Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA.
Johns Hopkins School of Public Health, Baltimore, MD, USA.
J Neurovirol. 2019 Aug;25(4):480-495. doi: 10.1007/s13365-019-00747-w. Epub 2019 Apr 26.
The age of the HIV-infected population is increasing. Although many studies document gray matter volume (GMV) changes following HIV infection, GMV also declines with age. Findings have been inconsistent concerning interactions between HIV infection and age on brain structure. Effects of age, substance use, and inadequate viral suppression may confound identification of GMV serostatus effects using quantitative structural measures. In a cross-sectional study of HIV infection, including 97 seropositive and 84 seronegative, demographically matched participants, ages 30-70, we examined serostatus and age effects on GMV and neuropsychological measures. Ninety-eight percent of seropositive participants were currently treated with anti-retroviral therapies and all were virally suppressed. Gray, white, and CSF volumes were estimated using high-resolution T1-weighted MRI. Linear regression modeled effects of serostatus, age, education, comorbidities, and magnetic field strength on brain structure, using both a priori regions and voxel-based morphometry. Although seropositive participants exhibited significant bilateral decreases in striatal GMV, no serostatus effects were detected in the thalamus, hippocampus, or cerebellum. Age was associated with cortical, striatal, thalamic, hippocampal, and cerebellar GMV reductions. Effects of age and serostatus on striatal GMV were additive. Although no main effects of serostatus on neuropsychological performance were observed, serostatus moderated the relationship between pegboard performance and striatal volume. Both HIV infection and age were associated with reduced striatal volume. The lack of interaction of these two predictors suggests that HIV infection is associated with premature, but not accelerated, brain age. In serostatus groups matched on demographic and clinical variables, there were no observed differences in neuropsychological performance. Striatal GMV measures may be promising biomarker for use in studies of treated HIV infection.
HIV 感染者的年龄正在增长。尽管许多研究都记录了 HIV 感染后灰质体积（GMV）的变化，但 GMV 也会随着年龄的增长而下降。关于 HIV 感染和年龄对大脑结构的相互作用，研究结果并不一致。年龄、物质使用和病毒抑制不足的影响可能会混淆使用定量结构测量来确定 GMV 血清状态的影响。在一项 HIV 感染的横断面研究中，包括 97 名血清阳性和 84 名血清阴性、年龄在 30-70 岁之间、人口统计学匹配的参与者，我们研究了血清状态和年龄对 GMV 和神经心理学测量的影响。98%的血清阳性参与者目前正在接受抗逆转录病毒治疗，并且所有参与者的病毒都得到了抑制。使用高分辨率 T1 加权 MRI 估计灰质、白质和 CSF 体积。线性回归模型采用基于先验区域和基于体素的形态计量学的方法，模拟了血清状态、年龄、教育、合并症和磁场强度对大脑结构的影响。虽然血清阳性参与者表现出双侧纹状体 GMV 显著减少，但在丘脑、海马体或小脑体中未检测到血清状态的影响。年龄与皮质、纹状体、丘脑、海马体和小脑 GMV 减少有关。年龄和血清状态对纹状体 GMV 的影响是累加的。虽然没有观察到血清状态对神经心理学表现的主要影响，但血清状态调节了棒状图表现与纹状体体积之间的关系。HIV 感染和年龄都与纹状体体积减少有关。这两个预测因子之间没有相互作用的影响表明，HIV 感染与大脑衰老的提前有关，但与加速无关。在匹配人口统计学和临床变量的血清状态组中，没有观察到神经心理学表现的差异。纹状体 GMV 测量可能是治疗后 HIV 感染研究中很有前途的生物标志物。
