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01-06-2013

Progressive cerebral injury in the setting of chronic HIV infection and antiretroviral therapy

Authors: Assawin Gongvatana, Jaroslaw Harezlak, Steven Buchthal, Eric Daar, Giovanni Schifitto, Thomas Campbell, Michael Taylor, Elyse Singer, Jeffrey Algers, Jianhui Zhong, Mark Brown, Deborah McMahon, Yuen T. So, Deming Mi, Robert Heaton, Kevin Robertson, Constantin Yiannoutsos, Ronald A. Cohen, Bradford Navia, HIV Neuroimaging Consortium

Published in: Journal of NeuroVirology | Issue 3/2013

Abstract

Emerging evidence suggests that CNS injury and neurocognitive impairment persist in the setting of chronic HIV infection and combination antiretroviral therapy (CART). Yet, whether neurological injury can progress in this setting remains uncertain. Magnetic resonance spectroscopy and neurocognitive and clinical assessments were performed over 2 years in 226 HIV-infected individuals on stable CART, including 138 individuals who were neurocognitively asymptomatic (NA). Concentrations of N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myoinositol, and glutamate/glutamine (Glx) were measured in the midfrontal cortex (MFC), frontal white matter (FWM), and basal ganglia (BG). Longitudinal changes in metabolite levels were determined using linear mixed effect models, as were metabolite changes in relation to global neurocognitive function. HIV-infected subjects showed significant annual decreases in brain metabolite levels in all regions examined, including NAA (2.95 %) and Cho (2.61 %) in the FWM; NAA (1.89 %), Cr (1.84 %), Cho (2.19 %), and Glx (6.05 %) in the MFC; and Glx (2.80 %) in the BG. Similar metabolite decreases were observed in the NA and subclinically impaired subgroups, including subjects with virologic suppression in plasma and CSF. Neurocognitive decline was associated with longitudinal decreases in Glx in the FWM and the BG, and in NAA in the BG. Widespread progressive changes in the brain, including neuronal injury, occur in chronically HIV-infected persons despite stable antiretroviral treatment and virologic suppression and can lead to neurocognitive declines. The basis for these findings is poorly understood and warrants further study.

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Title: Progressive cerebral injury in the setting of chronic HIV infection and antiretroviral therapy
Authors: Assawin Gongvatana
Jaroslaw Harezlak
Steven Buchthal
Eric Daar
Giovanni Schifitto
Thomas Campbell
Michael Taylor
Elyse Singer
Jeffrey Algers
Jianhui Zhong
Mark Brown
Deborah McMahon
Yuen T. So
Deming Mi
Robert Heaton
Kevin Robertson
Constantin Yiannoutsos
Ronald A. Cohen
Bradford Navia
HIV Neuroimaging Consortium
Publication date: 01-06-2013
Publisher: Springer US
Published in: Journal of NeuroVirology / Issue 3/2013
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-013-0162-1

At a glance: The STEP trials

Springer Medicine

Progressive cerebral injury in the setting of chronic HIV infection and antiretroviral therapy

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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