AIDS (London, England) · 2025
Glymphatic dysfunction in HIV: a resting-state functional magnetic resonance imaging biomarker linking cognitive impairment and immune suppression.
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Xue Ke, Shi YuXin, Song Fengxiang, Cai Danchao, Shen Jie, Yang Zecheng, Shan Fei, Zhang Zhiyong, Zhan Yi
Аннотация
OBJECTIVE: To investigate glymphatic dysfunction in people with HIV (PWH) and its associations with immunological status and cognitive function, utilizing the coupling strength of global blood-oxygen-level-dependent and cerebrospinal fluid (gBOLD-CSF).
DESIGN: Retrospective study of 75 PWH and 52 non-HIV controls undergoing neuropsychological tests and resting-state functional magnetic resonance imaging (rs-fMRI).
METHODS: GBOLD-CSF coupling, Montreal Cognitive Assessment (MoCA) and seven cognitive domain scores were calculated. Group difference in gBOLD-CSF coupling strength was analyzed using a general linear model, adjusting for age, sex, and education. Partial correlation analyses were performed to examine the correlations of cognitive performance and immunological status with gBOLD-CSF coupling. Multivariate regression analysis was utilized to further evaluate the associations of gBOLD-CSF coupling with cognition.
RESULTS: PWH exhibited significantly weaker gBOLD-CSF coupling than non-HIV controls ( P = 0.018) and revealed impairments in attention/working memory, speed of information processing, and abstract/executive function (all P < 0.05). Reduced gBOLD-CSF coupling was associated with deficits in MoCA scores ( r = -0.332, P = 0.004), verbal fluency ( r = 0.245, P = 0.038), attention/working memory ( r = 0.240, P = 0.042), speed of information processing ( r = 0.245, P = 0.038), and abstract/executive function ( r = 0.241, P = 0.042) in PWH. Multivariate regression analysis showed gBOLD-CSF coupling was the only independent predictor for speed of information processing ( β = 0.410, P = 0.031) and MoCA scores ( β = -0.399, P = 0.037). Weaker gBOLD-CSF coupling was correlated with lower nadir and current CD4 + cell count ( r = -0.379, P = 0.019; r = -0.321, P = 0.049, respectively).
CONCLUSION: Reduced gBOLD-CSF coupling in PWH suggests glymphatic dysfunction and was associated with cognitive impairment and HIV-related immune suppression. It may serve as a noninvasive biomarker for monitoring cognitive disturbances and disease progression in HIV.
DESIGN: Retrospective study of 75 PWH and 52 non-HIV controls undergoing neuropsychological tests and resting-state functional magnetic resonance imaging (rs-fMRI).
METHODS: GBOLD-CSF coupling, Montreal Cognitive Assessment (MoCA) and seven cognitive domain scores were calculated. Group difference in gBOLD-CSF coupling strength was analyzed using a general linear model, adjusting for age, sex, and education. Partial correlation analyses were performed to examine the correlations of cognitive performance and immunological status with gBOLD-CSF coupling. Multivariate regression analysis was utilized to further evaluate the associations of gBOLD-CSF coupling with cognition.
RESULTS: PWH exhibited significantly weaker gBOLD-CSF coupling than non-HIV controls ( P = 0.018) and revealed impairments in attention/working memory, speed of information processing, and abstract/executive function (all P < 0.05). Reduced gBOLD-CSF coupling was associated with deficits in MoCA scores ( r = -0.332, P = 0.004), verbal fluency ( r = 0.245, P = 0.038), attention/working memory ( r = 0.240, P = 0.042), speed of information processing ( r = 0.245, P = 0.038), and abstract/executive function ( r = 0.241, P = 0.042) in PWH. Multivariate regression analysis showed gBOLD-CSF coupling was the only independent predictor for speed of information processing ( β = 0.410, P = 0.031) and MoCA scores ( β = -0.399, P = 0.037). Weaker gBOLD-CSF coupling was correlated with lower nadir and current CD4 + cell count ( r = -0.379, P = 0.019; r = -0.321, P = 0.049, respectively).
CONCLUSION: Reduced gBOLD-CSF coupling in PWH suggests glymphatic dysfunction and was associated with cognitive impairment and HIV-related immune suppression. It may serve as a noninvasive biomarker for monitoring cognitive disturbances and disease progression in HIV.