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Structural brain abnormalities in successfully treated HIV infection: associations with disease and cerebrospinal fluid biomarkers.

Journal article
Authors Rosan A Van Zoest
Jonathan Underwood
Davide De Francesco
Caroline A Sabin
James H Cole
Ferdinand W Wit
Matthan W A Caan
Neeltje A Kootstra
Dietmar Fuchs
Henrik Zetterberg
Charles B L M Majoie
Peter Portegies
Alan Winston
David J Sharp
Magnus Gisslén
Peter Reiss
Published in The Journal of infectious diseases
Volume 217
Issue 1
Pages 69-81
ISSN 1537-6613
Publication year 2018
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Biomedicine, Department of Infectious Medicine
Pages 69-81
Language en
Subject categories Neurochemistry


Brain structural abnormalities have been reported in persons with HIV (PWH) on suppressive combination antiretroviral therapy (cART), but their pathophysiology remains unclear.We investigated factors associated with brain tissue volumes and white matter microstructure (fractional anisotropy) in 134 PWH on suppressive cART and 79 comparable HIV-negative controls, aged ≥45 years from the Co-morBidity in Relation to AIDS (COBRA) cohort, using multimodal neuroimaging and cerebrospinal fluid (CSF) biomarkers.Compared to controls, PWH had lower grey matter volumes (-13.7 mL [95%-confidence interval -25.1, -2.2 mL]) and fractional anisotropy (-0.0073 [-0.012, -0.0024]), with the largest differences observed in those with prior clinical AIDS. Hypertension and CSF soluble CD14 concentration were associated with lower fractional anisotropy. These associations were independent of HIV serostatus (Pinteraction=0.32 and Pinteraction=0.59, respectively) and did not explain the greater abnormalities in brain structure in relation to HIV.The presence of lower grey matter volumes and more white matter microstructural abnormalities in well-treated PWH partly reflect a combination of historical effects of AIDS, as well as the more general influence of systemic factors such as hypertension and ongoing neuroinflammation. Additional mechanisms explaining the accentuation of brain structure abnormalities in treated HIV infection remain to be identified.

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