Abstract
Despite the success of antiretroviral therapy (ART), perinatally infected HIV remains a major health problem worldwide. Although advance neuroimaging studies have investigated structural brain changes in HIV-infected adults, regional gray matter (GM) and white matter (WM) volume changes have not been reported in perinatally HIV-infected adolescents and young adults. In this cross-sectional study, we investigated regional GM and WM changes in 16 HIV-infected youths receiving ART (age 17.0 ± 2.9 years) compared with age-matched 14 healthy controls (age 16.3 ± 2.3 years) using magnetic resonance imaging (MRI)-based high-resolution T1-weighted images with voxel based morphometry (VBM) analyses. White matter atrophy appeared in perinatally HIV-infected youths in brain areas including the bilateral posterior corpus callosum (CC), bilateral external capsule, bilateral ventral temporal WM, mid cerebral peduncles, and basal pons over controls. Gray matter volume increase was observed in HIV-infected youths for several regions including the left superior frontal gyrus, inferior occipital gyrus, gyrus rectus, right mid cingulum, parahippocampal gyrus, bilateral inferior temporal gyrus, and middle temporal gyrus compared with controls. Global WM and GM volumes did not differ significantly between groups. These results indicate WM injury in perinatally HIV-infected youths, but the interpretation of the GM results, which appeared as increased regional volumes, is not clear. Further longitudinal studies are needed to clarify if our results represent active ongoing brain infection or toxicity from HIV treatment resulting in neuronal cell swelling and regional increased GM volume. Our findings suggest that assessment of regional GM and WM volume changes, based on VBM procedures, may be an additional measure to assess brain integrity in HIV-infected youths and to evaluate success of current ART therapy for efficacy in the brain.
Highlights
Perinatal infection with HIV remains a major public health problem worldwide disproportionately affecting children in developing countries, with still limited access to antiretroviral therapy (ART)
White matter volume (WMV) reduction appeared in HIV youths compared with control subjects, and are shown as three views of regions projections to two-dimensional (2D) glass brain panels (Fig. 1A)
In this study we found white matter atrophy in perinatally HIVinfected youths in the bilateral posterior corpus callosum (CC) and other brain areas including external capsule, ventral temporal WM, mid cerebral peduncles, and basal pons compared with controls
Summary
Perinatal infection with HIV remains a major public health problem worldwide disproportionately affecting children in developing countries, with still limited access to antiretroviral therapy (ART). Brain involvement with HIV is well documented for perinatally infected infants and children (Tardieu et al, 1995), long-term neurologic outcomes for HIV-infected children and youths need further study. Even though newer antiretroviral therapies have decreased the incidence of HIV encephalopathy in perinatally HIV infected children with early aggressive treatment (Patel et al, 2009), many children have survived to adulthood from earlier eras with less efficacious regimens and may experience indolent ongoing brain injury. Recent studies document neurocognitive compromise in the older, treated perinatally infected HIV patients and the need for noninvasive assessment of ongoing brain integrity in long-term treated survivors (Nagarajan et al, 2012; Smith et al, 2012). Improved detection of brain injury could result in treatment modifications to improve the cognitive function of HIV-infected patients
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