Gongvatana Assawin, Schweinsburg Brian C, Taylor Michael J, Theilmann Rebecca J, Letendre Scott L, Alhassoon Omar M, Jacobus Joanna, Woods Steven P, Jernigan Terry L, Ellis Ronald J, Frank Lawrence R, Grant Igor
San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego and La Jolla, California, USA.
J Neurovirol. 2009 Apr;15(2):187-95. doi: 10.1080/13550280902769756.
Approximately half of those infected with the human immunodeficiency virus (HIV) exhibit cognitive impairment, which has been related to cerebral white matter damage. Despite the effectiveness of antiretroviral treatment, cognitive impairment remains common even in individuals with undetectable viral loads. One explanation for this may be subtherapeutic concentrations of some antiretrovirals in the central nervous system (CNS). We utilized diffusion tensor imaging and a comprehensive neuropsychological evaluation to investigate the relationship of white matter integrity to cognitive impairment and antiretroviral treatment variables. Participants included 39 HIV-infected individuals (49% with acquired immunodeficiency syndrome [AIDS]; mean CD4 = 529) and 25 seronegative subjects. Diffusion tensor imaging indices were mapped onto a common whole-brain white matter tract skeleton, allowing between-subject voxelwise comparisons. The total HIV-infected group exhibited abnormal white matter in the internal capsule, inferior longitudinal fasciculus, and optic radiation; whereas those with AIDS exhibited more widespread damage, including in the internal capsule and the corpus callosum. Cognitive impairment in the HIV-infected group was related to white matter injury in the internal capsule, corpus callosum, and superior longitudinal fasciculus. White matter injury was not found to be associated with HIV viral load or estimated CNS penetration of antiretrovirals. Diffusion tensor imaging was useful in identifying changes in white matter tracts associated with more advanced HIV infection. Relationships between diffusion alterations in specific white matter tracts and cognitive impairment support the potential utility of diffusion tensor imaging in examining the anatomical underpinnings of HIV-related cognitive impairment. The study also confirms that CNS injury is evident in persons infected with HIV despite effective antiretroviral treatment.
感染人类免疫缺陷病毒（HIV）的人群中，约有一半会出现认知障碍，这与脑白质损伤有关。尽管抗逆转录病毒治疗有效，但即使在病毒载量检测不到的个体中，认知障碍仍然很常见。对此的一种解释可能是某些抗逆转录病毒药物在中枢神经系统（CNS）中的浓度低于治疗水平。我们利用扩散张量成像和全面的神经心理学评估来研究白质完整性与认知障碍及抗逆转录病毒治疗变量之间的关系。参与者包括39名HIV感染者（49%患有获得性免疫缺陷综合征[AIDS]；平均CD4 = 529）和25名血清学阴性的受试者。扩散张量成像指标被映射到一个共同的全脑白质束骨架上，从而实现个体间体素水平的比较。HIV感染组整体在内囊、下纵束和视辐射出现白质异常；而患有AIDS的患者损伤范围更广，包括内囊和胼胝体。HIV感染组的认知障碍与内囊、胼胝体和上纵束的白质损伤有关。未发现白质损伤与HIV病毒载量或抗逆转录病毒药物的估计CNS穿透率有关。扩散张量成像有助于识别与更晚期HIV感染相关的白质束变化。特定白质束的扩散改变与认知障碍之间的关系支持了扩散张量成像在检查HIV相关认知障碍的解剖学基础方面的潜在效用。该研究还证实，尽管进行了有效的抗逆转录病毒治疗，但HIV感染者的中枢神经系统损伤仍然明显。
