The purpose of this study was to determine the pattern and extent of caudate nucleus and putamen atrophy in HIV-infected men with well-controlled immune status and viral replication. 155 men underwent structural brain magnetic resonance imaging; 84 were HIV-infected and 71 were uninfected controls. MRI data were processed using the Fully Deformable Segmentation routine, producing volumes for the right and left caudate nucleus and putamen, and 3-D maps of spatial patterns of thickness. There was significant atrophy in the HIV-infected men in both the caudate and putamen, principally in the anterior regions. The volume of the basal ganglia was inversely associated with the time since first seropositivity, suggesting that either there is a chronic, subclinical process that continues in spite of therapy, or that the extent of the initial insult caused the extent of atrophy.Electronic supplementary materialThe online version of this article (doi:10.1007/s11682-011-9113-8) contains supplementary material, which is available to authorized users.

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HIV-associated dementia will eventually develop in 15-20% of individuals with advanced HIV disease. It has become one of the leading causes of dementia in the young, with 10,000 new cases annually in the USA. The clinical syndrome includes progressive development of psychomotor slowing and memory impairment, eventually with brain atrophy and neurol loss. The pathology is characterized by infection of macrophages and microglia, marked activation of macrophages, and release of a variety of postinflammatory cytokines into the parenchyma. Antiretroviral therapy has impacted positively on the incidence rates, and at least partial reversal of neurologic deficits can be achieved in established dementias.

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