Neurocognitive Disorder in HIV Positive Adults: My Summer Research

uvmmedicine blogger Katherine Clifford '19
uvmmedicine blogger Katherine Clifford ’19

When I received a 2016 Larner College of Medicine Summer Research Fellowship, I was thrilled to have the opportunity to return to the world of research.

For my summer research fellowship, I worked at the University of California San Francisco (UCSF) Memory and Aging Center on a project investigating longitudinal brain atrophy rates in virally suppressed HIV-positive adults over the age of 60 compared to age-matched HIV-negative controls.

Having mostly occupied supportive roles in the past, this was an opportunity to take responsibility for the whole research process: from coming up with a proposal and reviewing the literature, to analyzing the available data, to writing up a paper to discuss the results and implications of the findings. This project’s success was truly a product of collaboration. As everyone knows, research is never a fast process. The summer provided me just barely enough time to get results. Little did I know that the project would extend through the year. We had many conference calls to review new data analyses, and had various drafts circulating before we finally celebrated the publication of our paper in the Journal of Acquired Immune Deficiency Syndromes this summer, a full year after the project began.

As background to the project, HIV-related brain injury and cognitive impairment prior to the era of combination anti-retroviral therapy (cART) is well-known. However, despite current HIV treatments, which are effective in suppressing HIV plasma viral load to undetectable levels in most adherent patients, HIV-associated Neurocognitive Disorder (HAND) remains a concern, with increasing frequency with age. Previous studies have described brain volumetric reductions in HIV-positive adults in younger cohorts with often suboptimal HIV viral suppression.

Using longitudinal brain MRI analyses, we found that despite persistent viral suppression on long-term cART, our cohort of HIV-positive older adults had greater atrophy rates in the cerebellum, caudate, frontal lobe, total cortical gray matter, brainstem, and pallidum, compared to healthy aging. These findings suggest that adherence to cART may be insufficient in controlling persistent Central Nervous System (CNS) inflammation and long-term neurocognitive outcomes.

Coincidentally, my mentor at UCSF, Dr. Victor Valcour, and another member of the lab, Dr. Joanna Hellmuth, are both Larner College of Medicine alumni. It was an amazing experience to be able to collaborate with them. Both were incredibly supportive of my interests in research and in neurology. They gave me valuable feedback on my research project, and also gave me advice on medical school and my future career. I am very grateful to the Larner College of Medicine for this opportunity and to my colleagues and small UVM community out in San Francisco.

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