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Salan T, Willen EJ, Cuadra A, Sheriff S, Maudsley AA, Govind V. Whole-brain MR spectroscopic imaging reveals regional metabolite abnormalities in perinatally HIV infected young adults. Front Neurosci 2023; 17:1134867. [PMID: 36937663 PMCID: PMC10017464 DOI: 10.3389/fnins.2023.1134867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Perinatally acquired HIV (PHIV) has been associated with brain structural and functional deficiencies, and with poorer cognitive performance despite the advent of antiretroviral therapy (ART). However, investigation of brain metabolite levels in PHIV measured by proton magnetic resonance spectroscopy (MRS) methods, is still limited with often inconclusive or contradictory findings. In general, these MRS-based methods have used a single voxel approach that can only evaluate metabolite concentrations in a few select brain anatomical regions. Additionally, most of the published data have been on children perinatally infected with HIV with only a few studies examining adult populations, though not exclusively. Therefore, this prospective and cross-sectional study aims to evaluate metabolite differences at the whole-brain level, using a unique whole-brain proton magnetic resonance spectroscopy imaging (MRSI) method, in a group of PHIV infected young adults (N = 28) compared to age and gender matched control sample (N = 28), and to find associations with HIV clinical factors and neurocognitive scores. MRSI data were acquired on a 3T scanner with a TE of 70 ms. Brain metabolites levels of total N-acetylaspartate (tNAA), total choline (tCho) and total creatine (tCre), as well as ratios of tNAA/tCre, tCho/tCre, and tNAA/tCho, were obtained from the whole brain level and evaluated at the level of gray matter (GM) and white matter (WM) tissue types and anatomical regions of interest (ROI). Our results indicate extensive metabolic abnormalities throughout the brains of PHIV infected subjects with significantly elevated levels of tCre and tCho, notably in GM regions. Decreases in tNAA and ratios of tNAA/tCre and tNAA/tCho were also found mostly in WM regions. These metabolic alterations indicate increased glial activation, inflammation, neuronal dysfunction, and energy metabolism in PHIV infected individuals, which correlated with a reduction in CD4 cell count, and lower cognitive scores. Our findings suggest that significant brain metabolite alterations and associated neurological complications persist in the brains of those with PHIV on long-term ART, and advocates the need for continued monitoring of their brain health.
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Affiliation(s)
- Teddy Salan
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Elizabeth J. Willen
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Anai Cuadra
- Department of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Andrew A. Maudsley
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States
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Van den Hof M, Ter Haar AM, Caan MWA, Spijker R, van der Lee JH, Pajkrt D. Brain structure of perinatally HIV-infected patients on long-term treatment: A systematic review. Neurol Clin Pract 2019; 9:433-442. [PMID: 31750029 DOI: 10.1212/cpj.0000000000000637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
Abstract
Objective We aim to give an overview of the available evidence on brain structure and function in PHIV-infected patients (PHIV+) using long-term combination antiretroviral therapy (cART) and how differences change over time. Methods We conducted an electronic search using MEDLINE, Embase, and PsycINFO. We used the following selection criteria: cohort and cross-sectional studies that reported on brain imaging differences between PHIV+ of all ages who used cART for at least six months before neuroimaging and HIV-negative controls. Two reviewers independently selected studies, performed data extraction, and assessed quality of studies. Results After screening 1500 abstracts and 343 full-text articles, we identified 19 eligible articles. All included studies had a cross-sectional design and used MRI with different modalities: structural MRI (n = 7), diffusion tensor imaging (DTI) (n = 6), magnetic resonance spectroscopy (n = 5), arterial spin labeling (n = 1), and resting-state functional neuroimaging (n = 1). Studies showed considerable methodological limitations and heterogeneity, preventing us to perform meta-analyses. DTI data on white matter microstructure suggested poorer directional diffusion in cART-treated PHIV+ compared with controls. Other modalities were inconclusive. Conclusion Evidence may suggest brain structure and function differences in the population of PHIV+ on long-term cART compared with the HIV-negative population. Because of a small study population, and considerable heterogeneity and methodological limitations, the extent of brain structure and function differences on neuroimaging between groups remains unknown.
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Affiliation(s)
- Malon Van den Hof
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Anne Marleen Ter Haar
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Matthan W A Caan
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Rene Spijker
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Johanna H van der Lee
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
| | - Dasja Pajkrt
- Emma Children's Hospital (MVH, AMtH, DP), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, the Netherlands; Biomedical Engineering and Physics (MWAC), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Medical Library (RS), Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands (RS), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and Emma Children's Hospital (JHL), Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, the Netherlands
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