Reduced basal ganglia volume in HIV‐1‐associated dementia

Abstract

Although brain atrophy is a common neuroradiologic and pathologic finding in patients with HIV-1 infection, especially those with HIV-1-associated dementia complex, it is not clear whether specific regions of the brain are differentially responsible for tissue loss. In this study, we measured volumes of basal ganglia structures on MRIs for three groups: HIV-1-infected homosexual men with HIV-1-associated dementia complex (HIV+ demented), HIV-1-infected homosexual men without HIV dementia (HIV+ nondemented), and noninfected homosexual men. All groups were comparable on age and years of education, and the HIV+ groups were comparable on level of immunosuppression. Total brain volume was smaller in the HIV+ nondemented patients in comparison with HIV- control subjects; the HIV+ demented patients demonstrated even smaller brain volumes than the HIV+ nondemented patients. Smaller basal ganglia volumes, after corrections for intracranial volume, distinguished HIV+ demented patients from the other two groups; there were no differences between the HIV+ nondemented and HIV- groups on basal ganglia volumes. This study suggests that HIV infection causes generalized brain atrophy, but that the clinical features of HIV dementia develop with selective basal ganglia atrophy, consistent with the characterization of HIV dementia as subcortical.

3D pattern of brain atrophy in HIV/AIDS visualized using tensor-based morphometry

“…Oster et al (1993) demonstrated remarkable atrophy in the central brain nuclei (including striatum and thalamus) and cerebral white matter on examination of autopsied HIV-infected brains. Aylward et al (1993) demonstrated volumetrically that basal ganglia volumes were smaller in demented AIDS patients than non-demented or control subjects. Immunohistochemically, Kure et al (1990) found that HIV antigens were more numerous in the globus pallidus than in other sites.…”

“…However, there is a still a lack of detailed 3D maps that show the profile of HIV-associated changes throughout the brain. More conventional volumetric studies were the first to demonstrate global white matter atrophy, basal ganglia volume loss, and ventricular enlargement (Aylward et al, 1993;Hall et al, 1996;Stout et al, 1998). Nevertheless, volumetric studies are generally labor-intensive and cannot visualize the profile of deficits at the voxel level.…”

The Role of Medical Imaging in Defining CNS Abnormalities Associated with HIV-Infection and Opportunistic Infections

“…This line of investigation was initiated early in the HIV pandemic and quickly established a variety of pathological effects observable in vivo. The most common findings included regional gray matter atrophy, particularly in the basal ganglia [4][5][6], Electronic supplementary material The online version of this article (doi:10.1007/s13311-010-0010-4) contains supplementary material, which is available to authorized users. white matter lesions [7,8], ventricular expansion [9], and global cerebral atrophy [7,[10][11][12].…”

“…In particular, volumes of the basal ganglia are commonly decreased in HIV-infected patients [4-6, 13, 14] and have been shown to be associated with cognitive function [4,15] and biomarkers of HIV progression [16,17]. Specifically, atrophy of the caudate has been widely reported [6,15,18,19] and found to be associated with cognitive [5,20] and motor [21] dysfunction as well as lower CD4 T-cell counts [17].…”

HIV-1-induced neuronal injury in the developing brain

“…In adult patients the clinical presentation is usually a combination of cognitive, motor, and behavioral dysfunction, often associated with MRI or CT evidence of cortical atrophy and disproportionate loss of volume in the basal ganglia [3]. The counterpart in infants and children is loss of developmental milestones, symmetrical pyramidal (or extrapyramidal) motor abnormalities, and impaired brain growth [2].…”