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J Acquir Immune Defic Syndr. 2016 Jan 1;71(1):24-30. doi: 10.1097/QAI.0000000000000779.

Neuronal-Glia Markers by Magnetic Resonance Spectroscopy in HIV Before and After Combination Antiretroviral Therapy.

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*Department of Tropical Medicine, University of Hawaii, Honolulu, HI;†U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD;‡Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD;§SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand;‖Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;¶Division of Neurology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand;#Queen Savang Vadhana Memorial Hospital, Chomburi, Thailand;**Taksin Hospital, Bangkok, Thailand;††Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA; and‡‡Department of Psychology, Missouri Institute of Mental Health, University of Missouri, St. Louis, MO.



Combination antiretroviral therapy (cART) can suppress plasma HIV RNA to undetectable levels; yet reports indicate persistent HIV-associated neurocognitive disorders (HAND) among treated individuals. We sought to investigate imaging correlates of incomplete cognitive recovery among individuals with chronic HIV.


We used single voxel proton magnetic resonance spectroscopy in 4 regions of the brain to measure changes in neuronal and glia biomarkers in cART-naive subjects before (n = 59, 27 with HAND) and after 12 months of cART.


At baseline, we observed elevated total choline (CHO) in the basal ganglia (BG, P = 0.002) and in the posterior cingulate gyrus (PCG, P = 0.022) associated with HIV infection. Myo-inositol (MI) was elevated in the frontal white matter (FWM, P = 0.040). N-acetylaspartate was elevated in the BG (P = 0.047). Using a mixed model approach among all HIV-infected individuals, at 6 months, we observed decreased n- acetylaspartate in FWM (P = 0.031), decreased creatine in PCG (P = 0.026) and increased MI in frontal gray matter (FGM, P = 0.023). At 12 months, we observed an increase in BG MI (P = 0.038) and in FGM (P = 0.021). Compared to those with normal cognition, HAND cases had higher FGM MI (P = 0.014) at baseline. At 12 months, individuals that remained cognitively impaired compared with those without HAND exhibited elevated CHO in the PCG (P = 0.018) and decreased glutamate in both FWM (P = 0.027) and BG (P = 0.013).


cART started during chronic HIV is associated with reduced neuronal-glia and inflammatory markers. Alterations in CHO are noted among individuals who remain impaired after 12 months of cART.

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