Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA; Ahmanson-Lovelace Brain Mapping Center University of California, Los Angeles, Los Angeles, CA, USA; Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, USA.
Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
Neuroimage Clin. 2019;23:101810. doi: 10.1016/j.nicl.2019.101810. Epub 2019 Apr 2.
Alterations in subcortical brain structures have been reported in adults with HIV and, to a lesser extent, pediatric cohorts. The extent of longitudinal structural abnormalities in children with perinatal HIV infection (PaHIV) remains unclear. We modeled subcortical morphometry from whole brain structural magnetic resonance imaging (1.5 T) scans of 43 Thai children with PaHIV (baseline age = 11.09±2.36 years) and 50 HIV- children (11.26±2.80 years) using volumetric and surface-based shape analyses. The PaHIV sample were randomized to initiate combination antiretroviral treatment (cART) when CD4 counts were 15-24% (immediate: n = 22) or when CD4 < 15% (deferred: n = 21). Follow-up scans were acquired approximately 52 weeks after baseline. Volumetric and shape descriptors capturing local thickness and surface area dilation were defined for the bilateral accumbens, amygdala, putamen, pallidum, thalamus, caudate, and hippocampus. Regression models adjusting for clinical and demographic variables examined between and within group differences in morphometry associated with HIV. We assessed whether baseline CD4 count and cART status or timing associated with brain maturation within the PaHIV group. All models were adjusted for multiple comparisons using the false discovery rate. A pallidal subregion was significantly thinner in children with PaHIV. Regional thickness, surface area, and volume of the pallidum was associated with CD4 count in children with PaHIV. Longitudinal morphometry was not associated with HIV or cART status or timing, however, the trajectory of the left pallidum volume was positively associated with baseline CD4 count. Our findings corroborate reports in adult cohorts demonstrating a high predilection for HIV-mediated abnormalities in the basal ganglia, but suggest the effect of stable PaHIV infection on morphological aspects of brain development may be subtle.
皮质下脑结构的改变已在成人 HIV 患者中得到报道，在儿童队列中也有报道，但程度较轻。围产期 HIV 感染（PaHIV）儿童的纵向结构异常程度仍不清楚。我们使用容积和基于表面的形态分析，对 43 名泰国 PaHIV 儿童（基线年龄=11.09±2.36 岁）和 50 名 HIV-儿童（11.26±2.80 岁）的全脑结构磁共振成像（1.5T）扫描进行皮质下形态计量建模。根据 CD4 计数将 PaHIV 样本随机分为在 15-24%（立即：n=22）或 CD4<15%（延迟：n=21）时开始联合抗逆转录病毒治疗（cART）。在基线后大约 52 周进行随访扫描。为双侧伏隔核、杏仁核、壳核、苍白球、丘脑、尾状核和海马定义了捕获局部厚度和表面积扩张的容积和形状描述符。调整临床和人口统计学变量的回归模型，研究了与 HIV 相关的形态差异的组间和组内差异。我们评估了 PaHIV 组中基线 CD4 计数和 cART 状态或时间与脑成熟度的关系。所有模型均使用错误发现率进行了多次比较的调整。PaHIV 儿童的苍白球亚区明显变薄。儿童 PaHIV 中苍白球的区域厚度、表面积和体积与 CD4 计数相关。纵向形态学与 HIV 或 cART 状态或时间无关，但左苍白球体积的轨迹与基线 CD4 计数呈正相关。我们的研究结果证实了成人队列中的报告，表明基底节中 HIV 介导的异常具有很高的倾向性，但表明稳定的 PaHIV 感染对大脑发育的形态方面的影响可能是微妙的。
