbell L, Fennema-Notestine C, Saloner R, Hussain M, Chen A, Franklin D, Umlauf A, Ellis R, Collier A, Marra C, Clifford D, Gelman B, Sacktor N, Morgello S, McCutchan J, Letendre S, Heaton R | | Date: 02-20-2019 | | Abstract:Objective: Meyer et al. (2013) state that Frascati criteria for HIV-associated neurocognitive disorders (HAND) over-diagnoses mild HAND, resulting in excessive false positive errors. Meyer et al. recommend revisions to HAND criteria, as yet Meyer and Frascati methods have not been compared using independent evidence of brain abnormalities. The current study examines neuroimaging markers in those impaired via Frascati criteria but normal via Meyer criteria compared to concordantly normal and impaired HIV-infected (HIV+) participants.
Participants and Methods: 241 HIV+ adults without severe comorbidities completed neuropsychological (NP) testing assessing 7 cognitive domains, and demographically corrected NP norms were used. Participants also underwent structural MRI and MR spectroscopy. Meyer criteria defined impairment as ≤-1.5 SD in two of five domains. Frascati criteria defined impairment as <-1.0 SD in two of seven domains. Participants were classified as concordant normal (Nml/Nml), concordant impaired (Imp/Imp), or discordant (Nml/Imp) which were normal via Meyer criteria but impaired via Frascati criteria.
Results: Resulting groups were 144 (60%) Nml/Nml, 64 (27%) Nml/ Imp, and 33 (14%) Imp/Imp. Groups were similar with respect to most demographics, HIV disease characteristics, and comorbidities; however, Imp/Imp had more education and a greater proportion of participants with moderate (vs minimal) comorbidities than Nml/Nml. The Nml/Imp group had less cortical gray matter (β=.08, p=.02), greater sulcal CSF volume (β=-.14, p=.04), and greater neuroinflammation (i.e., choline) in FGM (β=-.17, p=.01) than Nml/Nml. Nml/Imp did not differ from Imp/Imp on any imaging measures.
Conclusions: Findings indicate the discordant Nml/Imp group displays worse brain integrity and more neuroinflammation than HIV+ adults with normal cognition. Therefore, Meyer criteria appear to underclassify HAND by failing to correctly identify a large, clinically relevant group of individuals with brain abnormalities. |
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