White matter hyperintensities correlate to cognition and fiber tract integrity in older adults with HIV
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Our aim was to examine the clinical relevance of white matter hyperintensities (WMH) in HIV. We used an automated approach to quantify WMH volume in HIV seropositive (HIV+; n = 65) and HIV seronegative (HIV−; n = 29) adults over age 60. We compared WMH volumes between HIV+ and HIV− groups in cross-sectional and multiple time-point analyses. We also assessed correlations between WMH volumes and cardiovascular, HIV severity, cognitive scores, and diffusion tensor imaging variables. Serostatus groups did not differ in WMH volume, but HIV+ participants had less cerebral white matter (mean: 470.95 [43.24] vs. 497.63 [49.42] mL, p = 0.010). The distribution of WMH volume was skewed in HIV+ with a high proportion (23%) falling above the 95th percentile of WMH volume defined by the HIV− group. Serostatus groups had similar amount of WMH volume growth over time. Total WMH volume directly correlated with measures of hypertension and inversely correlated with measures of global cognition, particularly in executive functioning, and psychomotor speed. Greater WMH volume was associated with poorer brain integrity measured from diffusion tensor imaging (DTI) in the corpus callosum and sagittal stratum. In this group of HIV+ individuals over 60, WMH burden was associated with cardiovascular risk and both worse diffusion MRI and cognition. The median total burden did not differ by serostatus; however, a subset of HIV+ individuals had high WMH burden.
KeywordsWhite matter Leukoaraiosis HIV Aging Cerebrovascular Diffusion tensor imaging
National Institutes of Health grants: K23-AG032872 (VV), P30 AG010129 (CD), K01 AG030514 (OC); The Larry L. Hillblom Foundation; the University of California, San Francisco/Gladstone Institute of Virology and Immunology Center For Acquired Immune Deficiency Syndrome Research; the University of California, San Francisco Acquired Immune Deficiency Syndrome Research Institute, K24MH098759 (VV) and P50-AG023501 (BM). Additional support from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through the University of California, San Francisco-Clinical and Translational Science Institute Grant No. UL1 RR024131.
Compliance with ethical standards
Dr. Valcour has served as a consultant for ViiV Healthcare and Merck related to aging and HIV. The authors declare that they have no conflict of interest.
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