Lazar Mihai, Chitu Cristina Emilia, Ion Daniela Adriana, Barbu Ecaterina Constanta
Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania.
National Institute for Infectious Diseases Prof. Dr. Matei Bals, No. 1, Calistrat Grozovici Street, Sector 2, 021105 Bucharest, Romania.
J Clin Med. 2025 Jun 22;14(13):4430. doi: 10.3390/jcm14134430.
This study aims to investigate the influence of demographic, behavioral, anthropometric, and comorbid factors on brain atrophy in people living with HIV (PLWH). We conducted a cross-sectional study involving 121 HIV-positive patients, stratified into two groups, those with and without brain atrophy (BA). For each participant, we recorded demographic data, smoking status, physical activity levels, disease and treatment duration, and comorbidities. BA was quantitatively assessed using MRI-derived volumetric measurements of 47 cerebral substructures. Patients with BA exhibited significantly reduced gray matter (GM) and white matter (WM) volumes alongside increased cerebrospinal fluid volumes, both in absolute and percentage measurements. WM atrophy was most pronounced in the frontal, parietal, and temporal lobes, with relative sparing of the occipital lobe. GM atrophy predominantly affected the basal ganglia (notably, the thalamus and putamen) and cortical regions, including the hippocampus, frontal, and parietal lobes. Significant positive correlations were observed between BA and both smoking status (pack-years) and disease duration, while physical activity demonstrated an inverse relationship (higher atrophy risk in those with less than 30 min of daily continuous walking). Non-adherence to antiretroviral therapy (ART) was also associated with BA. Among comorbidities, type 2 diabetes and HIV-associated neurocognitive disorders (HAND) showed the strongest associations with BA. Brain atrophy in PWH is correlated with smoking, physical inactivity, and the duration of HIV infection. Comorbid conditions, such as type II diabetes and HAND, amplify the risk for BA. We consider that early lifestyle interventions and optimized ART may mitigate the neurodegeneration process.
本研究旨在调查人口统计学、行为、人体测量学和合并症因素对艾滋病毒感染者（PLWH）脑萎缩的影响。我们进行了一项横断面研究，纳入了121名艾滋病毒阳性患者，分为有脑萎缩（BA）和无脑萎缩两组。对于每位参与者，我们记录了人口统计学数据、吸烟状况、身体活动水平、疾病和治疗持续时间以及合并症。使用MRI衍生的47个脑亚结构体积测量值对BA进行定量评估。BA患者的灰质（GM）和白质（WM）体积显著减少，同时脑脊液体积增加，无论是绝对值还是百分比测量值。WM萎缩在额叶、顶叶和颞叶最为明显，枕叶相对 spared。GM萎缩主要影响基底神经节（特别是丘脑和壳核）以及皮质区域，包括海马体、额叶和顶叶。BA与吸烟状况（包年数）和疾病持续时间之间均观察到显著正相关，而身体活动呈现负相关（每日持续步行少于30分钟的人萎缩风险更高）。抗逆转录病毒疗法（ART）不依从也与BA相关。在合并症中，2型糖尿病和艾滋病毒相关神经认知障碍（HAND）与BA的关联最强。PLWH中的脑萎缩与吸烟、身体不活动以及艾滋病毒感染持续时间相关。合并症，如II型糖尿病和HAND，会增加BA的风险。我们认为早期生活方式干预和优化ART可能会减轻神经退行性变过程。
