Cerebral FDG-PET scanning abnormalities in optimally treated HIV patients.
BACKGROUND
The long-term neurological consequences of HIV infection and treatment are not yet completely understood. In this study we examined the prevalence of cerebral metabolic abnormalities among a cohort of neurologically intact HIV patients with fully suppressed HIV viral loads. Concomitant analyses of circulating brain derived neurotrophic factor (BDNF) were performed to correlate these abnormalities with potential signs of neuro-regenerating/protective activity, and concomitant analyses of circulating tumour necrosis factor (TNF) alpha, interleukin (IL) 6, and soluble urokinase plasminogen activator receptor (suPAR) were performed to correlate these abnormalities with potential signs of neurodegenerative processes.


METHODS
The study population consisted of HIV-positive patients known to be infected for more than 5 years and on antiretroviral (ARV) treatment for a minimum of three years with no history of virological failure, a CD4 count above 200 x 106 cells/l and no other co-morbidities. The distribution of the regional cerebral metabolic rate of glucose metabolism was measured using fluorine-18-flourodeoxyglucose positron emission tomography (FDG-PET) scanning. The PET scans were evaluated for individual pathology using Neurostat software and for group pathology using statistical parametric mapping (SPM). Circulating levels of BDNF, TNF alpha, IL-6 and suPAR were measured by ELISA techniques.


RESULTS
More than half (55%) of the patients exhibited varying severities of mesial frontal reduction in the relative metabolic rate of glucose. Compared to healthy subjects, the patients with abnormal FDG-PET scanning results had a shorter history of known HIV infection, fewer years on antiretroviral therapy and higher levels of circulating TNF alpha and IL-6 (p = 0.08).


CONCLUSIONS
A large proportion of optimally treated HIV patients exhibit cerebral FDG-PET scanning abnormalities and elevated TNF alpha and IL-6 levels, which may indicate imminent neuronal damage. The neuroprotective effect of early ARV treatment should be considered in future prospective follow-up studies.
Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. bengaard@rh.dk
Ase B
AB
Andersen
Ian
I
Law
Karen S
KS
Krabbe
Helle
H
Bruunsgaard
Sisse R
SR
Ostrowski
Henrik
H
Ullum
Liselotte
L
Højgaard
Annemette
A
Lebech
Jan
J
Gerstoft
Andreas
A
Kjaer
D000328:Adult; D000368:Aged; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000473:pathology*; D016207:Cytokines / Q000097:blood; D005260:Female; D019788:Fluorodeoxyglucose F18; D015658:HIV Infections / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods
D016207:Cytokines; D019788:Fluorodeoxyglucose F18