From the Center for Infectious Disease Imaging, Radiology and Imaging Sciences (D.A.H., S. Sinharay), Clinical Center, National Institute of Neurological Diseases and Stroke (S. Steinbach, K.G., B.R.S., A.N.), Biostatistics and Clinical Epidemiology Service (P.G.W.), Clinical Center, National Institute of Mental Health (K.T., J.S.), National Heart, Lung, and Blood Institute (A.K.D., N.N.M.), National Institute for Allergy and Infectious Diseases (E.T.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), NIH, Bethesda, MD.
Neurology. 2018 Oct 23;91(17):e1591-e1601. doi: 10.1212/WNL.0000000000006398. Epub 2018 Sep 26.
To quantitatively measure brain glucose metabolism in treated HIV-positive individuals with [F]-labeled fluorodeoxyglucose (FDG) PET/CT.
We performed a cross-sectional comparison of FDG uptake in 47 treated HIV+ individuals, 10 age-matched controls (HIV-) sharing many of the comorbid conditions seen in the HIV+ group, and 19 age-matched healthy controls (HCs). We compared whole-brain (WB) and regional FDG standardized uptake values (SUVs) of select subcortical/central structures among the groups and correlated the values to clinical and neuropsychological assessments. A variable selection model was used to predict SUVs in HIV+ (n = 47) and in combined HIV+ and HIV- participants (n = 57).
We found lower WB SUVmax in HIV+ participants compared to HCs but not to HIV- participants. Among the relative SUVmean measurements (regional SUVmean/WB SUVmean), only relative thalamic uptake values were lower in HIV+ compared to HIV- participants. When HIV+ and HIV- participants were grouped, cardiovascular disease risk scores best predicted WB SUVmean and SUVmax, while HIV status best predicted thalamic relative SUVmean.
We identified an important role for cardiovascular disease in neuronal loss/dysfunction, as measured by FDG-PET, in treated HIV+ patients. This underscores the need for shifting the focus of clinical intervention in this vulnerable population from HIV effects alone to a wider set of comorbid conditions, mainly cardiovascular disease. Only the thalamus showed significantly lower relative uptake in the HIV+ compared to the HC and HIV- groups. This needs to be further evaluated for underlying pathophysiology and potential association with memory, executive functioning, and attention deficits seen in the HIV+ population.
使用 [F]-氟代脱氧葡萄糖（FDG）PET/CT 定量测量经治疗的 HIV 阳性个体的脑葡萄糖代谢。
我们对 47 名经治疗的 HIV 阳性个体、10 名年龄匹配的具有许多 HIV 阳性个体共病情况的对照组（HIV-）和 19 名年龄匹配的健康对照组（HCs）进行了 FDG 摄取的横断面比较。我们比较了各组的全脑（WB）和选定皮质下/中央结构的区域 FDG 标准化摄取值（SUV），并将这些值与临床和神经心理学评估相关联。使用变量选择模型来预测 HIV+（n=47）和 HIV+和 HIV-参与者（n=57）中的 SUV。
与 HCs 相比，我们发现 HIV+ 参与者的 WB SUVmax 较低，但与 HIV- 参与者相比则没有。在相对 SUVmean 测量值（局部 SUVmean/WB SUVmean）中，仅 HIV+参与者的相对丘脑摄取值低于 HIV- 参与者。当将 HIV+和 HIV-参与者分组时，心血管疾病风险评分最佳预测了 WB SUVmean 和 SUVmax，而 HIV 状态最佳预测了丘脑相对 SUVmean。
我们发现心血管疾病在经治疗的 HIV+患者中通过 FDG-PET 测量的神经元丢失/功能障碍中起重要作用。这强调了需要将这一脆弱人群的临床干预重点从 HIV 影响转移到更广泛的共病情况，主要是心血管疾病。只有丘脑在 HIV+组中显示出与 HCs 和 HIV- 组相比相对摄取明显较低。这需要进一步评估其潜在的病理生理学和与 HIV+人群中记忆、执行功能和注意力缺陷的潜在关联。
