Hoare Jacqueline, Fouche Jean-Paul, Phillips Nicole, Joska John A, Paul Robert, Donald Kirsten A, Thomas Kevin G F, Stein Dan J
aDepartment of Psychiatry and Mental Health bDepartment of Pediatrics, School of Child and Adolescent Health cDepartment of Psychology, University of Cape Town, Cape Town, South Africa dDepartment of Psychology and Behavioural Neuroscience, University of Missouri, St Louis, Missouri, USA.
AIDS. 2015 Sep 10;29(14):1793-801. doi: 10.1097/QAD.0000000000000766.
To describe the effect of HIV on white matter integrity and neurocognitive function in children vertically infected with HIV, compared to a HIV-negative healthy control group.
Cross-sectional.
We compared 75 HIV-infected children aged 6-16 years, including children on antiretroviral therapy (ART) and those who were ART-naive, with 30 controls on diffusion tensor imaging and a neuropsychological battery sensitive to fronto-striatal pathology. In a secondary analysis, we compared 'slow progressor' ART-naive children, children on ART without a diagnosis of encephalopathy and children on ART with HIV encephalopathy.
Compared to controls (n = 30), HIV-infected children (n = 75) displayed decreased fractional anisotropy and axial diffusion, and increased mean diffusivity and radial diffusion, indicating damaged neuronal microstructure. HIV-infected children performed poorly on the neuropsychological battery (P = <0.001). Within the HIV-infected group, children with HIV encephalopathy (n = 14) had poor white matter integrity when compared to ART-treated children without encephalopathy (n = 41), and there was significant myelin loss in ART-naive children (n = 20), compared with ART-treated children. ART-treated children had significant axonal damage in the corpus callosum (P = 0.009).
Children infected with HIV, irrespective of treatment status, displayed significantly poorer white matter integrity and impaired cognition compared to HIV-negative controls. Our findings suggest that despite immune recovery in children on ART, they remain at risk for developing central nervous system disease, and that initiation of ART as early as possible may reduce the risk of developing white matter damage in ART-naive slow progressors.
与未感染HIV的健康对照组相比，描述HIV对垂直感染HIV儿童白质完整性和神经认知功能的影响。
横断面研究。
我们将75名6至16岁的HIV感染儿童（包括接受抗逆转录病毒治疗[ART]的儿童和未接受ART的儿童）与30名对照组儿童进行弥散张量成像和对额纹状体病变敏感的神经心理测试比较。在二次分析中，我们比较了未接受ART的“缓慢进展者”儿童、未诊断为脑病的接受ART治疗的儿童和患有HIV脑病的接受ART治疗的儿童。
与对照组（n = 30）相比，HIV感染儿童（n = 75）表现出分数各向异性和轴向扩散降低，平均扩散率和径向扩散增加，表明神经元微观结构受损。HIV感染儿童在神经心理测试中表现不佳（P = <0.001）。在HIV感染组中，与未患脑病的接受ART治疗的儿童（n = 41）相比，患有HIV脑病的儿童（n = 14）白质完整性较差，与接受ART治疗的儿童相比，未接受ART的儿童（n = 20）存在明显的髓鞘丢失。接受ART治疗的儿童胼胝体有明显的轴突损伤（P = 0.009）。
与未感染HIV的对照组相比，感染HIV的儿童，无论治疗状态如何，白质完整性明显较差，认知受损。我们的研究结果表明，尽管接受ART治疗的儿童免疫功能有所恢复，但他们仍有发生中枢神经系统疾病的风险，尽早开始ART治疗可能会降低未接受ART的缓慢进展者发生白质损伤的风险。
