Basal ganglia shrinkage without remarkable hippocampal atrophy in chronic aviremic HIV-positive patients

Abstract

Conventional magnetic-resonance (MR) imaging is not sensitive enough in depicting subtle neurodegenerative changes that occur during chronic HIV infection with good peripheral viral suppression. The aim of this study was to compare brain volumes in HIV-positive subjects with age- and education-matched healthy controls with regard to influence of aging and immunologic parameters. An overall of 65 subjects (40 HIV-positive and 25 age-, gender-, and education-matched healthy subjects) underwent conventional MR imaging with three-dimensional sequence adequate for volumetric measurements. Volumes of specific brain regions were measured and compared between HIV-positive and healthy subjects using Student t test. Correlations between obtained brain volumes and immunologic parameters were determined using Pearson's correlation test. Influence of age as a covariate was determined using ANCOVA test. Statistical value was set at p < 0.05. Volumes of nucleus accumbens (p = 0.003), putamen (p = 0.003), and thalamus (p = 0.046) were significantly decreased in HIV-positive subjects compared with healthy, while volumes of lateral ventricles were significantly increased (p = 0.043). However, influence of age on atrophy was greater than presence of HIV infection in all observed volumes. Positive correlation of nadir CD4+ count and nucleus accumbens volume was obtained, as well as of therapy with lateral ventricle volumes. Volumes of putamen correlated negatively with duration of therapy. HIV-associated atrophic changes are visible in nucleus accumbens, putamen, and thalamus in neurocognitively asymptomatic stage, while no changes can be observed in the hippocampus, affected by other types of dementias. Under therapy, the influence of physiological aging on HIV-associated atrophy is greater than the presence of HIV infection per se.

Brain Volumetric Alterations in Preclinical HIV-Associated Neurocognitive Disorder Using Automatic Brain Quantification and Segmentation Tool

“…Moreover, the bilateral thalamus showed atrophy in preclinical HAND compared with NCs, which is consistent with previous research findings in that the atrophy was also observed in the same region even in the neurocognitively asymptomatic stage ( Tesic et al, 2018 ). For early-infected HIV individuals, the decreased volume in the thalamus may be related to hypometabolism, and hypometabolism in the thalamus was more pronounced than in the whole brain in HIV participants compared with NCs ( Hammoud et al, 2018 ).…”

Brain amyloid in virally suppressed HIV-associated neurocognitive disorder

“…Cases 3 and 5 exhibited major subcortical atrophy, consistent with severe HIV-related brain injury. [42][43][44][45] This level of subcortical atrophy potentially biased the measurement of amyloid in the basal ganglia. Nevertheless, there is at least 1 plausible mechanism for the abnormally low level of amyloid.…”

Different roles of frontal versus striatal atrophy in HIV‐associated neurocognitive disorders

“…One of the most consistent findings is subcortical atrophy in HIV, even in the era of cART (Becker et al, 2011). Studies have linked atrophy in basal ganglia to neurocognitive impairment (Kumar, Ownby, Waldrop-Valverde, Fernandez, & Kumar, 2011), disrupted cerebral metabolite levels (Cohen et al, 2010;Hua et al, 2013), HIV-disease duration (Ances, Ortega, Vaida, Heaps, & Paul, 2012;Becker et al, 2011), history of immune dysfunction (Tesic et al, 2018), immune recovery (Fennema-Notestine et al, 2013), and viral suppression (Guha et al, 2016;Kallianpur et al, 2013;Krivine et al, 1999). Studies have even suggested that the size of caudate nucleus might serve as a potential biomarker of HAND (Dal Pan et al, 1992;Hestad et al, 1993;Kieburtz et al, 1996).…”