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Incidental white matter hyperintensities on magnetic resonance imaging in HIV-1 infection. Multicenter AIDS Cohort
J C McArthur1, A J Kumar, D W Johnson
1Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Abstract:
Magnetic resonance (MR) scans were performed as part of a prospective neuropsychological study within the Multicenter AIDS Cohort Study. Fifty HIV-1-seronegative men, 85 HIV-1-seropositive men without constitutional symptoms, and 14 with symptomatic HIV disease underwent MR imaging using a uniform protocol. Scans were rated by neuroradiologists blinded to all clinical details except age. The majority of MR scans were normal in all of the clinical groups and no covert mass lesions or diffuse white matter abnormalities were identified. Focal hyperintensities in the white matter were observed in 24% of the HIV-1 seronegatives, 26% of HIV-1 asymptomatic seropositives (CDC II/III), and 17% of those with ARC/AIDS. No significant associations were noted between the white matter hyperintensities and HIV-1 serostatus, neurological abnormalities, CD4 count, alcohol or drug use, hypertension, or smoking. In one individual classified with early HIV-1 dementia, MR demonstrated several hyperintensities in the deep parietal white matter, but at autopsy no microscopic abnormalities corresponding to the MR findings were identified. Our studies imply that focal white matter hyperintensities identified on MR are not specific for HIV-1 infection and are probably incidental and of no clinical significance.
Insights
Magnetic resonance (MR) imaging revealed that focal white matter hyperintensities are common in men, regardless of HIV-1 status. These findings on MR scans are likely incidental and not specific to HIV-1 infection.
Area of Science:
- Neuroimaging
- Neurology
- Infectious Diseases
Background:
- The Multicenter AIDS Cohort Study (MACS) investigates the long-term effects of HIV-1 infection.
- Neuropsychological studies are crucial for understanding the neurological impact of HIV-1.
- Magnetic resonance (MR) imaging is a key tool for assessing brain structure.
Purpose of the Study:
- To investigate the prevalence and significance of focal white matter hyperintensities on MR scans in HIV-1-seronegative and HIV-1-seropositive men.
- To determine if MR findings correlate with HIV-1 status, neurological symptoms, or other clinical factors.
Main Methods:
- Prospective study involving 149 men (50 HIV-1-seronegative, 85 asymptomatic HIV-1-seropositive, 14 symptomatic HIV-1-seropositive).
- Standardized MR imaging protocol used for all participants.
- Neuroradiologists, blinded to clinical details (except age), evaluated MR scans.
Main Results:
- The majority of MR scans were normal across all groups; no covert mass lesions or diffuse white matter abnormalities were found.
- Focal white matter hyperintensities were observed in 24% of HIV-1-seronegative, 26% of asymptomatic HIV-1-seropositive, and 17% of symptomatic HIV-1-seropositive men.
- No significant associations were found between white matter hyperintensities and HIV-1 serostatus, neurological abnormalities, CD4 count, or lifestyle factors.
Conclusions:
- Focal white matter hyperintensities identified on MR scans are not specific to HIV-1 infection.
- These MR findings are likely incidental and do not appear to have clinical significance in the context of HIV-1 infection.
- Further investigation is warranted to understand the etiology of these common MR findings.