Emma Children's Hospital, Pediatric Infectious Diseases.
Department of Radiology and Nuclear Medicine.
AIDS. 2021 Jul 1;35(8):1221-1228. doi: 10.1097/QAD.0000000000002873.
Cross-sectional studies, including one from our NOVICE cohort [Neurological Visual and Cognitive performance in children with treated perinatally acquired HIV (PHIV) compared with matched HIV-negative controls], have revealed that the brains of children with PHIV have lower white matter and grey matter volumes, more white matter hyperintensities (WMH) and poorer white matter integrity. This longitudinal study investigates whether these differences change over time.
We approached all NOVICE participants to repeat MRI after 4.6 ± 0.3 years, measuring total white matter and grey matter volume, WMH volume and white matter integrity, obtained by T1-weighted, fluid-attenuated inversion recovery (FLAIR) and diffusion tensor imaging (DTI), respectively. We compared rates of change between groups using multivariable linear mixed effects models, adjusted for sex and age at enrolment. We investigated determinants of developmental deviation, and explored associations with cognitive development.
Twenty out of 31 (65%) PHIV-positive, and 20 out of 37 (54%) HIV-negative participants underwent follow-up MRI. Groups did not significantly differ in terms of age and sex. Over time, we found no statistically different changes between groups for white matter and WMH volumes, and for white matter integrity (P > 0.1). Total grey matter volume decreased significantly less in PHIV [group∗time 10 ml, 95% confidence interval -1 to 20, P = 0.078], but this difference in rate of change lost statistical significance after additional adjustment for height (group∗time 9 ml, 95% confidence interval -2 to 20, P = 0.112). We found no HIV-associated determinants for potential reduced grey matter pruning, nor associations with cognitive development.
While using long-term antiretroviral treatment, structural brain development of adolescents growing up with perinatally acquired HIV appears largely normal.
横断面研究，包括我们的 NOVICE 队列中的一项研究[与未感染 HIV 的对照相比，经治疗的围生期获得性 HIV（PHIV）患儿的神经视觉和认知表现]表明，PHIV 患儿的大脑白质和灰质体积较低，白质高信号（WMH）更多，白质完整性更差。这项纵向研究调查了这些差异是否随时间而变化。
我们联系了所有 NOVICE 参与者，在 4.6±0.3 年后重复 MRI，分别通过 T1 加权、液体衰减反转恢复（FLAIR）和弥散张量成像（DTI）测量总白质和灰质体积、WMH 体积和白质完整性。我们使用多变量线性混合效应模型比较了组间的变化率，调整了入组时的性别和年龄。我们研究了发育偏差的决定因素，并探索了与认知发展的关联。
31 名 PHIV 阳性参与者中有 20 名（65%）和 37 名 HIV 阴性参与者中有 20 名（54%）接受了随访 MRI。两组在年龄和性别方面无显著差异。随着时间的推移，我们发现两组之间在白质和 WMH 体积以及白质完整性方面没有统计学上的差异（P>0.1）。PHIV 组的总灰质体积减少明显较少[组间时间 10ml，95%置信区间-1 至 20，P=0.078]，但在对身高进行额外调整后，这种变化率的差异失去了统计学意义[组间时间 9ml，95%置信区间-2 至 20，P=0.112]。我们没有发现与潜在灰质修剪减少相关的 HIV 相关决定因素，也没有发现与认知发展相关的因素。
在长期接受抗逆转录病毒治疗的情况下，围生期获得性 HIV 患儿的大脑结构发育似乎基本正常。
