by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

October 13, 2020

Featured Literature:

Jing Sui J. et al, Structural and Functional Brain Abnormalities in HIV Disease Revealed by Multimodal MRI Fusion: Association with Cognitive Function. Clin Infect Dis. 2020 Sep 18: ciaa1415. doi: 10.1093/cid/ciaa1415. Epub ahead of print. PMID: 32948879.

HIV-associated neurocognitive disorder (HAND) remains prevalent in persons with HIV and can impact daily functioning and increase morbidity. While HIV infection is known to cause CNS deficits, including AIDS dementia in the pre-ART era, MRI and other imaging modalities have not been well-integrated into the care of PWH to assist with diagnosis or prognosis. This study included 59 subjects with HIV disease and 58 who were HIV-negative, all who underwent neuropsychological testing and subsequent MRI scanning of the brain to obtain anatomical, diffusion-weighted, and resting-state functional images. The authors then applied what is referred to as multimodal canonical correlation analysis with reference and joint independent component analysis (MCCAR + jICA) while using cognitive functioning as the primary reference. Compared to control patients, PWH had lower global cognitive functioning at baseline. The authors were able to correlate cognitive function with neuroanatomic findings on MRI. These included:  variations in the corpus callosum, corticopontine fibers, gray matter volume in thalamus, changes in the prefrontal cortex and occipital lobes and functional connectivity in fronto-parietal and visual processing regions.  These results suggest that alterations in brain structure seen on MRI may help distinguish persons with and without HIV and correlate with levels of cognitive impairment. As MRI becomes more frequently used to assess PWH, these findings could help confirm diagnosis and possibly guide therapies for HAND.

Author’s Commentary:

Neurological disorders including progressive neurocognitive impairment are uncommon in the post-ART era but many PWH do not have normal results with neuropsychological testing. Aging and other co-morbid conditions likely contribute, but do not fully account for the frequency of HAND. Lab markers including CD4 count and viral load also do not correlate well with ongoing impairment. Research has provided some CSF biomarkers, but more data is needed to help optimize the diagnosis of HAND and gain a better understanding of the mechanisms of neurologic impairment in PWH.

The author has no conflicts of interest to disclose.

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