Biomarkers Needed for HIV-Associated Neurocognitive Disorder

There is a need to uncover diagnostic and prognostic biomarkers for HIV-associated neurocognitive disorder (HAND), according to a recent article by Howard E. Gendelman and published by EBioMedicine.

Gendelman explained HAND is a viral co-morbidity that remains common despite advancements in antiretroviral therapy (ART). Additionally, the commentary noted that cognitive, behavioral, and motor dysfunctions, including asymptomatic neurocognitive impairment (ANI), mild neuro cognitive disorder (MND), and HIV-associated dementia (HAD) often lead to HAND in up to half of ART-treated and virus infected people.

“The presence of inflammation and linked neurodegeneration in both the brain as well as the cerebrospinal fluid of infected and ART-treated people affects production of disease biomarkers. Each also underscores the strong associations between inflammation and disease,” noted Gendelman. “Several groups propose several of disease inflammatory biomarkers including, but are not limited to, platelet activating factor, arachidonic acid and its metabolites, granulocyte macrophage colony stimulating factor, interleukin-6, tumor necrosis factor alpha (TNF-a) and matrix metalloproteinases 1 and 7 (reviewed in 1).”

Gendelman suggested that there is an immediate need to identify diagnostic and prognostic biomarkers for HAND and for a separation of co-morbid conditions, substance abuse disorders, and immune deterioration in the regards to ART.

The article also mentioned a previous study that uncovered new biomarkers by demonstrating circulating levels of ATP and PG₂ are easily identifiable during viral infection, even when below the detection limit in the uninfected.

“Taken together, the results of this study indicate that circulating ATP levels may be a useful predictor of [cognitive impairments] and possibly that blocking Panx-1 channels could lead to novel therapeutics by reducing the common chronic inflammation seen in infected individuals,” said Gendelman. “While the mechanism of increased levels of ATP seen in HIVinfected population is not known there the findings were selective as no association of ATP levels were seen in stroke or other infections as well as genetic factors, ethnicity or gender.”

Gendelman concluded by emphasizing the need for future studies that use previous findings to help establish a clinical biomarker for HAND.

Reference

Gendelman H.E. Predictive biomarkers for cognitive decline during progressive HIV infection [published online November 20, 2019]. EBioMedicine. doi: 10.1016/j.ebiom.2019.10.064.