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Cerebral β-amyloid deposition predicts HIV-associated neurocognitive disorders in APOEε4 carriers

  • Author(s): Soontornniyomkij, V
  • Moore, DJ
  • Gouaux, B
  • Soontornniyomkij, B
  • Tatro, ET
  • Umlauf, A
  • Masliah, E
  • Levine, AJ
  • Singer, EJ
  • Vinters, HV
  • Gelman, BB
  • Morgello, S
  • Cherner, M
  • Grant, I
  • Achim, CL
  • et al.

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Objective: The apolipoprotein E (APOE)ε4 allele enhances cerebral accumulation of β-amyloid (Aβ) and is a major risk factor for sporadic Alzheimer's disease. We hypothesized that HIV-associate neurocognitive disorders (HAND) would be associated with the APOEε4 genotype and cerebral Aβ deposition. Design: Clinicopathological study of HIV-infected adults from four prospective cohorts in the US National NeuroAIDS Tissue Consortium. Methods: We used multivariable logistic regressions to model outcomes [Aβ plaques (immunohistochemistry) and HAND (standard criteria)] on predictors [APOEε4 (allelic discrimination assay), older age (≥50 years), Aβ plaques, and their two-way interactions] and comorbid factors. Results: Isocortical Aβ deposits generally occurred as diffuse plaques and mild-to-moderate amyloid angiopathy. Isocortical phospho-Tau-immunoreactive neurofibrillary lesions were sparse. The APOEε4 and older age were independently associated with the presence of Aβ plaques [adjusted odds ratio (OR) 10.16 and 5.77, 95% confidence interval (CI) 2.89 - 35.76 and 1.91-17.48, P = 0.0003 and 0.0019, respectively, n = 96]. The probability of HAND was increased in the presence of Aβ plaques among APOE ε4 carriers (adjusted OR 30.00, 95% CI 1.41-638.63, P = 0.029, n = 15), but not in non-ε4 carriers (n = 57). Conclusion: The APOEε4 and older age increased the likelihood of cerebral Aβ plaque deposition in HIV-infected adults. Generally, Aβ plaques in HIV brains were immunohistologically different from those in symptomatic Alzheimer's disease brains. Nonetheless, Aβ plaques were associated with HAND among APOEε4 carriers. The detection of APOEε4 genotype and cerebral Aβ deposition biomarkers may be useful in identifying living HAND patients who could benefit from Aβ-targeted therapies. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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