[Nuclear imaging in AIDS-related neurologic diseases]

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Human Immunodeficiency Virus type 1 (HIV-1) infection can affect the central nervous system (CNS).
• Early detection of HIV-related neurological changes is crucial for patient management.
• Conventional imaging techniques may not be sensitive enough for early-stage CNS involvement.

Purpose of the Study:

• To evaluate the sensitivity of SPECT with HMPAO-99mTc in detecting early brain abnormalities in HIV-1 infected patients.
• To compare the diagnostic performance of SPECT with CT and MRI in different stages of HIV-1 neurological disease.
• To assess the correlation between SPET findings and the immunological and neurological status of HIV-1 patients.

Main Methods:

• A cohort of 356 HIV-1 patients, excluding those with opportunistic CNS signs, underwent SPET with HMPAO-99mTc.
• A subset of patients also had brain CT (n=166) or MRI (n=48) within 30 days of SPET.
• A control group of 12 HIV-negative intravenous drug users was included for comparison.

Main Results:

• All SPET exams in the control group were negative.
• Positive SPET findings increased with the progression of clinical and neurological disease in HIV-1 patients.
• In the asymptomatic stage, 54% of SPET findings were positive.
• SPET demonstrated higher sensitivity than CT and MRI in identifying abnormal changes in earlier disease stages.

Conclusions:

• SPET with HMPAO-99mTc is a sensitive tool for detecting early brain abnormalities in HIV-1 infection, even in asymptomatic patients.
• The study suggests significant HIV-1 activity within the brain, independent of opportunistic infections or neoplasms.
• Regular monitoring of early-stage HIV-1 related neurological disease using SPET is recommended.