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EFFECTS OF VIRAL LOAD ON NEUROIMAGING AND NEUROPSYCHOLOGICAL PERFORMANCE
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CROI 2020
Reported by Jules LevinSarah A. Cooley1, Jaimie Navid1, Julie Wisch1, Jane A. O'Halloran1, Beau Ances1
1Washington University in St Louis, St Louis, MO, USA
Program Abstract
Previous studies have investigated the relationship between viral load (VL) and brain atrophy in people with HIV (PLWH). However, these studies often combine PLWH on and off antiretroviral therapy (ART) including those with and without detectable VL. Here we compare brain volumetrics and neuropsychological performance (NP) in HIV- controls (HIV-) and PWHL receiving ART who are further categorized into: 1) virologic suppression (VS, VL 20 copies/mL), low-level viremia (LL, 21 - 200 copies/mL) and virologic failure (VF > 200 copies/mL).
128 HIV- (mean age 42.4, 50% male) and 239 PLWH (mean age 43.7, 62% male) on stable ART regimen completed NP testing (executive function, learning and memory, psychomotor speed, and language domains) and structural neuroimaging. Of the 239 PLWH, 175 (73.2%) demonstrated VS (≤ 20 copies/mL) and 64 had detectable VL (38 LL, 26 VF). NP scores, cortical volumes (frontal, occipital, parietal, and temporal) and subcortical volumes were converted into demographically-corrected z-scores. T-tests analyzed differences in NP domains, global cognition and volumetric z-scores between PLWH and HIV-. Analyses of variance with post-hoc Tukey's tests were used to examine differences in NP scores and volumetrics between groups.
In general, PLWH had significantly decreased NP z-scores in the executive function, language, and psychomotor speed domains as well as significantly smaller subcortical volumes compared to HIV- (p <0.05). When PLWH were subgrouped by VL, results indicated no significant differences between the VS, LL, and VF groups in any of the NP domains, global cognition or volumetric z-score (p >0.05). The VS group had significantly lower executive function and language z-scores compared to HIV-, and both the VS and LL groups had lower subcortical z-scores compared to HIV-. The VF group exhibited larger subcortical volume compared to the LL group, although this was non-significant (Figure 1).
Results suggest an HIV effect on subcortical volumes and NP scores but not a VL effect. Higher subcortical volumes in the VF group compared to the LL group may indicate inflammation, but increased group sizes are needed to determine if this effect is significant. The lack of a significant VL effect may signify that ART use is critical rather than viral suppression, but longitudinal studies are needed.
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