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Reversible large-scale network disruption correlates with neurocognitive improvement in HIV-associated minor neurocognitive disorder with combined anti-retroviral therapy intensification: a prospective longitudinal resting-state functional magnetic resonance imaging study

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Abstract

Objective

HIV-associated neurocognitive disorder (HAND) affects multiple cognitive domains and currently, the neuropsychological testing is the gold standard to identify these deficits. The aim of this longitudinal 12-month pilot study is to determine the effect of intensified combination antiretroviral therapy (cART) on rs-fMRI in virally suppressed (both in CSF and blood) patients with active HAND (those who have progressive neurocognitive impairment) and correlated with neurocognitive function tests.

Methods

In this pilot study, we have evaluated sixteen patients with active HAND with viral suppression in both blood and CSF to study the effect of cART on functional connectivity. Participants underwent rs-fMRI at the baseline (time point-1 (TP-1) and 12-month visits (time point-2 (TP-2)). Connectivity in the five major networks was measured at TP-1 and TP-2 using the seed-based approach. All the participants underwent a five-domain neuropsychological battery at TP-1 and TP-2. Neurocognitive scores (NC) as well as blood and CSF markers were correlated with functional connectivity (FC).

Results

There was a significant increase in the FC between the two time points within the executive, salience, default mode, dorsal attention, and visual networks at voxel level threshold of p < 0.001 and cluster level threshold of p < 0.05 and corrected for false detection rate (FDR). The neurocognitive scores were positively correlated with all the networks at similar cluster and voxel level thresholds.

Conclusions

These results indicate that rs-fMRI can be potentially used as one of the biomarkers for treatment efficacy in HAND.

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Data Availability

Data is available and some data can be shared upon request.

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Authors and Affiliations

  1. Department of Medical Imaging, St Vincent’s Hospital, Sydney, Australia

    Joga Chaganti

  2. Center for Applied Medical Research Program, St Vincent’s Hospital, Sydney, Australia

    Thomas M. Gates

  3. Department of Neurology, Head Neuroscience Program and Peter Duncan Neuroscience Centre for Applied Medical Research, St Vincent’s Hospital, University of New South Wales, Sydney, Australia

    Bruce J. Brew

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  1. Joga Chaganti
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  2. Thomas M. Gates
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Corresponding author

Correspondence to Joga Chaganti.

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Ethics approval and informed consent

This is a prospective longitudinal design (“The patient group was chosen from the study which was previously published in AIDS (2016, 30:591–600)”, at St Vincent’s Hospital (SVH), Sydney, Australia (ClinicalTrials.gov Identifier: NCT01449006).

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The authors declare no competing interests.

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Chaganti, J., Gates, T.M. & Brew, B.J. Reversible large-scale network disruption correlates with neurocognitive improvement in HIV-associated minor neurocognitive disorder with combined anti-retroviral therapy intensification: a prospective longitudinal resting-state functional magnetic resonance imaging study. Neurol Sci 44, 3261–3269 (2023). https://doi.org/10.1007/s10072-023-06783-z

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  • DOI: https://doi.org/10.1007/s10072-023-06783-z

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