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Cerebral white matter Hyperintensities in HIV–positive patients

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Abstract

White matter hyperintensities (WMHs) have been associated with neurological complications including cognitive impairment. WMHs have been often described in HIV positive subjects and they have been linked to neurocognitive impairment, cerebrospinal fluid (CSF) residual viral replication and biomarkers of monocyte activation. Aim of this study was to grade WMHs in HIV-positive individuals using a simple visual scale and to explore their severity with clinical, neurocognitive and biomarker characteristics. Brain MRIs were retrospectively evaluated by two reviewers who rated WMHs following the “age-related white matter changes (ARWMC)” scale. 107 adult HIV-positive patients receiving lumbar punctures for clinical reasons were included. 70 patients (66.6%) were diagnosed with WMHs. Average WMH scores were higher in treated [7 (1–11)] vs. naïve individuals [3 (0–6)] (p = 0.008). Higher WHMs scores were observed in patients with chronic renal impairment along with chronic hepatitis (naïve) and longer HIV duration (treated participants). No consistent associations between plasma, CSF biomarkers and WMHs scores were found. 45 patients underwent full neurocognitive tests and WMHs scores were non-significantly higher in patients diagnosed with HAND [6.5 (0.5–8.3) vs. 1.5 (0–7), p = 0.165]; screening (IHDS and FAB), visuo-spatial (Corsi’s) and auditory-verbal memory (disillabic words repetition) tests scored worse in patients with higher WMHs. In our population of HIV-positive patients with low CD4 nadir and partial CD4 cell recovery the burden of WMHs was associated with the duration of HIV infection and with commonly observed comorbidities (such as renal and hepatic impairment). Given the association with worse neurocognition, further studies on tailored interventions are needed.

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Authors and Affiliations

  1. Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy

    Alice Trentalange, Jessica Cusato, Mariacristina Tettoni, Ambra Barco, Stefano Bonora, Giovanni Di Perri & Andrea Calcagno

  2. Department of Radiology, San Giovanni Bosco Hospital, ASL TO2, Torino, Italy

    Adolfo Prochet

  3. Department of Neurology, Maria Vittoria Hospital, ASL TO2, Torino, Italy

    Daniele Imperiale

  4. Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Giuseppe Nunnari

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  1. Alice Trentalange
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  2. Adolfo Prochet
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  3. Daniele Imperiale
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  4. Jessica Cusato
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  5. Mariacristina Tettoni
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  8. Stefano Bonora
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  9. Giovanni Di Perri
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  10. Andrea Calcagno
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Correspondence to Alice Trentalange.

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Conflict of interest

A. Calcagno. has received honoraria from Gilead, Janssen-Cilag, MSD and ViiV, and is currently receiving research grants from ViiV. G. Di Perri and S. Bonora have received honoraria from AbbVie, BMS, Gilead, Janssen-Cilag, MSD and ViiV. G.Nunnari has received speaker’s honoraria and consultancy fees from Viiv, Gilead, MSD. A. Trentalange declares that she has no conflict of interest. A. Prochet declares that he has no conflict of interest. D. Imperiale declares that he has no conflict of interest. M. Tettoni declares that she has no conflict of interest. A. Barco declares that she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Trentalange, A., Prochet, A., Imperiale, D. et al. Cerebral white matter Hyperintensities in HIV–positive patients. Brain Imaging and Behavior 14, 10–18 (2020). https://doi.org/10.1007/s11682-018-9966-1

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