Factors affecting brain structure in men with HIV disease in the post-HAART era

Abstract

Introduction The purpose of this study was to characterize brain volumetric differences in HIV seropositive and seronegative men and to determine effects of age, cardiovascular risk, and HIV infection on structural integrity. Methods Magnetic resonance imaging was used to acquire high-resolution neuroanatomic data in 160 men aged 50 years and over, including 84 HIV seropositive and 76 seronegative controls. Voxel-based morphometry was used to derive volumetric measurements at the level of the individual voxel. Data from a detailed neuropsychological test battery were recombined into four summary scores representing psychomotor speed, visual memory, verbal memory, and verbal fluency. Results Both age and HIV status had a significant effect on both gray matter (GM) and white matter (WM) volume. The age-related GM atrophy was primarily in the superior temporal and inferior frontal regions; the HIV-related GM loss included the posterior and inferior temporal lobes, the parietal lobes, and the cerebellum. Among all subjects, the performance on neuropsychological tests, as indexed by a summary variable, was related to the volume of both the GM and WM. Contrary to our predictions, the CVD variables were not linked to brain volume in statistically adjusted models. Conclusion In the post-HAART era, having HIV infection is still linked to atrophy in both GM and WM. Secondly, advancing age, even in this relatively young cohort, is also linked to changes in GM and WM volume. Thirdly, CNS structural integrity is associated with overall cognitive functions, regardless of the HIV infection status of the study volunteers.

Regional Cerebral Gray Matter Volume in HIV‐Positive Patients with Executive Function Deficits

“…18 A study found a reduction in cortical thickness in the bilateral insula, orbitofrontal and temporal cortices and right superior frontal cortex in patients using HAART, with detectable HIV-deoxyribonucleic acid (DNA) in peripheral blood, compared with HIV patients using HAART without HIV-DNA detected in peripheral blood, which was correlated with psychomotor speed dysfunction. 17 However, we did not identify any differences in cortical thickness in HIV-positive patients, with and without executive functions deficits, when compared with the controls.…”

“…Besides that, the two HIV-positive groups in our study were matched by CD4 T lymphocyte count and years of known infection. Kallianpu et al 17 and Thompson et al 16 included participants with high 18 included only participants older than 50 years in their study. Furthermore, differences in CNS Penetration-Effectiveness Score for different HAART schemes used by the participants may have contributed to these differences in the results.…”

“…[5][6][7][8] Several authors have previously evaluated brain volume and cortical thickness of HIV-positive patients and have found diffuse brain atrophy and volume reduction in the basal ganglia. [9][10][11][12][13][14][15][16][17][18] However, the majority of previous studies included patients with HIV-associated dementia, 9,10 or did not consider cognitive domains. 15 To the best of our knowledge, no previous study has investigated the cortical thickness and brain volume of HIV-patients with executive functions deficits.…”

HIV and Aging: Effects on the Central Nervous System

“…Voxel-based morphometry studies (VBM) have reported independent effects of HIV and aging, but some suggest premature aging in HIV. Becker et al 30 found age and HIV effects on gray (GM) and white matter (WM). Specifically, age-related GM atrophy was found in inferior frontal and superior temporal regions, as well as medial temporal and cingulate areas.…”

“…30,43 For instance, Nakamoto et al 55 in a small sample of older HIV+ individuals found marginal correlations between the presence of cardiovascular risk factors (abnormal glucose metabolism) and abnormalities in DTI (microstructural alterations in caudate and hippocampus). However, the number of such studies is still limited.…”