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Structural Neuroimaging and Neuropsychologic Signatures in Children With Vertically Acquired HIV
Robert Paul1, Wasana Prasitsuebsai2, Neda Jahanshad3
1From the Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri.
Insights
Vertically acquired HIV in children is linked to abnormal brain maturation, with larger gray matter volumes but no correlation to cognitive deficits. Further research is needed to understand neuroimaging impacts on psychosocial function.
Area of Science:
- Neuroscience
- Pediatric Infectious Diseases
- Medical Imaging
Background:
- Children with vertically acquired human immunodeficiency virus (HIV) often experience lasting cognitive impairments.
- The specific neuroimaging markers associated with vertical HIV infection are not well understood.
Purpose of the Study:
- To investigate the neuroimaging signatures of vertically acquired HIV in children.
- To compare brain volumes between HIV-infected children and healthy controls.
- To explore the relationship between brain volumes, cognitive function, and disease markers in pediatric HIV survivors.
Main Methods:
- Magnetic resonance imaging (MRI) was used to measure brain volumes in 51 vertically HIV-infected children and 50 healthy controls.
- Brain regions analyzed included the caudate, putamen, thalamus, pallidum, hippocampus, nucleus accumbens, and total white and gray matter.
- Correlational analyses assessed links between brain volumes, cognitive test performance, CD4 counts, and HIV RNA levels.
Main Results:
- HIV-infected children showed significantly larger volumes in the caudate, nucleus accumbens, total gray matter, and cortical gray matter compared to controls.
- These volumetric differences were most pronounced in children younger than 12 years.
- Despite cognitive impairments in HIV-infected children, their cognitive performance and laboratory markers did not correlate with observed brain volumes.
Conclusions:
- The findings suggest abnormal brain maturation in pediatric HIV survivors acquired vertically.
- Longitudinal studies are necessary to examine brain integrity and resilience factors.
- Further research should clarify the impact of neuroimaging abnormalities on psychosocial functioning in pediatric HIV.
Background:
Children with vertically acquired HIV exhibit persistent cognitive impairments, yet the corresponding neuroimaging signature of vertical infection remains unclear.
Methods:
Fifty healthy control children and 51 vertically infected children were included in the study. The HIV-infected group consisted of survivors who had not received antiretroviral therapy at birth. The HIV-infected group averaged 11.4 (2.5) years of age, with a median CD4 count of 683 cells/mm(3). Most (71%) of the HIV-infected children were on antiretroviral therapy for a median of 34 months (range: 33-42) with HIV RNA <40 copies/mL in 89% of the sample. The HIV-uninfected group averaged 10.6 (2.6) years of age. Magnetic resonance imaging was acquired to determine volumes of the caudate, putamen, thalamus, pallidum, hippocampus, nucleus accumbens, total white matter, total gray matter and cortical gray matter. Correlational analyses examined the degree of shared variance between brain volumes and both cognitive performances and laboratory markers of disease activity (T cells and plasma viral load).
Results:
HIV-infected children exhibited larger volumes of the caudate, nucleus accumbens, total gray matter and cortical gray matter when compared with the controls. Volumetric differences were predominately evident in children under 12 years of age. HIV-infected children performed worse than controls on most neuropsychologic tests, though neither cognitive performances nor laboratory markers corresponded to brain volumes in the HIV-infected children.
Conclusions:
Outcomes of the present study suggest abnormal brain maturation among HIV-infected pediatric survivors. Longitudinal studies of brain integrity and related resilience factors are needed to determine the impact of neuroimaging abnormalities on psychosocial function in pediatric HIV.
