Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 4676 Admiralty Way Suite 200, Marina del Rey, Los Angeles, CA, 90292, USA.
Graduate Interdepartmental Program in Neuroscience, UCLA School of Medicine, Los Angeles, CA, USA.
J Neurovirol. 2019 Jun;25(3):342-353. doi: 10.1007/s13365-019-00723-4. Epub 2019 Feb 14.
Growing evidence points to persistent neurological injury in chronic HIV infection. It remains unclear whether chronically HIV-infected individuals on combined antiretroviral therapy (cART) develop progressive brain injury and impaired neurocognitive function despite successful viral suppression and immunological restoration. In a longitudinal neuroimaging study for the HIV Neuroimaging Consortium (HIVNC), we used tensor-based morphometry to map the annual rate of change of regional brain volumes (mean time interval 1.0 ± 0.5 yrs), in 155 chronically infected and treated HIV+ participants (mean age 48.0 ± 8.9 years; 83.9% male) . We tested for associations between rates of brain tissue loss and clinical measures of infection severity (nadir or baseline CD4+ cell count and baseline HIV plasma RNA concentration), HIV duration, cART CNS penetration-effectiveness scores, age, as well as change in AIDS Dementia Complex stage. We found significant brain tissue loss across HIV+ participants, including those neuro-asymptomatic with undetectable viral loads, largely localized to subcortical regions. Measures of disease severity, age, and neurocognitive decline were associated with greater atrophy. Chronically HIV-infected and treated individuals may undergo progressive brain tissue loss despite stable and effective cART, which may contribute to neurocognitive decline. Understanding neurological complications of chronic infection and identifying factors associated with atrophy may help inform strategies to maintain brain health in people living with HIV.
越来越多的证据表明，慢性 HIV 感染会导致持续的神经损伤。目前尚不清楚，在接受联合抗逆转录病毒疗法 (cART) 的慢性 HIV 感染者中，尽管病毒得到了成功抑制和免疫功能得到了恢复，是否会出现进行性脑损伤和认知功能障碍。在 HIV 神经影像学联盟 (HIVNC) 的一项纵向神经影像学研究中，我们使用基于张量的形态测量学来描绘 155 名慢性感染和接受治疗的 HIV+参与者的区域脑容量的年度变化率（平均时间间隔为 1.0±0.5 年）（平均年龄为 48.0±8.9 岁；83.9%为男性）。我们测试了脑组织损失率与感染严重程度的临床指标（最低或基线 CD4+细胞计数和基线 HIV 血浆 RNA 浓度）、HIV 持续时间、cART 对中枢神经系统的穿透效果评分、年龄以及艾滋病痴呆综合征阶段变化之间的相关性。我们发现，HIV+参与者的大脑组织普遍存在损失，包括那些病毒载量不可检测但神经无症状的参与者，大脑组织损失主要发生在皮质下区域。疾病严重程度、年龄和神经认知能力下降的指标与更大的萎缩相关。尽管 cART 稳定且有效，但慢性 HIV 感染者和接受治疗的个体可能会经历进行性的脑组织损失，这可能导致神经认知能力下降。了解慢性感染的神经并发症并确定与萎缩相关的因素，可能有助于为维持 HIV 感染者的大脑健康提供策略。
