Changes in functional connectivity in people with HIV switching antiretroviral therapy
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Changes in functional connectivity in people with HIV switching antiretroviral therapy Sofia Toniolo 1,2 & Mara Cercignani 1 & Borja Mora-Peris 3,4 & Jonathan Underwood 3 & Jasmini Alagaratnam 3 & Marco Bozzali 1 & Marta Boffito 3,5 & Mark Nelson 5 & Alan Winston 3 & Jaime H. Vera 6 Received: 13 January 2020 / Revised: 14 April 2020 / Accepted: 12 May 2020 # The Author(s) 2020
Abstract We assessed changes in functional connectivity by fMRI (functional magnetic resonance imaging) and cognitive measures in otherwise neurologically asymptomatic people with HIV (PWH) switching combination antiretroviral therapy (cART). In a prospective study (baseline and follow-up after at least 4 months), virologically suppressed PWH switched non-nuclease reverse-transcriptase inhibitors (NNRTI; tenofovir-DF/emtricitabine with efavirenz to rilpivirine) and integrase-strand-transfer inhibitors (INSTI; tenofovir-DF/emtricitabine with raltegravir to dolutegravir). PWH were assessed by resting-state fMRI and stop-signal reaction time (SSRT) task fMRI as well as with a cognitive battery (CogState™) at baseline and follow-up. Switching from efavirenz to rilpivirine (n = 10) was associated with increased functional connectivity in the dorsal attention network (DAN) and a reduction in SSRTs (p = 0.025) that positively correlated with the time previously on efavirenz (mean = 4.8 years, p = 0.02). Switching from raltegravir to dolutegravir (n = 12) was associated with increased connectivity in the left DAN and bilateral sensory-motor and associative visual networks. In the NNRTI study, significant improvements in the cognitive domains of executive function, working memory and speed of visual processing were observed, whereas no significant changes in cognitive function were observed in the INSTI study. Changes in fMRI are evident in PWH without perceived neuropsychiatric complaints switching cART. fMRI may be a useful tool in assisting to elucidate the underlying pathogenic mechanisms of cART-related neuropsychiatric effects. Keywords HIV . fMRI . Neuropsychological assessment . Memory . Attention
Introduction Alan Winston and Jaime H. Vera contributed equally to this work. * Sofia Toniolo [email protected] 1
Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Knightsgate Road, Falmer Campus, Brighton BN1 9RR, UK
2
Present address: Nuffield Department of Clinical Neurosciences, University of Oxford, New Radcliffe House, Walton St., Oxford OX2 6BW, UK
3
Department of Infectious Disease, Faculty of Medicine, St Mary’s Campus, Imperial College London, Praed Street, London W2 1NY, UK
4
Division of Infection and Immunity, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK
5
Department of HIV Medicine, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
6
Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
Earlier treatment initiation and wider access to combination antiretroviral therapy (
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