McConnell Brain Imaging Center WB-324, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada.
Department of Neurology, Washington University, St. Louis, Missouri, USA.
AIDS. 2019 Jun 1;33(7):1197-1205. doi: 10.1097/QAD.0000000000002193.
The objective of this study is to investigate whether cerebral small vessel disease (CSVD) is more common in virologically suppressed HIV-positive participants compared with HIV-negative controls and examine the potential synergistic effects of HIV and CSVD on brain structure and cognition.
Cross-sectional analysis of 119 treated, virologically suppressed HIV-positive and 55 HIV-negative participants. Forty-six HIV-positive and 30 HIV-negative participants had follow-up 2 years later. All participants underwent MRI and neuropsychological testing.
Volume of white matter hyperintensities (WMH) was used as a surrogate measure of CSVD severity. Tensor-based morphometry and cortical modeling estimated brain volumes and cortical thickness, respectively. Rasch measurement theory was applied to neuropsychological test scores to estimate overall cognition. Linear models compared WMH loads, brain volumes, and cognition between groups; evaluated the association of WMH loads with brain volumes and cognition; and tested the interaction between HIV and WMH loads on brain volumes and cognition. Mixed-effects models compared the change in WMH loads between groups.
WMH loads and change in WMH loads were similar between the groups. HIV-positive participants had poorer cognition, thinner cortex and reduced subcortical volumes compared with HIV-negative controls. Higher WMH loads were associated with reduced cortical thickness and subcortical volumes and worse cognition, regardless of HIV serostatus. No significant interactions were observed between HIV and WMH loads with regards to brain volumes or cognition.
These findings suggest that the contributions of HIV and CSVD on brain atrophy and cognitive impairment are independent but additive processes. This argues that optimizing vascular health may mitigate brain injury and cognitive decline, especially in treated, virologically suppressed HIV-positive individuals.
本研究旨在探讨与 HIV 阴性对照相比，病毒学抑制的 HIV 阳性参与者中是否更常见脑小血管病（CSVD），并研究 HIV 和 CSVD 对大脑结构和认知的潜在协同作用。
对 119 名接受治疗、病毒学抑制的 HIV 阳性和 55 名 HIV 阴性参与者进行横断面分析。46 名 HIV 阳性和 30 名 HIV 阴性参与者在 2 年后进行了随访。所有参与者均接受 MRI 和神经心理学测试。
用脑白质高信号（WMH）体积作为 CSVD 严重程度的替代指标。张量基形态计量学和皮质建模分别估计脑容量和皮质厚度。Rasch 测量理论应用于神经心理学测试分数，以估计整体认知。线性模型比较组间 WMH 负荷、脑容量和认知；评估 WMH 负荷与脑容量和认知的相关性；并检验 HIV 和 WMH 负荷对脑容量和认知的交互作用。混合效应模型比较组间 WMH 负荷的变化。
组间 WMH 负荷和 WMH 负荷变化相似。与 HIV 阴性对照相比，HIV 阳性参与者的认知能力较差，皮质较薄，皮质下体积减少。无论 HIV 血清状态如何，较高的 WMH 负荷与皮质厚度和皮质下体积减少以及认知能力下降相关。在大脑体积或认知方面，未观察到 HIV 和 WMH 负荷之间存在显著的相互作用。
这些发现表明，HIV 和 CSVD 对脑萎缩和认知障碍的贡献是独立但累加的过程。这表明优化血管健康可能减轻脑损伤和认知能力下降，尤其是在接受治疗、病毒学抑制的 HIV 阳性个体中。
