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Abstract
Objective: The current study aims to evaluate the neurologic state of perinatally HIV-infected children on combination antiretroviral therapy and to attain a better insight into the pathogenesis of their persistent neurologic and cognitive deficits.
Methods: We included perinatally HIV-infected children between 8 and 18 years and healthy controls matched for age, sex, ethnicity, and socioeconomic status. All participants underwent a 3.0 T MRI with 3D-T1-weighted, 3D–fluid-attenuated inversion recovery, and diffusion-weighted series for the evaluation of cerebral volumes, white matter hyperintensities (WMH), and white matter (WM) diffusion characteristics. Associations with disease-related parameters and cognitive performance were explored using linear regression models.
Results: We included 35 cases (median age 13.8 years) and 37 controls (median age 12.1 years). A lower gray matter and WM volume, more WMH, and a higher WM diffusivity were observed in the cases. Within the HIV-infected children, a poorer clinical, immunologic, and virologic state were negatively associated with volumetric, WMH, and diffusivity markers.
Conclusions: In children with HIV, even when long-term clinically and virologically controlled, we found lower brain volumes, a higher WMH load, and poorer WM integrity compared to matched controls. These differences occur in the context of a poor cognitive performance in the HIV-infected group, and larger, longitudinal studies are needed to increase our understanding of the pathogenesis of cerebral injury in perinatally HIV-infected children.
GLOSSARY
- cART=
- combination antiretroviral therapy;
- CDC=
- Centers for Disease Control and Prevention;
- DTI=
- diffusion tensor imaging;
- DWI=
- diffusion-weighted image;
- FA=
- fractional anisotropy;
- FLAIR=
- fluid-attenuated inversion recovery;
- FOV=
- field of view;
- GM=
- gray matter;
- ICV=
- intracranial volume;
- MD=
- mean diffusivity;
- NPA=
- neuropsychological assessment;
- RD=
- radial diffusivity;
- SES=
- socioeconomic status;
- TBSS=
- tract-based spatial statistics;
- TE=
- echo time;
- TI=
- inversion time;
- TR=
- repetition time;
- WM=
- white matter;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
Editorial, page 13
- Received December 24, 2014.
- Accepted in final form July 17, 2015.
- © 2015 American Academy of Neurology
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