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Updated: Apr 30, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Cross-sectional study of unexplained white matter lesions in HIV positive individuals undergoing brain magnetic
Lewis J Haddow1, Cristina Dudau, Hoskote Chandrashekar
11 Research Department of Infection and Population Health, Institute of Epidemiology and Health Care, Institute of Neurology, University College London , London, United Kingdom .
Abstract:
White matter (WM) abnormalities are frequently seen on brain MRI of HIV positive (HIV+) patients. We aimed to determine the prevalence of unexplained WM abnormalities and their associations with HIV disease and cardiovascular risk factors. We conducted a retrospective, cross-sectional study of brain MRI of HIV+ patients conducted between 2004 and 2009 at our center. Clinical and laboratory data were compiled, and images were independently reviewed for WM lesions. Images were obtained from 254 patients: 70% male, 53% white, 40% black, mean age 42 years, median current CD4 count 240 cells/mm(3), and 41% not taking antiretroviral therapy (ART). Hyperintense WM lesions were present in 161 patients (63.4%): 89 scans (35.0%) showed diffuse WM signal abnormality (DWMSA), 61 (24.0%) were consistent with small vessel disease (SVD, graded by Fazekas' scale), and 37 (14.6%) showed large asymmetrical focal WM lesions. SVD changes were associated with age and cardiovascular risk factors, and while cerebral SVD may be related to HIV infection, the MRI findings were not associated with HIV-related factors. The only risk factor for DWMSA was black race, and no correlation with cardiovascular risk factors, CD4 count, or clinical presentation was identified. DWMSA are therefore of uncertain neurological significance in HIV+ patients and could represent more than one clinicopathological entity.
Insights
Brain MRI in HIV+ patients reveals frequent white matter abnormalities. Diffuse abnormalities were linked to Black race, while small vessel disease correlated with age and cardiovascular risks, with unclear neurological significance in HIV.
Area of Science:
- Neuroimaging
- Infectious Diseases
- Cardiovascular Health
Background:
- White matter (WM) abnormalities are common in brain MRI scans of individuals with HIV.
- Understanding the prevalence and causes of these abnormalities is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of unexplained white matter abnormalities on brain MRI in HIV-positive patients.
- To investigate associations between these abnormalities and HIV disease characteristics, as well as cardiovascular risk factors.
Main Methods:
- Retrospective, cross-sectional study of brain MRIs from 254 HIV-positive patients (2004-2009).
- Independent review of MRI scans for white matter lesions, categorizing them into diffuse WM signal abnormality (DWMSA), small vessel disease (SVD), and focal lesions.
- Compilation of clinical, laboratory, and HIV-related data, including CD4 counts and antiretroviral therapy (ART) status.
Main Results:
- 63.4% of patients had hyperintense WM lesions.
- Diffuse WM signal abnormalities (DWMSA) were associated with Black race (14.6%).
- Small vessel disease (SVD) was associated with older age and cardiovascular risk factors, but not directly with HIV-specific factors.
Conclusions:
- White matter abnormalities are prevalent in HIV+ patients, with distinct patterns.
- Diffuse WM signal abnormalities (DWMSA) in HIV+ individuals lack clear associations with HIV disease metrics or cardiovascular risks, suggesting uncertain neurological significance.
- Small vessel disease (SVD) on MRI in HIV+ patients appears linked to aging and cardiovascular health, warranting further investigation into its relationship with HIV infection.
