Severe depression in people with HIV is a complex public health issue requiring urgent attention. The 25th International AIDS Conference (AIDS 2024) was held from July 22 to 26 in Munich, Germany, attracting 15,000 professionals and attendees from around the world to discuss the latest advancements and future challenges in AIDS prevention and treatment. At the conference, a study revealed a significant association between neuroinflammation and severe depressive symptoms in people with HIV. This study utilized diffusion-weighted magnetic resonance spectroscopy (DW-MRS) to measure the diffusion of metabolites in the anterior cingulate cortex (ACC) of people with HIV, finding that increased diffusion of creatine and choline is significantly correlated with the severity of depressive symptoms. These findings suggest that neuroinflammation may be an important pathophysiological mechanism of severe depression in people with HIV.Study Design
The study aimed to investigate whether severe depressive symptoms in people with HIV are associated with increased neuroinflammation. Using DW-MRS, a non-invasive method to measure neuroinflammation levels, the study conducted a cross-sectional analysis based on Patient Health Questionnaire-9 (PHQ-9) scores. By comparing the diffusion coefficients of specific metabolites in the ACC of people with HIV with varying severity of depressive symptoms, the study explored biomarkers of neuroinflammation.
Research Methods
The study included 16 people with HIV, all in a state of viral suppression, with a median age of 51 years, of which 88% were male and 75% were white. Participants were divided into two groups based on their PHQ-9 scores: a high depressive symptom group (HD, PHQ-9=15, n=11) and a low depressive symptom group (LD, PHQ-9=7, n=5). Using a 3T Siemens Prisma scanner, DW-MRS data were obtained, focusing on the ACC region’s four metabolites (creatine, choline, myo-inositol, and N-acetylaspartate). The apparent diffusion coefficients (ADCs) of these metabolites were calculated and correlated with PHQ-9 scores using Spearman’s correlation.
Research Results
Results showed that in the ACC, the ADCs of creatine (r=0.72, P=0.008) and choline (r=0.58, P=0.045) were significantly positively correlated with PHQ-9 scores, indicating that increased diffusion of these metabolites is related to the severity of depressive symptoms. No significant correlation was found between the ADCs of myo-inositol and N-acetylaspartate and PHQ-9 scores (P>0.05).
In summary, this study is the first to use DW-MRS technology to reveal a potential link between severe depressive symptoms and increased neuroinflammation in people with HIV. Specifically, increased intracellular diffusion of creatine and choline in the ACC may serve as biomarkers of neuroinflammation. These findings are consistent with previous reports on neuroinflammatory diseases such as multiple sclerosis and neuropsychiatric lupus, as well as human experimental induced inflammation.
Researchers indicated that this finding is significant for understanding the pathophysiological mechanisms of severe depression in people with HIV. It suggests that neuroinflammation may play a key role in the development of depressive symptoms in people with HIV. If these biomarkers can be further validated, they could help elucidate the role of neuroinflammation in the pathogenesis of severe depression in people with HIV and potentially lead to targeted interventions to improve the mental health and quality of life of people with HIV.
Additionally, these results emphasize the importance of multidisciplinary collaboration in HIV management and research, particularly combining neuroscience, psychology, and virology to comprehensively understand and address the complex health issues faced by people with HIV.
