Independent effects of HIV, aging, and HAART on brain volumetric measures

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 59; no. 5; p. 469
• Main Authors: Ances, Beau M, Ortega, Mario, Vaida, Florin, Heaps, Jodi, Paul, Robert
• Format: Journal Article
• Language: English
• Published: United States 15.04.2012
• Subjects: Adult; Aging - physiology; Analysis of Variance; Antiretroviral Therapy, Highly Active - adverse effects; Atrophy - pathology; Brain - drug effects; Brain - pathology; Brain - physiology; Executive Function - drug effects; Executive Function - physiology; Female; HIV Infections - drug therapy; HIV Infections - pathology; HIV Infections - physiopathology; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Memory - drug effects; Memory - physiology; Middle Aged; Neuropsychological Tests; Psychomotor Performance - drug effects; Psychomotor Performance - physiology
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0b013e318249db17

Neurocognitive impairment remains prevalent in HIV-infected (HIV+) individuals despite highly active antiretroviral therapy (HAART). We assessed the impact of HIV, HAART, and aging using structural neuroimaging. Seventy-eight participants [HIV- (n = 26), HIV+ on stable HAART (HIV+/HAART+; n = 26), HIV+ naive to HAART (HIV+/HAART-; n = 26)] completed neuroimaging and neuropsychological testing. A subset of HIV+ subjects (n = 12) performed longitudinal assessments before and after initiating HAART. Neuropsychological tests evaluated memory, psychomotor speed, and executive function, and a composite neuropsychological score was calculated based on normalized performances (neuropsychological summary Z score, NPZ-4). Volumetrics were evaluated for the amygdala, caudate, thalamus, hippocampus, putamen, corpus callosum, and cerebral gray and white matter. A 3-group 1-way analysis of variance assessed differences in neuroimaging and neuropsychological indices. Correlations were examined between NPZ-4 and volumetrics. Exploratory testing using a broken-stick regression model evaluated self-reported duration of HIV infection on brain structure. HIV+ individuals had significant reductions in brain volumetrics within select subcortical regions (amygdala, caudate, and corpus callosum) compared with HIV- participants. However, HAART did not affect brain structure as regional volumes were similar for HIV+/HAART- and HIV+/HAART+. No association existed between NPZ-4 and volumetrics. HIV and aging were independently associated with volumetric reductions. Exploratory analyses suggest caudate atrophy due to HIV slowly occurs after self-reported seroconversion. HIV associated volumetric reductions within the amygdala, caudate, and corpus callosum occurs despite HAART. A gradual decline in caudate volume occurs after self-reported seroconversion. HIV and aging independently increase brain vulnerability. Additional longitudinal structural magnetic resonance imaging studies, especially within older HIV+ participants, are required.