Format

Send to

Choose Destination
Clin Infect Dis. 2017 Aug 1;65(3):422-432. doi: 10.1093/cid/cix301.

Gray and White Matter Abnormalities in Treated Human Immunodeficiency Virus Disease and Their Relationship to Cognitive Function.

Author information

1
Divisions of Infectious Diseases.
2
Brain Sciences, Imperial College London, United Kingdom.
3
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
4
Department of Infection and Population Health, University College London, United Kingdom.
5
Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development.
6
Department of Medical Psychology.
7
Department of Neurology, Academic Medical Center.
8
Public Health Service Amsterdam.
9
HIV Monitoring Foundation.
10
Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.

Abstract

Background:

Long-term comorbidities such as cognitive impairment remain prevalent in otherwise effectively treated people living with human immunodeficiency virus (HIV). We investigate the relationship between cognitive impairment and brain structure in successfully treated patients using multimodal neuroimaging from the Comorbidity in Relation to AIDS (COBRA) cohort.

Methods:

Cognitive function, brain tissue volumes, and white matter microstructure were assessed in 134 HIV-infected patients and 79 controls. All patients had suppressed plasma HIV RNA at cohort entry. In addition to comprehensive voxelwise analyses of volumetric and diffusion tensor imaging, we used an unsupervised machine learning approach to combine cognitive, diffusion, and volumetric data, taking advantage of the complementary information they provide.

Results:

Compared to the highly comparable control group, cognitive function was impaired in 4 of the 6 cognitive domains tested (median global T-scores: 50.8 vs 54.2; P < .001). Patients had lower gray but not white matter volumes, observed principally in regions where structure generally did not correlate with cognitive function. Widespread abnormalities in white matter microstructure were also seen, including reduced fractional anisotropy with increased mean and radial diffusivity. In contrast to the gray matter, these diffusion abnormalities correlated with cognitive function. Multivariate neuroimaging analysis identified a neuroimaging phenotype associated with poorer cognitive function, HIV infection, and systemic immune activation.

Conclusions:

Cognitive impairment, lower gray matter volume, and white matter microstructural abnormalities were evident in HIV-infected individuals despite fully suppressive antiretroviral therapy. White matter abnormalities appear to be a particularly important determinant of cognitive dysfunction seen in well-treated HIV-infected individuals.

KEYWORDS:

HIV; cognitive impairment; diffusion tensor imaging; neuroimaging; voxel-based morphometry

PMID:
28387814
PMCID:
PMC5850629
DOI:
10.1093/cid/cix301
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center