Regional brain gray and white matter changes in perinatally HIV-infected adolescents

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.

White matter microstructure among youth with perinatally acquired HIV is associated with disease severity

“…It is possible that higher MD, observed in PHIV youth and HIV+ adults [20], may represent neurodegeneration of WM: where a loss in neurons during neurodegeneration, corresponds to increased water molecules, possibly resulting in higher MD [46]. Supporting this hypothesis, smaller WM volumes have been observed among PHIV youth [32]. Adults with Hepatitis C virus (HCV) infection also exhibit lower FA and higher MD compared to healthy controls [47], suggesting that different types of chronic peripheral infections and inflammation may result in similar profiles of WM microstructure abnormalities.…”

“…The effects of HIV on WM microstructure may possibly differ in youth with PHIV, compared to those who acquired HIV in adulthood, given that HIV exposure and cART occur when significant brain development is occurring. Sarma and colleagues [32] examined volume of WM in PHIV youth and identified WM atrophy that differed from those observed with adult-acquired HIV. To our knowledge, no study to date has utilized tractography to examine associations between disease severity markers and microstructural properties at specific points along WM tracts among PHIV youth.…”

White Matter Development is Potentially Influenced in Adolescents with Vertically Transmitted HIV Infections: A Tract-Based Spatial Statistics Study

“…For example, a voxel-based morphometry study reported WM atrophy in the posterior part of corpus callosum, external capsule, and ventral temporal lobe in vertically infected youths (age range, 13-25 years). 13 Hoare et al 14 found that vertically HIV-infected children (age range, 8 -12 years) had lower FA and higher MD and radial diffusivity (RD) in the corpus callosum and increased MD in the superior longitudinal fasciculus. Taken together, these findings suggest that abnormal WM integrity may also be present in adolescents (age range, 12-18 years) with vertically transmitted HIV infections.…”

Lower Limb Landing Biomechanics in Subjects with Chronic Ankle Instability

“…To avoid focus bias, the use o f statistical parametric mapping (SPM), extensively used in brain research (13,22,32), enabled us to perform a compre hensive curve analysis during the whole prelanding and post landing phase. …”