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Independent and Combined Effects of Chronic HIV-Infection and Tobacco Smoking on Brain Microstructure

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Abstract

HIV-infected individuals (HIV+) have 2–3 times higher prevalence of tobacco smoking than the general U.S. population. This study aims to evaluate the independent and combined effects of tobacco-smoking and HIV-infection on brain microstructure and cognition using a 2 × 2 design. 21 HIV + Smokers, 25 HIV + Nonsmokers, 25 Seronegative (SN)-Smokers and 23 SN-Nonsmokers were evaluated using diffusion tensor imaging. Fractional anisotropy (FA), mean (MD), radial (RD) and axial (AD) diffusivity were assessed in 8 major cerebral fiber tracts and 5 subcortical regions. Cognitive performance in 7 neurocognitive domains was also assessed. Compared to SN, HIV+ had higher AD in genu of corpus callosum (GCC, p = 0.002). Smokers also had higher diffusivities in GCC, splenium of corpus callosum (SCC), anterior corona radiata (ACR), sagittal stratum (SS) and superior fronto-occipital fasciculus (SFO), than Nonsmokers (p-values<0.001–0.003). Tobacco-Smoking and HIV-infection showed synergistic effects on AD_SS (p = 0.002) and RD_SFO (p = 0.02), but opposite effects in FA_putamen (p = 0.024). Additive effects from HIV+ and Tobacco-Smoking were observed in 9 other white matter tracts, with highest diffusivities and lowest FA in HIV + Smokers. Higher diffusivities in the GCC, SCC, ACR and SS predicted poorer cognitive performance across all participants (p ≤ 0.001). Higher AD_GCC also predicted slower Speed of information processing and poorer Fluency and Attention only in HIV + Smokers (p = 0.001–0.003). Chronic tobacco smoking and HIV-infection appear to have additive and synergistic adverse effects on brain diffusivities, suggesting greater neuroinflammation, which may contribute to poorer cognition. Therefore, chronic tobacco-smoking may be a risk factor for HIV-associated neurocognitive disorders.

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Acknowledgments

This work was supported by the National Institutes of Health grants (2 K24-DA16170; U54- NS56883; G12 MD007601). We are grateful to our research participants and the referral physicians from our community providers, including Dr. Drew Kovach, Dr. Dominic Chow, Dr.Jennifer Frank, Dr. Cyril Goshima, and the personnel at the Life Foundation, the Gregory House and at Save the Food Basket. We also appreciate the meticulous and hard work from the multiple clinical and technical research staff members (especially Mark Lum, M.D. and Eric Lau, M.D.) who assisted in the data collection of this study and David Greenstein, B.A. for DTI image processing.

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  1. Department of Radiology, University of Maryland Baltimore School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA

    Huajun Liang, Linda Chang, Rong Chen & Thomas Ernst

  2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Linda Chang & Thomas Ernst

  3. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Kenichi Oishi

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  1. Huajun Liang
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Correspondence to Linda Chang.

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Huajun Liang and Linda Chang are co-first authors.

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Liang, H., Chang, L., Chen, R. et al. Independent and Combined Effects of Chronic HIV-Infection and Tobacco Smoking on Brain Microstructure. J Neuroimmune Pharmacol 13, 509–522 (2018). https://doi.org/10.1007/s11481-018-9810-9

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