Clinical factors related to brain structure in HIV: the CHARTER study

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• 作者：Terry L. Jernigan (1) (2)
  Sarah L. Archibald (1)
  Christine Fennema-Notestine (1) (2)
  Michael J. Taylor (1)
  Rebecca J. Theilmann (2)
  Michelle D. Julaton (1)
  Randy J. Notestine (1)
  Tanya Wolfson (6)
  Scott L. Letendre (3)
  Ronald J. Ellis (4)
  Robert K. Heaton (1)
  Anthony C. Gamst (5)
  Donald R. Franklin Jr. (1)
  David B. Clifford (7)
  Ann C. Collier (8)
  Benjamin B. Gelman (10)
  Christina Marra (8) (9)
  Justin C. McArthur (11)
  J. Allen McCutchan (3)
  Susan Morgello (12)
  David M. Simpson (13)
  Igor Grant (1)
  
• 关键词：HIV ; MRI ; Neuroimaging ; Immunospupression
• 刊名：Journal of NeuroVirology
• 出版年：2011
• 出版时间：June 2011
• 年：2011
• 卷：17
• 期：3
• 页码：248-257
• 全文大小：381KB
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• 作者单位：Terry L. Jernigan (1) (2)
  Sarah L. Archibald (1)
  Christine Fennema-Notestine (1) (2)
  Michael J. Taylor (1)
  Rebecca J. Theilmann (2)
  Michelle D. Julaton (1)
  Randy J. Notestine (1)
  Tanya Wolfson (6)
  Scott L. Letendre (3)
  Ronald J. Ellis (4)
  Robert K. Heaton (1)
  Anthony C. Gamst (5)
  Donald R. Franklin Jr. (1)
  David B. Clifford (7)
  Ann C. Collier (8)
  Benjamin B. Gelman (10)
  Christina Marra (8) (9)
  Justin C. McArthur (11)
  J. Allen McCutchan (3)
  Susan Morgello (12)
  David M. Simpson (13)
  Igor Grant (1)
  
  1. Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive M/C 0115, La Jolla, CA, USA
  2. Department of Radiology, University of California, San Diego, 92093-0115, La Jolla, CA, USA
  6. Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center (SDSC), La Jolla, CA, USA
  3. Department of Medicine, University of California, San Diego, La Jolla, CA, USA
  4. Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
  5. Department of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, USA
  7. Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
  8. Department of Medicine, University of Washington, Seattle, WA, USA
  10. Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
  9. Department of Neurology, University of Washington, Seattle, WA, USA
  11. Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
  12. Department of Pathology, Mount Sinai School of Medicine, New York, NY, USA
  13. Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
  
• ISSN：1538-2443

文摘

Despite the widening use of combination antiretroviral therapy (ART), neurocognitive impairment remains common among HIV-infected (HIV+) individuals. Associations between HIV-related neuromedical variables and magnetic resonance imaging indices of brain structural integrity may provide insight into the neural bases for these symptoms. A diverse HIV+ sample (n--51) was studied through the CNS HIV Antiretroviral Therapy Effects Research initiative. Multi-channel image analysis produced volumes of ventricular and sulcal cerebrospinal fluid (CSF), cortical and subcortical gray matter, total cerebral white matter, and abnormal white matter. Cross-sectional analyses employed a series of multiple linear regressions to model each structural volume as a function of severity of prior immunosuppression (CD4 nadir), current CD4 count, presence of detectable CSF HIV RNA, and presence of HCV antibodies; secondary analyses examined plasma HIV RNA, estimated duration of HIV infection, and cumulative exposure to ART. Lower CD4 nadir was related to most measures of the structural brain damage. Higher current CD4, unexpectedly, correlated with lower white and subcortical gray and increased CSF. Detectable CSF HIV RNA was related to less total white matter. HCV coinfection was associated with more abnormal white matter. Longer exposure to ART was associated with lower white matter and higher sulcal CSF. HIV neuromedical factors, including lower nadir, higher current CD4 levels, and detectable HIV RNA, were associated with white matter damage and variability in subcortical volumes. Brain structural integrity in HIV likely reflects dynamic effects of current immune status and HIV replication, superimposed on residual effects associated with severe prior immunosuppression.