White matter measures are near normal in controlled HIV infection except in those with cognitive impairment and longer HIV duration
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The objective of the current study was to quantify the degree of white matter (WM) abnormalities in chronic and virally suppressed HIV-infected (HIV+) persons while carefully taking into account demographic and disease factors. Diffusion tensor imaging (DTI) was conducted in 40 HIV− and 82 HIV+ men with comparable demographics and life style factors. The HIV+ sample was clinically stable with successful viral control. Diffusion was measured across 32 non-colinear directions with a b-value of 1000 s/mm2; fractional anisotropy (FA) and mean diffusivity (MD) maps were quantified with Itrack IDL. Using the ENIGMA DTI protocol, FA and MD values were extracted for each participant and in 11 skeleton regions of interest (SROI) from standard labels in the JHU ICBM-81 atlas covering major striato-frontal and parietal tracks. We found no major differences in FA and MD values across the 11 SROI between study groups. Within the HIV+ sample, we found that a higher CNS penetrating antiretroviral treatment, higher current CD4+ T cell count, and immune recovery from the nadir CD4+ T cell count were associated with increased FA and decreased MD (p < 0.05–0.006), while HIV duration, symptomatic, and asymptomatic cognitive impairment were associated with decreased FA and increased MD (p < 0.01–0.004). Stability of HIV treatment and antiretroviral CNS penetration efficiency in addition to current and historical immune recovery were related to higher FA and lower MD (p = 0.04–p < 0.01). In conclusion, WM DTI measures are near normal except for patients with neurocognitive impairment and longer HIV disease duration.
KeywordsHIV/AIDS HIV-associated neurocognitive disorder Diffusion tensor imaging Antiretroviral treatment Immune functions
We would like to thank the participants for their time.
(1) Conception and design of the study: LAC, BJB, CR, RGH.
(2) Acquisition and analysis of data: JS, JG, MS, KM.
(3) Drafting a significant portion of the manuscript or figures: LAC, BJB, CR, JS, MG, RGH.
Compliance with ethical standards
NHMRC project grant (APP568746; CIA/PI Cysique) and NHMRC Career Development Fellowship (APP1045400; CIA/PI Cysique), Peter Duncan Neuroscience Unit at the Sydney St. Vincent’s Hospital Applied Medical Research Centre (Director: Prof. Brew).
Conflict of interest
All authors report no disclosure for the submitted work.
Dr. Cysique reports a Gilead science fellowship grant, outside the submitted work.
Prof. Brew reports personal fees from AbbVie, personal fees from Viiv, grants and personal fees from Biogen Idec, personal fees from Merck Sharpe and Dohme, grants from National Health and Medical Research Council, and grants from National Institutes of Health, outside the submitted work.
Prof. Rae reports personal fees from Philips Healthcare and personal fees from Springer, outside the submitted work.
Other authors report no disclosures outside the submitted work.
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