Persistent brain abnormalities in antiretroviral-naive HIV patients 3 months after HAART.
BACKGROUND
Proton magnetic resonance spectroscopy (1H-MRS) and neuropsychological tests may be useful for monitoring the effectiveness of highly active antiretroviral therapy (HAART) in HIV-associated brain injury. We aimed to evaluate whether brain abnormalities will improve 3 months after HAART.


METHODS
Thirty-three HIV patients naive to antiretroviral medications were evaluated before and 3 months after HAART using 1H-MRS and neuropsychological tests; results were compared with those of 26 seronegative control subjects.


RESULTS
Despite significant improvement in CD4 counts, and suppression of plasma and cerebrospinal fluid (CSF) viral loads, elevated brain metabolites (choline compounds and myoinositol in the frontal lobes) and neuropsychological tests abnormalities (including the computerized tests [CalCAP]) persisted after 3 months of HAART. In the basal ganglia, choline and myoinositol became elevated only after treatment. No interaction effect was observed between the number of CSF-penetrating drugs (one vs two) and changes (baseline vs 3 months) in any of the brain metabolites, cognitive performance or CSF viral load.


CONCLUSIONS
The persistent brain abnormalities suggest ongoing repair or reactive inflammatory processes in the brain after 3 months of HAART. Regimens with two CSF-penetrating antiretroviral medications do not appear to be more effective than those with one CSF-penetrating drug in treating HIV brain injury at 3 months.
Chang
Linda
L
Medical Department, Brookhaven National Laboratory, Upton, NY, USA ChangL@bnl.gov
Ernst
Thomas
T
Witt
Mallory D
MD
Ames
Nina
N
Walot
Irwin
I
Jovicich
Jorge
J
DeSilva
Menaka
M
Trivedi
Neha
N
Speck
Oliver
O
Miller
Eric N
EN
D015526:AIDS Dementia Complex / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009483:Neuropsychological Tests; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D016896:Treatment Outcome; D019562:Viral Load
D012367:RNA, Viral