Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive M/C 0115, La Jolla, CA, USA.
J Neurovirol. 2011 Jun;17(3):248-57. doi: 10.1007/s13365-011-0032-7. Epub 2011 May 5.
Despite the widening use of combination antiretroviral therapy (ART), neurocognitive impairment remains common among HIV-infected (HIV+) individuals. Associations between HIV-related neuromedical variables and magnetic resonance imaging indices of brain structural integrity may provide insight into the neural bases for these symptoms. A diverse HIV+ sample (n = 251) was studied through the CNS HIV Antiretroviral Therapy Effects Research initiative. Multi-channel image analysis produced volumes of ventricular and sulcal cerebrospinal fluid (CSF), cortical and subcortical gray matter, total cerebral white matter, and abnormal white matter. Cross-sectional analyses employed a series of multiple linear regressions to model each structural volume as a function of severity of prior immunosuppression (CD4 nadir), current CD4 count, presence of detectable CSF HIV RNA, and presence of HCV antibodies; secondary analyses examined plasma HIV RNA, estimated duration of HIV infection, and cumulative exposure to ART. Lower CD4 nadir was related to most measures of the structural brain damage. Higher current CD4, unexpectedly, correlated with lower white and subcortical gray and increased CSF. Detectable CSF HIV RNA was related to less total white matter. HCV coinfection was associated with more abnormal white matter. Longer exposure to ART was associated with lower white matter and higher sulcal CSF. HIV neuromedical factors, including lower nadir, higher current CD4 levels, and detectable HIV RNA, were associated with white matter damage and variability in subcortical volumes. Brain structural integrity in HIV likely reflects dynamic effects of current immune status and HIV replication, superimposed on residual effects associated with severe prior immunosuppression.
尽管联合抗逆转录病毒疗法（ART）的应用越来越广泛，但 HIV 感染者（HIV+）仍普遍存在神经认知障碍。HIV 相关神经医学变量与大脑结构完整性的磁共振成像指标之间的关联，可能为这些症状的神经基础提供深入了解。通过中枢神经系统 HIV 抗逆转录病毒治疗效果研究倡议，对一个多样化的 HIV+样本（n=251）进行了研究。多通道图像分析产生了脑室和脑沟脑脊液（CSF）、皮质和皮质下灰质、总脑白质以及异常白质的体积。横断面分析采用一系列多元线性回归模型，将每个结构体积作为先前免疫抑制（CD4 最低点）严重程度、当前 CD4 计数、可检测 CSF HIV RNA 的存在以及 HCV 抗体存在的函数进行建模；二次分析检查了血浆 HIV RNA、估计的 HIV 感染持续时间和累积 ART 暴露。较低的 CD4 最低点与大多数结构性脑损伤指标有关。出乎意料的是，较高的当前 CD4 与较低的白质和皮质下灰质以及增加的 CSF 相关。可检测到的 CSF HIV RNA 与总白质减少有关。HCV 合并感染与更多的异常白质有关。较长的 ART 暴露与较低的白质和较高的脑沟 CSF 有关。HIV 神经医学因素，包括较低的最低点、较高的当前 CD4 水平和可检测到的 HIV RNA，与白质损伤和皮质下体积的变异性有关。HIV 中的大脑结构完整性可能反映了当前免疫状态和 HIV 复制的动态影响，叠加了与严重先前免疫抑制相关的残留影响。
