Delay in HIV Treatment Associated with Brain Atrophy
Findings indicate the importance of early diagnosis and treatment
• Science Update
Research has shown that people infected with the human immunodeficiency virus, known as HIV, display reductions in brain volume compared with people who are not infected with HIV. Now, a new study funded by the National Institute of Mental Health (NIMH) has shed light on the course of this deterioration and shows that antiretroviral treatment started in the first few years of infection may stop these brain changes. The findings, which were published online on April 24, 2018 in Clinical Infectious Diseases, highlight the importance of early diagnosis and treatment of HIV.
Longitudinal studies have shown that people who have been infected with HIV for more than a year show significant reductions in their brain volume compared with people who do not have HIV. These brain changes are hypothesized to underlie some of the mild cognitive impairment experienced by those with HIV. In this study, the researchers examined how early in the course of HIV infection these brain changes begin and the impact of combination antiretroviral therapy (cART) on brain volume reductions.
The researchers examined this by taking longitudinal structural magnetic resonance imaging (MRI) scans of 65 participants who had been infected with HIV for less than a year (primary HIV infection; PHI), 26 of which began cART during the study period. MRI scans were taken when participants entered into the study, six weeks after entry into the study, and every six months thereafter.
The data from the PHI group were compared with data from 19 HIV-negative participants and 16 participants who had been infected with HIV for at least three years. The researchers found that in the PHI group, the longer the time between initial HIV infection and treatment, the greater the volume loss or thinning seen in various brain areas. This loss ceased after participants began cART and small increases in the thickness of some brain areas were seen after longer durations of cART.
“In addition to the many short- and long-term health benefits from early initiation of cART following infection, this study now shows that loss in brain volume starts to happen soon after HIV infection, which can have a negative impact on brain function. Initiating treatment can prevent this from happening,” said Dianne Rausch, Ph.D., Director of the Division of AIDS Research at NIMH. “This reinforces the importance of expanding efforts to get people diagnosed and treated as early as possible after infection.”
Sanford, R., Ances, B. M., Meyerhoff, D. J., Price, R. W., Fuchs, D., Zetterberg, H., Spudich, S., and Collins, D. L. (in press). Longitudinal Trajectories of Brain Volume and Cortical Thickness in Treated and Untreated Primary HIV Infection. Clinical Infectious Diseases