ABSTRACT
People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.
ABSTRACT
BACKGROUND: Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. METHODS: We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. RESULTS: We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region. INTERPRETATION: Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
Subject(s)
COVID-19 , Stroke , COVID-19/complications , COVID-19/therapy , Hospitalization , Humans , Prognosis , Risk FactorsABSTRACT
In a longitudinal cohort, a significant proportion of patients had persistent symptoms 8 months after initial #COVID19 infection. There was no significant improvement in symptoms or health-related quality of life between 4- and 8-month assessments. https://bit.ly/2Wtb7IX.
ABSTRACT
ObjectivesTo understand NeuroCovid pathogenesis by using MR spectroscopy and dynamic contrast perfusion in 2 SARS-COV-2 patients with neurological complications.MethodsMR spectroscopy (MRS) and dynamic contrast-enhanced perfusion (k-trans), which is a sensitive marker of blood brain barrier (BBB) damage, were performed in 2 patients with respiratory viral PCR confirmed SARS-CoV-2 infection and 2 local controls. The MRS and k-trans results were also compared with published controls.ResultsCase 1 was a 73-year-old man with critical SARS-CoV-2 infection requiring 4 days of mechanical ventilation. He had persistent anosmia, anorexia and apathy;saccadic pursuit eye movements, action tremor in the left hand and a positive right-sided palmomental reflex. These changes normalised by day 30 of presentation. MRI brain was undertaken on day 37.Case 2 was a 61-year-old man with critical SARS-CoV-2 infection requiring 43 days of mechanical ventilation. He was slow to wake post weaning of sedation and had residual mild cognitive impairment. MRI brain was undertaken on day 62 of presentation.No abnormalities were detected on T1, T2, FLAIR, DWI, SWI MR sequences. However, for both patients there was diffuse increase in k-trans especially in the frontal cortex and increased glutamate-glutamine MRS signal intensities in the pons compared to controls.ConclusionsThe MRS and k-trans changes show excitotoxicity and BBB damage, in the absence of stroke or MR-defined white matter injury. They suggest a direct effect of SARS-CoV-2 on the brain. These MR techniques can offer insight into NeuroCovid pathogenesis when patients are no longer infectious.ReferencesHeye AK, Culling RD, Valdés Hernández MC, Thrippleton MJ, Wardlaw JM. Assessment of blood-brain barrier disruption using dynamic contrast-enhanced MRI. A systematic review. Neuroimage Clin 2014;6:262–274.Langer DL, Rakaric P, Kirilova A, Jaffray DA, Damyanovich AZ. Assessment of metabolite quantitation reproducibility in serial 3D-(1)H-MR spectroscopic imaging of human brain using stereotactic repositioning. Magn Reson Med 2007;58(4):666–673.Chang L, Munsaka SM, Kraft-Terry S, Ernst T. Magnetic resonance spectroscopy to assess neuroinflammation and neuropathic pain. J Neuroimmune Pharmacol 2013;8(3):576–593.
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ObjectivesTo characterise cognitive performance and olfaction in recovered COVID-19 patients.MethodsPatients underwent cognitive, olfaction and mental health assessments 2 months after initial SARS-CoV-2 infection as part of the Sydney St. Vincent’s Hospital ADAPT study, a prospective cohort study. Cognition was assessed with the Cogstate computerised battery and expressed as a demographically-corrected composite z-score and clinically classified as impaired/borderline/unimpaired. Anxio-depressive symptoms were assessed with the Depression in the Medical ill scale-10 (DMI-10), the Somatic and Psychological HEalth Report-34 (SPHERE) Psych sub-scale, and the Impact of Events Scale-Revised (IESR) and reduced into single Principal Component explaining 80% of the variance. Olfaction was assessed with the NIH Toolbox Odor Identification test and expressed as demographically-corrected T-scores, and impaired/unimpaired. Disease severity was classified as mild (40%), moderate (50%) or hospitalised (10%).Results132 patients (mean age=46±15;40% women, median education=16 years, 10% Non-English-Speaking Background-NESB) were included. 17% had impaired cognition, 10% had borderline deficits, 25% has impaired olfaction. 25% had clinically elevated symptoms on the DMI-10, 13% on the IESR, and 35% on the SPHERE. Regression analyses showed that anxio-depression was not associated with cognitive performance (unadjusted p=.43;adjusted for sex & NESB p=.98) nor impaired/unimpaired status (unadjusted p=.50;adjusted for sex & NESB p=.78). Cognitively impaired patients were more likely to have impaired olfaction (p<.009). Results were independent of disease severity.ConclusionsCognitive impairment is common and not related to psychological factors, may occur independent of disease severity and is associated with anosmia. These point to direct brain effects of COVID-19.