Abstract
BackgroundIn vivo proton magnetic resonance spectroscopy (1H-MRS) studies on brain in HIV infected patients have shown significant alteration in neuro-biochemicals.MethodsIn this study, we measured the neuro-biochemical metabolites from the left frontal white matter (FWM) and left basal ganglia (BG) caudate head nucleus in 71 subjects that include 30 healthy controls, 20 asymptomatic HIV and 21 HIV patients with CNS lesion. Proton MR spectra were acquired at 3 T MRI system and the concentration (institutional units) of tNAA (N-acetylaspartate, NAA + N-acetylaspartylglutamate, NAAG), tCr (Creatine, Cr + phosphocreatine, PCr), choline containing compounds (tCho), glutamate + glutamine (Glx) and lipid and macromolecules at 0.9 ppm were determined using LC Model.ResultsIn BG, the concentration of tNAA (6.71 ± 0.64) was decreased and in FWM, the concentration of Glx (20.4 ± 7.8), tCr (9.14 ± 3.04) and lipid and macromolecules at 0.9 ppm (8.69 ± 2.96) were increased in HIV patients with CNS lesion. In healthy controls, the concentration of tNAA in BG was 7.31 ± 0.47 and concentration of Glx, tCr and lipid and macromolecules in FWM were 15.0 ± 6.06, 6.95 ± 2.56, 5.59 ± 1.56, respectively.ConclusionReduced tNAA in BG suggests neuronal loss in HIV patients with CNS lesion while increased Glx in FWM may suggest excito-toxicity. In addition, increased levels of tCr in FWM of HIV patients were observed. The study indicates region specific metabolic changes in tNAA, tCr and Glx in brain of HIV infected patients.
Highlights
In vivo proton magnetic resonance spectroscopy (1H-MRS) studies on brain in Human immunodeficiency virus (HIV) infected patients have shown significant alteration in neuro-biochemicals
The present study showed increase in Glutamate and glutamine (Glx) in frontal white matter (FWM) of HIV patients with Central nervous system (CNS) lesions compared to asymptomatic HIV patients and healthy controls
Lipid and macromolecules The present study showed significant increase in Lip09/ MM09 signal at 0.9 ppm in FWM in HIV patients with CNS lesion compared to healthy subjects
Summary
In vivo proton magnetic resonance spectroscopy (1H-MRS) studies on brain in HIV infected patients have shown significant alteration in neuro-biochemicals. 36.9 [34.3–41.4] million people were living with HIV in 2014 whereas 2.0 [1.9-2.2] million people died of HIV related illnesses in 2014 and more than 95 % of all HIV-infected people live in developing world [1]. India ranks third with the estimated number of people living with HIV/AIDS is approximately 2.089 million (2012) with an estimated adult (15–49 age group) HIV prevalence of 0.27 % in 2011 [2]. Central nervous system (CNS) involvement in HIV can occur both early as well as late. Involvement is characterized by impaired abstracting ability, learning difficulties and slow speed of information processing. Late involvement of CNS can be either by neoplasms or opportunistic infections [3]
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