Novel Neuroimaging Methods to Understand How HIV Affects the Brain

In much of the developed world, the HIV epidemic has largely been controlled by antiretroviral treatment. Even so, there is growing concern that HIV-infected individuals may be at risk for accelerated brain aging and a range of cognitive impairments. What promotes or resists these changes is largely unknown. There is also interest in discovering factors that promote resilience to HIV and combat its adverse effects in children. Here, we review recent developments in brain imaging that reveal how the virus affects the brain. We relate these brain changes to changes in blood markers, cognitive function, and other patient outcomes or symptoms, such as apathy or neuropathic pain. We focus on new and emerging techniques, including new variants of brain MRI. Diffusion tensor imaging, for example, can map the brain’s structural connections, while fMRI can uncover functional connections. Finally, we suggest how large-scale global research alliances, such as ENIGMA, may resolve controversies over effects where evidence is now lacking. These efforts pool scans from tens of thousands of individuals and offer a source of power not previously imaginable for brain imaging studies.