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Structural Neuroimaging and Neuropsychologic Signatures of Vertically Acquired HIV

Paul Robert PhD; Prasitsuebsai, Wasana MD; Jahanashad, Neda PhD; Puthanakit, Thanyawee MD; Thompson, Paul PhD; Aurpibul, Linda MD; Hansudewechakul, Rawiwan MD; Kosalaraksa, Pope MD; Kanjanavanit, Suparat MD; Ngampiyaskul, Chaiwat MD; Luesomboon, Wicharn MD; Lerdlum, Sukalaya MD; Pothisri, Mantana BSc; Visrutaratna, Pannee MD; Valcour, Victor MD, PhD; Nir, Talia M. BS; Saremi, Arvin BS; Kerr, Stephen PhD; Ananworanich, Jintanat MD, PhD; on behalf of the PREDICT Study Group
The Pediatric Infectious Disease Journal: Post Acceptance: December 01, 2017
doi: 10.1097/INF.0000000000001852
HIV Reports: PDF Only

BACKGROUND:

Children with vertically acquired human immunodeficiency virus (HIV) exhibit persistent cognitive impairments, yet the corresponding neuroimaging signature of vertical infection remains unclear.

METHODS:

Fifty healthy control children and 51 vertically infected children were included in the study. The HIV-infected group consisted of survivors who had not received antiretroviral therapy (ART) at birth. The HIV-infected group averaged 11.4 (2.5) years of age, with a median CD4 count of 683 cells/mm3. Most (71%) of the HIV-infected children were on ART for a median of 34 months (range: 33-42) with HIV RNA <40 copies/ml in 89% of the sample. The HIV-uninfected group averaged 10.6 (2.6) years of age. Magnetic resonance imaging was acquired to determine volumes of the caudate, putamen, thalamus, pallidum, hippocampus, nucleus accumbens, total white matter, total gray matter, and cortical gray matter. Correlational analyses examined the degree of shared variance between brain volumes and both cognitive performances and laboratory markers of disease activity (T-cells and plasma viral load).

RESULTS:

HIV-infected children exhibited larger volumes of the caudate, nucleus accumbens, total gray matter, and cortical gray matter when compared to the controls. Volumetric differences were predominately evident in children under 12 years of age. HIV-infected children performed worse than controls on most neuropsychological tests, though neither cognitive performances nor laboratory markers corresponded to brain volumes in the HIV-infected children.

CONCLUSIONS:

Outcomes of the present study suggest abnormal brain maturation among HIV-infected pediatric survivors. Longitudinal studies of brain integrity and related resilience factors are needed to determine the impact of neuroimaging abnormalities on psychosocial function in pediatric HIV.

Disclaimer: The views expressed are those of the authors and should not be construed to represent the positions of the U.S. Army or the Department of Defense

Acknowledgement: The PREDICT study is sponsored by National Institute of Allergy and Infectious Disease (NIAID), Grant number U19 AI053741, Clinical trial.gov identification number NCT00234091. Antiretoviral drugs for PREDICT are provided by ViiV Healthcare (AZT, 3TC), Boehringer Ingelheim (NVP), Merck (EFV), Abbott (RTV) and Roche (NFV). The neuroimaging and neurodevelopment work are supported by R01MH089722 (PI: Valcour) and R01MH102151 (PI: Ananworanich).

Corresponding Author: Robert Paul. PhD, Missouri Institute of Mental Health, University of Missouri-St. Louis, MO, USA. paulro@umsl.edu

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