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01-10-2019 | Human Immunodeficiency Virus

Diagnostic and prognostic biomarkers for HAND

Authors: Kristen A. McLaurin, Rosemarie M. Booze, Charles F. Mactutus

Published in: Journal of NeuroVirology | Issue 5/2019

Abstract

In 2007, the nosology for HIV-1-associated neurocognitive disorders (HAND) was updated to a primarily neurocognitive disorder. However, currently available diagnostic tools lack the sensitivity and specificity needed for an accurate diagnosis for HAND. Scientists and clinicians, therefore, have been on a quest for an innovative biomarker to diagnose (i.e., diagnostic biomarker) and/or predict (i.e., prognostic biomarker) the progression of HAND in the post-combination antiretroviral therapy (cART) era. The present review examined the utility and challenges of four proposed biomarkers, including neurofilament light (NFL) chain concentration, amyloid (i.e., sAPPα, sAPPβ, amyloid β) and tau proteins (i.e., total tau, phosphorylated tau), resting-state functional magnetic resonance imaging (fMRI), and prepulse inhibition (PPI). Although significant genotypic differences have been observed in NFL chain concentration, sAPPα, sAPPβ, amyloid β, total tau, phosphorylated tau, and resting-state fMRI, inconsistencies and/or assessment limitations (e.g., invasive procedures, lack of disease specificity, cost) challenge their utility as a diagnostic and/or prognostic biomarker for milder forms of neurocognitive impairment (NCI) in the post-cART era. However, critical evaluation of the literature supports the utility of PPI as a powerful diagnostic biomarker with high accuracy (i.e., 86.7–97.1%), sensitivity (i.e., 89.3–100%), and specificity (i.e., 79.5–94.1%). Additionally, the inclusion of multiple CSF and/or plasma markers, rather than a single protein, may provide a more sensitive diagnostic biomarker for HAND; however, a pressing need for additional research remains. Most notably, PPI may serve as a prognostic biomarker for milder forms of NCI, evidenced by its ability to predict later NCI in higher-order cognitive domains with regression coefficients (i.e., r) greater than 0.8. Thus, PPI heralds an opportunity for the development of a brief, noninvasive diagnostic and promising prognostic biomarker for milder forms of NCI in the post-cART era.

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Title: Diagnostic and prognostic biomarkers for HAND
Authors: Kristen A. McLaurin
Rosemarie M. Booze
Charles F. Mactutus
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keywords: Human Immunodeficiency Virus
Biomarkers
Published in: Journal of NeuroVirology / Issue 5/2019
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-018-0705-6

At a glance: The ONWARDS insulin icodec trials

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Diagnostic and prognostic biomarkers for HAND

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

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