2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Progressive atrophy in older HIV+ Despite persistent suppression of plasma HIV RNA

 Seen largely in subcortical regions, including asymptomatic suppressed participants 1  Seen in cerebellum, caudate, frontal lobe, total cortical gray matter, brainstem, and pallidum 2  During acute HIV despite immediate therapy, reduced volumes over 2 years in putamen and caudate 3 - Brain volume reductions seen during primary HIV (not onART) 4 including putamen despite treatment 5  Two contrasting studies among younger individuals compared to demographically matched controls and a study where individuals with substantial cerebrovascular disease were excluded 6,7

1.Niretal, JNeurovirologgy2019;2.Clifford&Sambojuetal JAIDS2017;3.Kallianpur etalCROI2016 ; 4.RaginAnnals Clinical/translational neurology 2015;5.WrightetalAIDS2016;6SamfordetalJAMA Neurology2017;7.ColeetalCID2018

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The Role of Inflammation Despite Viral Suppression

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Numerous studies demonstrate correlations to chronic inflammation Among individuals optimally treated with plasma viral suppression  In vivo brain imaging using ligands (PET) - TPSO binding (microglialactivation) increased in HIV compared to controls and inversely associated with cognitive performance 1,2  Plasma markers and Immunological markers - sCD163 and global performance 3 - CD 14 CD 16 CD 163 and CD 14 CD 38 (% CD14) and progressive worsening of memory performance 4 Additionally: - Chronic inflammationpersists even whenARV started during acute HIV 5 S 

CD163 links

to brain pathology at autopsy 6

1.RubinetalAIDS2018;2.VeraetalNeurology2016;3. Impetal JID2017;4.FabbianiM JAIDS2017; 5.SeretietalCID2017;6.BryantetalAIDS2017

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