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HIV-Associated DementiaHIV-associated dementia (HAD) results from infection with the human immunodeficiency virus (HIV) that causes AIDS. HAD can cause widespread destruction of the brain's white matter. This leads to a type of dementia that generally includes impaired memory, apathy, social withdrawal, and difficulty concentrating. People with HIV-associated dementia often develop movement problems as well. There is no specific treatment for HAD, but AIDS drugs can delay onset of the disease and may help to reduce symptoms. About 10 to 15 percent of people living with HIV eventually develop HAD. The condition causes loss of memory and thinking abilities. Patients also may have motor deterioration and/or changes in their behavior and personality. Researches Researchers do not know how HIV infection leads to HIV-associated dementia. In this study, the researchers tested a unique hypothesis that HIV attacks immune cells in the blood that travel to the brain, rather than infecting the nerve cells. In a healthy individual, those blood immune cells, called monocytes, nourish the brain. However, studies have suggested that in a person with HAD, the corrupted immune cells may release substances that damage brain cells. Dr. Valerie Wojna, M.D., and Dr. Melendez developed a cohort of Hispanic women at the University of Puerto Rico Medical Sciences Campus. Within 3 months complete neurological testing was done and blood samples were obtained from 31 Puerto Rican women aged 21-45 years. Nine of the women had HIV with relatively high levels of cognitive impairment, 12 had HIV without dementia, and 10 control subjects were HIV-negative and had no cognitive impairment. Researchers at Nebraska then used a relatively new technique known as proteomics, which maps out patterns of activity for particular groups of proteins, essentially providing a molecular "fingerprint" unique to each patient. Proteomic analysis showed that of the 177 proteins examined in the study, 38 proteins exhibited different activity levels in the HAD groups than in people without dementia. All of the patients with the distinct protein pattern were HAD-positive, but not all HAD patients had the profile. The findings suggest that physicians may one day be able to screen for HIV-associated dementia using a simple blood test. A blood test would be quicker, less expensive, and more specific than currently used magnetic resonance imaging techniques and clinical evaluations. Even further down the road, researchers might be able to identify specific proteins responsible for causing the dementia. If researchers can find ways to inhibit those proteins, they might be able to prevent the onset of dementia. Studies need to be done to more fully describe the protein profile for HAD, says Dr. Gendelman. "Our results are encouraging, but proteomics is still in its infancy. We've taken the first step in a very long journey to find better ways to diagnose HIV-associated dementia and other diseases." The researchers have followed the same group of patients and healthy subjects for one year, and they plan to continue following them for another year, Dr. Melendez says. They also hope to double the number of study subjects in the future, in order to improve the statistical significance of their results, and to begin including men in the studies. In addition to continuing the current work, the researchers plan to purify and sequence the proteins that are altered in HIV-associated dementia and to see how the protein patterns change over time as patients improve or decline. They also hope to examine whether genetic factors influence HIV dementia. The study represents some of the first published results from one of the National Institutes of Health (NIH)'s Specialized Neuroscience Research Programs (SNRPs). The SNRP awards are designed to help minority institutions develop state-of-the-art neuroscience research programs, prepare the next generation of neuroscience investigators, and create opportunities for collaborations among researchers at minority institutions and other NIH grantees. Directing the SNRP program and coordinating the research between the Medical Sciences Campus and the University of Nebraska is Edmundo Kraiselburd, Ph.D., professor and director of the Unit of Comparative Medicine.
More on DementiaConditions That Are Not Dementia
Sources: National Institutes of Health |
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