We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Brain Perfusion, Regional Volumes, and Cognitive Function in Human Immunodeficiency Virus–positive Patients Treated With Protease Inhibitor Monotherapy.
- Authors
Haddow, Lewis J; Williams, Ian G; Johnson, Margaret; Paton, Nick; Arenas-Pinto, Alejandro; Golay, Xavier; Jäger, Hans Rolf; Godi, Claudia; Sokolska, Magdalena; Cardoso, M Jorge; Oliver, Ruth; Winston, Alan; Stöhr, Wolfgang; Clarke, Amanda; Chen, Fabian
- Abstract
Background Protease inhibitor monotherapy (PIM) for human immunodeficiency virus (HIV) may exert suboptimal viral control in the central nervous system. We determined whether cerebral blood flow (CBF) and regional brain volumes were associated with PIM, and whether specific cognitive domains were associated with imaging biomarkers. Methods Cognitive assessments and brain magnetic resonance imaging were performed after the final visit of a randomized HIV-treatment strategy trial. Participants were virologically suppressed on triple therapy at trial entry and followed for 3–5 years. We studied 37 patients randomized to ongoing triple therapy and 39 randomized to PIM. Resting CBF and normalized volumes were calculated for brain regions of interest, and correlated with treatment strategy and neuropsychological performance. Results Mean age was 48.1 years (standard deviation 8.6 years), 63 male (83%), and 64 white (84%). Participants had median 8.1 years (interquartile range 6.4, 10.8) of antiretroviral therapy experience and CD4+ counts of median 640 cells/mm3 (interquartile range 490, 780). We found no difference between treatment arms in CBF or regional volumes. Regardless of treatment arm, poorer fine motor performance correlated with lower CBF in the caudate nucleus (P =.01), thalamus (P =.04), frontal cortex (P =.01), occipital cortex (P =.004), and cingulate cortex (P =.02), and was associated with smaller supratentorial white matter volume (decrease of 0.16 in Z-score per -1% of intracranial volume, 95% confidence interval 0.02–0.29; P =.023). Conclusions PIM does not confer an additional risk of neurological injury compared with triple therapy. There were correlations between fine motor impairment, grey matter hypoperfusion, and white matter volume loss. Clinical Trials Registration ISRCTN-04857074
- Subjects
THERAPEUTIC use of protease inhibitors; BRAIN injuries; BASAL ganglia; BIOMARKERS; DIAGNOSIS of brain abnormalities; CEREBRAL circulation; COGNITIVE testing; CONFIDENCE intervals; FRONTAL lobe; HIV infections; LIMBIC system; MAGNETIC resonance imaging; MOTOR ability; NEUROPSYCHOLOGY; OCCIPITAL lobe; PERFUSION; RADIONUCLIDE imaging; THALAMUS; WHITE people; RANDOMIZED controlled trials; CD4 lymphocyte count; WHITE matter (Nerve tissue); INJURY risk factors
- Publication
Clinical Infectious Diseases, 2019, Vol 68, Issue 6, p1031
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy617