Objective:To test the hypothesis that brain white matter hyperintensities (WMH) are more common in people living with HIV (PLWH), even in the setting of well-controlled infection, and to identify clinical parameters that correlate with these abnormalities.Methods:Research brain MRI scans, acquired within longitudinal studies evaluating neurocognitive outcomes, were reviewed to determine WMH load using the Fazekas visual rating scale in PLWH with well-controlled infection (antiretroviral therapy for at least one year and plasma viral-load < 200 copies/ml) and in socio-demographically-matched controls without HIV (CWOH). The primary outcome measure of this cross-sectional analysis was increased WMH load, determined by total Fazekas score ≥ 2. Multiple logistic regression analysis was performed to evaluate the effect of HIV serostatus on WMH load, and to identify MRI, CSF and clinical variables that associate with WMH in PLWH group.Results:The study included 203 PLWH and 58 CWOH who completed a brain MRI scan between April 2014 and March 2019. The multiple logistic regression analysis, with age and history of tobacco use as covariates, showed that the adjusted odds ratio of the PLWH group for increased WMH load is 3.7 (95% confidence interval 1.8–7.5, p=0.0004). For the PLWH group, increased WMH load was associated with older age, male sex, tobacco use, hypertension, and hepatitis C virus co-infection, and also with the presence of measurable tumor necrosis factor-alpha in CSF.Conclusions:Our results suggest that HIV serostatus affects the extent of brain WMH. This effect is mainly associated with aging and modifiable co-morbidities.

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Twenty-seven previously healthy (of 36 consecutive eligible patients), HIV-negative cryptococcal meningoencephalitis (CM) patients underwent comprehensive neuropsychological evaluation during the late post-treatment period (1.3–4 years post diagnosis), assessing attention, language, learning, memory, visuospatial, executive function, information processing, psychomotor functioning, as well as mood symptoms. Seven of eight domains (all except attention) showed increased percentages of CM patients scoring in the less than 16th percentile range compared to standardized normative test averages, adjusted for education level and age. Comparison with a matched archival dataset of mild cognitive impairment/Alzheimer’s disease patients showed that CM patients exhibited relative deficits in psychomotor and executive function with fewer deficits in memory and learning, consistent with a frontal-subcortical syndrome. MRI evaluation at the time of testing demonstrated an association of lower neuropsychological functioning with ventriculomegaly. These studies suggest that CM should be included in the list of treatable causes of dementia in neurological work ups. Future studies are needed to identify diagnostic and treatment regimens that may enhance neurological function after therapy.

Proportional reasoning is an important skill that relates to fraction learning and math achievement. Because both proportional and analogical reasoning involve comparing relations, we hypothesized that supports for analogical reasoning (multiple exemplars and labels) would help children match discrete proportions. Fourth and 5th graders (N = 119) completed a 16-item proportional equivalence choice task in a 2 (exemplars: one, two) x 3 (script type: juice mixing narrative, novel adjectives, no labels) x 2 (trial type: part-foil, whole-foil) mixed-effects design. The juice mixing script included common labels and a story paradigm, whereas the novel adjectives script only utilized common labels. The least-informative no-labels script served as a baseline. Results showed a significant three-way interaction between exemplars, script type, and trial type. Viewing two exemplars led to no significant differences across the other factors. However, when viewing one exemplar, children exhibited a part-matching bias with novel adjectives and no labels, but not the juice narrative. In sum, multiple exemplars and the juice narrative reduced children’s part-matching bias; we conclude that supports for analogical reasoning can aid proportional reasoning as well.