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Early Brain Injury Visualized in People With Recent HIV Infection
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18th Conference on Retroviruses and Opportunistic Infections, February 27-March 2, 2011, Boston
Mark Mascolini
In a Late Breaker Oral Presentation: Brain imaging detected significant deficits in gray matter and left and right cerebral cortex volume in 43 adults with recent HIV infection compared with 22 HIV-negative controls. The investigators suggested that "the brain may be injured by the dramatic burst of viremia in association with acute HIV, before host cellular immune defenses can contain massive viral replication associated with initial exposure."
How HIV affects the brain throughout the course HIV infection remains a topic of intense interest, though most studies rely on tests of neurocognitive function to gauge HIV's impact. This study used high-resolution magnetic resonance imaging to focus on 43 people (38 men) with "compelling clinical evidence" of recent HIV infection. The investigators compared these members of the Chicago Early HIV Infection Cohort with 22 HIV-negative people (16 men). No one with or without HIV had a history of neurologic disorder, stroke, head trauma, opportunistic central nervous system infection, or psychosis.
Age averaged 32.9 in the HIV group and 31.4 in controls. The HIV-negative group had completed slightly though significantly more years of education (15.7 versus 14.3, P = 0.02). Proportions of whites were 56% in the HIV group and 72% in the control group. Twenty-four people in the HIV group and 8 in the control group had more than 5 alcoholic drinks in the past 30 days (56% versus 36%). While 6 people in the HIV group used amphetamines and 3 used cocaine, none of the controls used these drugs. Among people with HIV, CD4 counts averaged 550 (range 162 to 1282) and viral loads ranged from undetectable to 346,000 copies. Twenty people in the HIV group (46.5%) had not taken antiretrovirals. Estimated average time since HIV infection was 1 year.
High-resolution magnetic resonance imaging showed that total gray matter volume and cortical gray matter volume were both significantly lower in people with HIV (P = 0.05 and P = 0.01). Left and right cerebral cortex volume fractions were significantly lower in the HIV group (P = 0.02 and P = 0.04), while third ventricle volume fraction was more than twice greater with HIV (P = 0.04). Third ventricle enlargement, the investigators noted, is "consistent with ongoing injury in subcortical regions."
Among people with HIV infection for less than a half year, total gray matter and cortical gray matter were also significantly lower in the HIV group than in HIV-negative controls (P = 0.01 for both). Those differences from the HIV-negative group remained significant for people infected with HIV for fewer than 2 months (P = 0.02 for both).
The researchers concluded that "intensive volumetric analysis finds a consistent pattern of loss of brain gray matter early in the clinical course of HIV infection." They stressed that "a clearer understanding of the natural history of brain injury in HIV infection, particularly in the earliest stages, is critical to neuroprotection strategies."
Reference
1. Ragin A, Wu Y, Du H, et al. Injury to the brain is evident early in HIV infection. 18th Conference on Retroviruses and Opportunistic Infections. February 27-March 2, 2011. Boston. Abstract 55LB.
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