Structural gray and white matter changes in patients with HIV

Abstract

In this cross-sectional study we used magnetic resonance imaging (MRI)-based voxel based morphometry (VBM) in a sample of HIV positive patients to detect structural gray and white matter changes. Forty-eight HIV positive subjects with (n = 28) or without (n = 20) cognitive deficits (mean age 48.5 ± 9.6 years) and 48 age- and sex-matched HIV negative controls underwent MRI for VBM analyses. Clinical testing in HIV patients included the HIV dementia scale (HDS), Unified Parkinson's Disease Rating Scale (UPDRS) and the grooved pegboard test. Comparing controls with HIV positive patients with cognitive dysfunction (n = 28) VBM showed gray matter decrease in the anterior cingulate and temporal cortices along with white matter reduction in the midbrain region. These changes were more prominent with increasing cognitive decline, when assigning HIV patients to three cognitive groups (not impaired, mildly impaired, overtly impaired) based on performance in the HIV dementia scale. Regression analysis including all HIV positive patients with available data revealed that prefrontal gray matter atrophy in HIV was associated with longer disease duration (n = 48), while motor dysfunction (n = 48) was associated with basal ganglia gray matter atrophy. Lower CD4 cell count (n = 47) correlated with decrease of occipital gray matter. Our results provide evidence for atrophy of nigro-striatal and fronto-striatal circuits in HIV. This pattern of atrophy is consistent with motor dysfunction and dysexecutive syndrome found in HIV patients with HIV-associated neurocognitive disorder.

Regional Cerebral Gray Matter Volume in HIV‐Positive Patients with Executive Function Deficits

“…[9][10][11][12][13] Previous studies also found smaller volumes in several specific anatomical structures, such as the basal ganglia, 9 caudate, 11,13,14 putamen, 14 and total cortex volume of HIV-positive patients. 12 These studies found a correlation between diffuse brain atrophy and motor impairments, 10,14 dementia severity 10 and CDC stages of HIV infection, 11,13 smaller basal ganglia volume and motor dysfunction, 15 caudate and putamen atrophy and longer disease duration. 14 Similarly to these studies, we observed smaller volumes predominantly in the basal ganglia, primarily in the caudate, in HIV-positive patients with cognitive deficits.…”

“…Other studies have assessed the cortical thickness of HIVpositive patients and showed atrophy in anterior cingulate and temporal cortices, 15 primary sensory and motor cortices, parietal association cortex, medial frontal and premotor cortex, 16 posterior and inferior temporal lobes, parietal lobes, and in the cerebellum. 18 A study found a reduction in cortical thickness in the bilateral insula, orbitofrontal and temporal cortices and right superior frontal cortex in patients using HAART, with detectable HIV-deoxyribonucleic acid (DNA) in peripheral blood, compared with HIV patients using HAART without HIV-DNA detected in peripheral blood, which was correlated with psychomotor speed dysfunction.…”

“…[9][10][11][12][13][14][15][16][17][18] However, the majority of previous studies included patients with HIV-associated dementia, 9,10 or did not consider cognitive domains. 15 To the best of our knowledge, no previous study has investigated the cortical thickness and brain volume of HIV-patients with executive functions deficits.…”

Brain Structural Changes following HIV Infection: Meta-Analysis

“…In a study with 94% of participants treated with ART, impaired motor function was associated with basal ganglia gray matter atrophy. 55 A study with 100% ART-treated subjects demonstrated a correlation between cortical thinning and reduced psychomotor speed. 56 Another study of 100% ART-treated subjects revealed correlations between decreased TBv and reduced motor function and processing speed, and decreased thalamic volumes with reduced motor function.…”

Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study

“…Some authors reported volumetric changes in the cortical areas, basal ganglia and white matter in HIV-infected patients at different stages of their disease: these changes were more severe in most advanced stages but were evident even in asymptomatic individuals [46]. Other authors reported a severe gray matter reduction in the left lateral temporal and anterior cingulate cortex in HIV patients with cognitive impairment (even if the decline was mild), and a white matter atrophy in the frontal lobe and within the midbrain [47]. In the same study, there was no difference between HIV-negative controls and HIV patients with normal cognitive performance [47].…”