NHMRC Research Fellow, NeuRA
Senior Lecturer, UNSW
Affiliate, St Vincent’s Hospital Applied Medical Research Centre
+612 9399 1880
Dr Cysique’s cursus includes a PhD (09/2005, UNSW) in the neuropsychology of HIV infection, a 3-year post-doctoral fellowship at the prestigious HIV Neurobehavioral Research Centre (University of California San Diego, UCSD) where she was trained in the neuropsychology of HIV and Hep C. While at UCSD, Dr Cysique also received training in MRI of HIV and HCV at the Laboratory of Cognitive Imaging. Upon her return to Australia in 2008, she was awarded a three-year Brain Sciences UNSW fellowship, and subsequently a three-year NHMRC project grant and, several industries’ support grants. In 2009, Dr Cysique became a visiting research officer at Neuroscience Research Australia in the Brain Structure and Functions Theme where she received training in MR Spectroscopy and diffusion imaging. In 2013, Dr Cysique was awarded a four-year NHMRC Clinical Career Development Fellowship to pursue her independent research career into the chronic effects of HIV on brain functions. In June 2013, Dr Cysique was promoted to Senior Lecturer at UNSW Medicine. She is chief investigator on one multi-center international trial (Strategic Timing of AntiRetroviral Treatment- START), one multi-sites overseas study in Canada (Brain Health Now in HIV), and seven national studies/trials and leader of the HIV and Brain Ageing studies at NeuRA/UNSW. Dr Cysique has started to develop an angle of research into effects of alcohol on brain functions in teenagers in collaboration with Prof Caroline Rae, the study investigates the integrity of the white matter structure in teenagers who binge versus those who are alcohol abstainers. Dr Cysique’s research also investigates other conditions and factors that are relevant to the global HIV epidemic such as the development of cross-culturally valid tools and methods to assess cognitive function, mental health and the effects of alcohol on the brain.
DR. HTEIN LINN AUNG
KIMBERLEY BASSETT Masters student
DR VINCENT OXENHAM Research Associate
NICOLA EARLS Masters Student
JOSHUA HOOD Research Assistant
THOMAS GATES Research Associate
DAVID JAKABEK Research Associate
This study determines the optimal cut-off scores for the Montreal Cognitive Assessment (MoCA) to detect HIV-associated neurocognitive disorders (HAND) in a multi-ethnic Malaysian HIV-positive cohort by developing demographically corrected normative standards among 283 HIV-negative community-based controls with overlapping demographic characteristics. The norms (corrected for age, sex, education, ethnicity) were applied to 342 HIV-positive virally suppressed individuals on cART. Impairment rates were classified using the Global Deficit Score (GDS ≥ .5) method. The MoCA was also scored according to the recommended cut-off of ≤ 26, and functional decline was applied to both impairment definitions to classify HAND per the Frascati criteria. The ≤ 26 cut-off considerably overestimated cognitive impairment in both samples (59.4% HIV-negative; 69.3% HIV-positive). In contrast, corrected scores yielded impairment rates consistent with what has been reported internationally in virally suppressed cohorts (23.4% with 83.3% mild impairment, 16.7% moderate impairment). A supplemental file allowing the computation of corrected MoCA scores and impairment status is included.
To compare the effect of immediate versus deferred antiretroviral treatment (ART) on neuropsychological test performance in treatment-naive HIV-positive adults with more than 500 CD4 cells/μl. We observed substantial improvement in neurocognitive test performance during the first year in both study arms, underlining the importance of using a control group in studies assessing neurocognitive performance over time. Immediate ART neither benefitted nor harmed neurocognitive performance in individuals with CD4 cell counts above 500 cells/μl.
The present review on HIV-associated neurocognitive disorders (HAND) provides a worldwide overview of studies that have investigated the rate and neuropsychological (NP) profile of HAND research since the inception of the 2007 HAND diagnostic nomenclature. In the first part, the review highlights some of the current controversies around HAND prevalence rates. In the second part, the review critically assesses some solutions to move the field forward. In the third part, we present the cross-sectional NP profile in non-Western HIV+ cohorts and in relation to Western cohorts' findings. The adopted global perspective highlights the successful expansion of NP studies in HIV infection to culturally diverse low- to medium-income countries with high HIV burden. These studies have produced interestingly similar rates of HAND whether patients were naïve or treated and/or virally suppressed compared to the rich income countries where the NP research in NeuroHIV has originated. The perspective also demonstrates that globally, the group which is the most representative of the HIV epidemic, and thus at risk for HAND are persons with chronic HIV infection and survivors of past immunosuppression, while in relative terms, those who have been treated early with long-term viral suppression represent a minority. In the last part, we present a review of the naturalistic longitudinal NP global studies in HIV+cohorts, discuss the role of longitudinal design in solving issues around the question of asymptomatic neurocognitive impairment, and the question of biomarker discovery. Finally, we conclude by calling for greater methods and data harmonization at a global level. (JINS, 2017, 23, 860-869).