Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA.
Department of Family and Preventive Medicine, University of California, San Diego, California, USA.
J Infect Dis. 2022 Aug 12;226(1):49-58. doi: 10.1093/infdis/jiac156.
Persons with HIV (PWH) undergo white matter changes, which can be quantified using the brain-age gap (BAG), the difference between chronological age and neuroimaging-based brain-predicted age. Accumulation of microstructural damage may be accelerated in PWH, especially with detectable viral load (VL).
In total, 290 PWH (85% with undetectable VL) and 165 HIV-negative controls participated in neuroimaging and cognitive testing. BAG was measured using a Gaussian process regression model trained to predict age from diffusion magnetic resonance imaging in publicly available normative controls. To test for accelerated aging, BAG was modeled as an age × VL interaction. The relationship between BAG and global neuropsychological performance was examined. Other potential predictors of pathological aging were investigated in an exploratory analysis.
Age and detectable VL had a significant interactive effect: PWH with detectable VL accumulated +1.5 years BAG/decade versus HIV-negative controls (P = .018). PWH with undetectable VL accumulated +0.86 years BAG/decade, although this did not reach statistical significance (P = .052). BAG was associated with poorer global cognition only in PWH with detectable VL (P < .001). Exploratory analysis identified Framingham cardiovascular risk as an additional predictor of pathological aging (P = .027).
Aging with detectable HIV and cardiovascular disease may lead to white matter pathology and contribute to cognitive impairment.
艾滋病毒（HIV）感染者会发生白质变化，可以通过脑龄差距（BAG）来量化，即实际年龄与基于神经影像学的大脑预测年龄之间的差异。HIV 感染者的微观结构损伤可能会加速积累，尤其是在可检测到病毒载量（VL）的情况下。
共有 290 名 HIV 感染者（85%的病毒载量不可检测）和 165 名 HIV 阴性对照者参与了神经影像学和认知测试。BAG 是使用高斯过程回归模型测量的，该模型经过训练，可以根据来自公开的正常对照者的弥散磁共振成像数据来预测年龄。为了检测加速老化，将 BAG 建模为年龄与 VL 的交互作用。还检查了 BAG 与全球神经心理学表现之间的关系。在探索性分析中，还研究了其他潜在的病理性老化预测因子。
年龄和可检测到的 VL 有显著的交互作用：携带可检测 VL 的 HIV 感染者每十年 BAG 增加 1.5 年，而 HIV 阴性对照者则增加 1.0 年（P=0.018）。未检测到 VL 的 HIV 感染者 BAG 每十年增加 0.86 年，但这并未达到统计学意义（P=0.052）。仅在携带可检测 VL 的 HIV 感染者中，BAG 与较差的整体认知能力相关（P<0.001）。探索性分析发现，弗雷明汉心血管风险是病理性老化的另一个预测因子（P=0.027）。
可检测的 HIV 和心血管疾病导致的衰老可能会导致白质病变，并导致认知障碍。
