Cardiovascular Disease, Brain Glucose Metabolism, and Neurocognitive Decline in People With Human Immunodeficiency Virus

Overview

Journal Open Forum Infect Dis

Specialty Infectious Diseases

Date 2024 Oct 7

PMID 39371364

Authors

Anna Lyndaker

Chuen-Yen Lau

Swati Shah

Paul Wakim

Erin Kelly

Elizabeth Horne

Cynthia McMahan

Alicia Spiegel

Elyse Gollomp

Alice Chien

Amelia Mitchell

Cynthia Monroe

Alan Kim

Govind Nair

Joseph Snow

Bryan Smith

Avindra Nath

Dima A Hammoud

Affiliations

Soon will be listed here.

Abstract

Background: Cardiovascular disease (CVD) and neuroinflammation are thought to exacerbate neurocognitive dysfunction in treated people with human immunodeficiency virus (PWH). Here, we longitudinally measured brain glucose metabolism as a measure of neuronal integrity in treated PWH using [F]Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in correlation with atherosclerotic cardiovascular disease (ASCVD) scores, cerebrospinal fluid (CSF) neuroinflammatory markers, neurocognitive outcomes, and other clinical and laboratory variables (CLVs).

Methods: Well-controlled PWH (n = 36) underwent baseline and follow-up FDG PET/CT obtained 3.5 years apart on average. Longitudinal changes in whole brain and regional relative FDG uptake, brain volumes, CLVs, CSF cytokines, and neuropsychological measures were measured. A variable selection model identified baseline variables related to future brain metabolic changes while multivariable models explored neuropsychological implications of brain metabolism and volumetrics.

Results: High ASCVD scores predicted future decreased thalamic uptake (slope = -0.0068, = .027) and decreasing thalamic uptake correlated with worsening cognition (slope = 15.80, = .020). Despite longitudinal greater than expected gray matter loss, whole brain FDG uptake did not change over the follow-up period. Most CSF cytokines decreased longitudinally but were not predictive of FDG changes.

Conclusions: We found that high ASCVD scores in a group of treated PWH were related to thalamic hypometabolism, which in turn correlated with neurocognitive decline. Our findings support the contribution of CVD to neurocognitive dysfunction. More proactive CVD management may have a role in mitigating progression of cognitive impairment. Lack of change in global brain glucose metabolism despite documented accelerated gray matter volume loss over the same period suggests that FDG PET might underestimate neuronal injury in PWH compared to structural magnetic resonance imaging.

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