Despite treatment with
combination antiretroviral therapy (cART), cognitive impairment is still
observed in perinatally HIV-infected children. We aimed to evaluate potential
underlying cerebral injury by comparing neurometabolite levels between
perinatally HIV-infected children and healthy controls.
This cross-sectional
study evaluated neurometabolites, as measured by Magnetic Resonance
Spectroscopy (MRS), in perinatally HIV-infected children stable on cART
(n = 26) and healthy controls (n = 36).Participants were included from a cohort
of perinatally HIV-infected children and healthy controls, matched group-wise
for age, gender, ethnicity, and socio-economic status. N-acetylaspartate (NAA),
glutamate (Glu), myo-inositol (mI), and choline (Cho) levels were studied as
ratios over creatine (Cre). Group differences and associations with HIV-related
parameters, cognitive functioning, and neuronal damage markers (neurofilament
and total Tau proteins) were determined using age-adjusted linear regression
analyses.HIV-infected children had increased Cho:Cre in white matter (HIV-infected = 0.29 ± 0.03;
controls = 0.27 ± 0.03; P value = 0.045). Lower nadir CD4+ T-cell Z-scores were
associated with reduced neuronal integrity markers NAA:Cre and Glu:Cre. A
Centers for Disease Control and Prevention (CDC) stage C diagnosis was associated
with higher glial markers Cho:Cre and mI:Cre. Poorer cognitive performance was
mainly associated with higher Cho:Cre in HIV-infected children, and with lower
NAA:Cre and Glu:Cre in healthy controls.
There were no associations between
neurometabolites and neuronal damage markers in blood or CSF.Compared to
controls, perinatally HIV-infected children had increased Cho:Cre in white
matter, suggestive of ongoing glial proliferation. Levels of several
neurometabolites were associated with cognitive performance, suggesting that
MRS may be a useful method to assess cerebral changes potentially linked to
cognitive outcomes.
Below: Exemplar planning of chemical shift imaging (CSI),
superimposed on a 3D-T1-weighted image. Based on the 3D-T1-weighted scan (A),
gray matter (GM), and white matter (WM) segmentation was performed within the
CSI field-of-view (B). Estimated metabolite levels (C) were averaged within all
GM and WM voxels to obtain mean GM and WM values (D). CSI = chemical shift
imaging, GM = gray matter, WM = white matter.
Full article at:
By:
- 1From the Department of Pediatric Hematology, Immunology and Infectious Diseases, (YWVD, CB, SC, JATS, HJS, TWK, DP); Psychosocial Department (JATS), Emma Children's Hospital/Academic Medical Center; Neurochemistry Laboratory and Biobank (CET), Department of Clinical Chemistry, VU University Medical Center and Neurocampus Amsterdam, the Netherlands; Neurology (JK), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland; Department of Experimental Immunology (NAK); Department of Global Health and Amsterdam Institute of Global Health and Development (PR), Academic Medical Center; HIV Monitoring Foundation (PR); Department of Internal Medicine (PR), Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA); and Department of Radiology (CBLMM, MWAC), Academic Medical Center, Amsterdam, the Netherlands.
- Medicine (Baltimore). 2016 Mar;95(12):e3093. doi: 10.1097/MD.0000000000003093.
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