Behavioral Medicine

HIV-Infected Cells May Persist in Cerebrospinal Fluid of Some Patients

It is well-known that persistence of HIV in reservoir (sanctuary) sites is a major barrier to viral eradication despite treatment with antiretroviral therapy (ART). A study published in the Journal of Clinical Investigation reaffirms this challenge and also brings attention to the problem of neurocognitive impairment in some patients on long-term ART.

The authors find that cerebrospinal fluid (CSF) can offer a window into the neuropathogenesis of HIV in living patients, although HIV-infected cells in CSF does not necessarily cause neurocognitive impairment. Overall, the investigators from the University of North Carolina, the University of Pittsburgh, and Yale University find that examining CSF cells revealed a higher prevalence of persistent HIV in the central nervous system (CNS). The CNS and persistent HIV in CSF cells despite years of viral suppression due to ART may be a significant barrier to optimal neurocognitive function and finding a cure for HIV.

HIV-associated neurocognitive disorder (HAND) is indicated with patients perform below expectations for age and ability on formal neurocognitive tests. Cross sectional studies demonstrate that approximately half of all treated HIV patients have cognitive impairment. Co-morbidity and lifestyle behaviors are known to contribute to impairment, but are insufficient to explain the frequency of impairment that currently exists in patients with HIV.

The CSF study consisted of sixty-nine participants (97% male, median age 50 years, CDF 696 cells/mm3, plasma HIV RNA <100 copies/mL) enrolled in the AIDS Clinical Trials Group (ACTG) HIV Reservoirs Cohort Study (A5321). The observational study was supported by the National Institutes of Health (NIAID and NIMH). To read this article, visit the JCI website.

Tips to Reduce Fatigue

Fatigue is a feeling of tiredness and lack of energy. Individuals suffering from fatigue may experience a reduction in overall alertness and cognition, causing everyday activities to become difficult. Most adults experience fatigue at some point in their lifetime. Listed below are tips provided by the National Institutes of Health on how to reduce fatigue:

  • Get a sufficient amount of sleep every night.

  • Maintain a healthy and balanced diet.

  • Drink plenty of water throughout the day.

  • Exercise regularly.

  • Find ways to relax (e.g., yoga).

  • Follow a reasonable work and personal schedule.

  • Take a vitamin (with the aid of a credible provider).

  • Abstain from alcohol, nicotine, and drug use.


It is important to note that, while fatigue is a common symptom and generally not indicative of a serious health concern, it may be a sign of a severe illness. If the aforementioned tips do not help to relieve fatigue, contact your physician. Additionally, notify your physician if you experience any of the following: confusion or dizziness, blurred vision, little to no urine, swelling, weight gain, or thoughts of self-harm or suicide. Additional information can be accessed here.


Works Cited

“Fatigue: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/003088.htm.


Human Rights + Social Justice Radio: WHIV FM

If you are looking for a radio station that is dedicated to human rights and social justice issues, consider dialing into WHIV FM! Dr. MarkAlain Dery and Liana Elliott are co-founders of WHIV, which features more than 70 hosts and DJs, broadcasting over 12 hours of daily and original content throughout New Orleans, and streaming online in all 50 states and 85 countries worldwide.

FM 102.3 WHIV-LP is a program of The New Orleans Society for Infectious Disease Awareness (NOSIDA), which was established in 2009 by local activist and infectious diseases physician Dr. MarkAlain Dery. NOSIDA's focus is to raise awareness about HIV and other infectious diseases through music. Such illnesses are completely preventable, yet disproportionately affect disadvantaged and marginalized populations. NOSIDA received its non-profit status in 2010.

Expanding its impact locally, NOSIDA was awarded an FCC license for a lower power (100 watt) FM community radio station in 2014. On World AIDS Day 2014, 102.3FM WHIV-LP was officially launched, featuring local music, protest songs, and programming dedicated to human rights and social justice.

Visit the WHIV FM at whivfm.org.

Are Autoimmune Diseases on the Rise?

The Complexity of the Immune System

The immune system is a complex organization within the body.  It consists of specialized cells that carry out immune process functions, and chemical messengers that facilitate the communication immune system cells have with each other, other cells, and tissues within the body. Autoimmune disease results when the immune system mistakenly attacks the body’s own tissues. Examples include multiple sclerosis, type 1 diabetes, rheumatoid arthritis, celiac disease, and systemic lupus erythematosus. Inflammatory Bowel Disease (IBD), including Crohn’s and ulcerative colitis, has characteristics of both immune-mediated and autoimmune conditions. Immune-mediated conditions occur because a functioning immune system begins to work overtime.

Autoimmune disease appears to be on the rise and researchers at the Center for Disease Control and Prevention (CDC) are uncertain why. A study by the American Diabetes Association found that type 1 diabetes increased by 23% between 2001 and 2009. The incidence of celiac disease, a condition where the body’s immune system attacks the small intestine, is also on the rise according to the U.S. National Institutes of Health and the University of Chicago Celiac Disease Center.

The research methodology used in the study of immune system function is quite extensive. It is as complex as the immune system itself. It covers all aspects of biomedical research, from molecular and cellular to animal models and clinical studies. Psychoneuroimmunology is another area of study examining the link between the brain and the immune system. We know that both interact through several pathways and mechanisms and can affect health and disease. Psychoneuroimmunology includes the study of the nervous system (the central nervous system and the peripheral nervous system) and its functioning as it relates to the immune system.

Social Media and the Exchange of Information

With the rise in autoimmune disorders, it is no surprise that the public is taking to social media and the internet to find information or share personal experiences. We conducted a review of Facebook posts from January 5, 2018 through March 5, 2018 searching for postings dedicated to the issue of inflammation and autoimmune disorders.

Out of 101 Facebook published posts during this time frame, 13 posts described personal experiences with an autoimmune disease, 61 posts shared an article about one or more autoimmune disorders, and 29 posts shared both a personal experience and an article or information about one or more autoimmune disorders. While Facebook can be an important source of support from the community, there are an alarming number of posts proposing solutions or cures to inflammation or autoimmune disorders.

Sales of nutritional and herbal supplements have surged as a result of the rising number of self-directed consumers, proliferation of online and media content, and the significance of e-commerce. Self-help books, diet plans, herbal supplements, and a variety of written resources are widely available for free or at a cost and are targeted to consumers managing an inflammatory or autoimmune disease.

The concern with the proliferation of these resources and claims of cures, however, is the high level of misinformation about these products and the lack of studies validating the claims made by the distributors of these products. Additionally, the complexity of the immune system, autoimmune disorders, and immune-mediated disorders is typically unknown to the general public. Some marketing approaches to selling products call for consumers to learn the “true cause of autoimmune disease.”

We always recommend that individuals consult literature that has a clearly identified and reputable source. Any claim of a cure or selling of "unknown secrets" are questionable. More importantly, you should consult your medical provider before introducing any supplements or products to your treatment plan. And certainly consult with your doctor before stopping treatment.

Current Knowledge and Future Directions on Aging and HIV Research

Aging with HIV

While AIDS-defining illnesses are increasingly rare in those who are on effective antiretroviral therapy, there is concern about the growing number of HIV-associated, non-AIDS (HANA) conditions requiring medical attention. To understand the true differences between older individuals with and without HIV infection, studies require careful design to manage how these populations differ in a number of behavioral and biological factors known to affect the aging process.

The prevalence of HIV infection in people aged 50 years or older is rapidly increasing. Age-associated inflammation and chronic inflammation are risk factors for morbidity and mortality in older adults given its impact on the functioning of the immune system. Other common issues in older people with HIV infection include multi-morbidity, poly-pharmacy, HIV-associated neurocognitive impairment, and lifestyle behaviors that impact health. Further, the complexity of assessing HIV vs. treatment effects vs. aging vs. concurrent disease, and the interrelated mechanisms of immune senescence, inflammation and hypercoagulability give rise to the critical need for research in HIV and aging.

Biomedical Challenges, Psychosocial Resilience

As the medical science community works to address the biomedical challenges associated with HIV and aging, behavioral health scientists can contribute in another important way. In addition to neurocognitive assessment, examining factors that contribute to successful psychosocial aging is important. While self-rated successful aging has been found to be lower in those with HIV when compared to their HIV- counterparts, people aging with HIV have reported optimism, personal mastery, and social support as contributing to successful aging (Moore et al., 2014). It is essential that an individual's resilience and ability to access supportive resources are understood in the context of managing HIV-associated impairments exacerbated by aging.

A Review of the Literature

Charles A. Emlet of the University of Washington discusses research on the subject of HIV in older adults in his 2014 article, "Current Knowledge and Future Directions on Aging and HIV Research." The article brings attention to the biopsychosocial challenges present when caring for older adults living with HIV infection. In addition, it will be time to review and assess our approach to determine what changes, if any, are needed in the future or HIV treatment for an aging HIV-positive population. Recently, Negredo and colleagues published their review article, "Aging in HIV-Infected Subjects: A New Scenario and a New View." This article is available in the open access journal "BioMed Research International."

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