Cerebral Injury in Perinatally HIV-Infected Children Compared to Matched Healthy Controls

OBJECTIVE:

The current study aims to evaluate the neurologic state of perinatally HIV-infected children on combination antiretroviral therapy and to attain a better insight into the pathogenesis of their persistent neurologic and cognitive deficits.

METHODS:

We included perinatally HIV-infected children between 8 and 18 years and healthy controls matched for age, sex, ethnicity, and socioeconomic status. All participants underwent a 3.0 T MRI with 3D-T1-weighted, 3D-fluid-attenuated inversion recovery, and diffusion-weighted series for the evaluation of cerebral volumes, white matter hyperintensities (WMH), and white matter (WM) diffusion characteristics. Associations with disease-related parameters and cognitive performance were explored using linear regression models.

RESULTS:

We included 35 cases (median age 13.8 years) and 37 controls (median age 12.1 years). A lower gray matter and WM volume, more WMH, and a higher WM diffusivity were observed in the cases. Within the HIV-infected children, a poorer clinical, immunologic, and virologic state were negatively associated with volumetric, WMH, and diffusivity markers.

CONCLUSIONS:

In children with HIV, even when long-term clinically and virologically controlled, we found lower brain volumes, a higher WMH load, and poorer WM integrity compared to matched controls. These differences occur in the context of a poor cognitive performance in the HIV-infected group, and larger, longitudinal studies are needed to increase our understanding of the pathogenesis of cerebral injury in perinatally HIV-infected children.

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By:   Cohen S¹, Caan MW², Mutsaerts HJ², Scherpbier HJ², Kuijpers TW², Reiss P², Majoie CB², Pajkrt D².

¹From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands. s.cohen@amc.nl.

²From the Department of Pediatric Hematology, Immunology and Infectious Diseases (S.C., H.J.S., T.W.K., D.P.), Emma Children's Hospital AMC, Amsterdam; the Department of Radiology (M.W.A.C., H.-J.M., C.B.L.M.M.), the Department of Global Health and Amsterdam Institute of Global Health and Development (P.R.), and the Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) (P.R.), Academic Medical Centre, University of Amsterdam; and HIV Monitoring Foundation (P.R.), Amsterdam, the Netherlands.

Neurology. 2016 Jan 5;86(1):19-27. doi: 10.1212/WNL.0000000000002209. Epub 2015 Nov 11.

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