title: Structural brain alterations can be detected early in HIV infection.
abstract: OBJECTIVE
  Brain changes occurring early in HIV infection are not well characterized. The Chicago Early HIV Infection Study aimed to evaluate the presence and extent of structural brain alterations using quantitative MRI.
  
  
  METHODS
  Forty-three HIV and 21 control subjects were enrolled. Mean length of infection was estimated as less than 1 year based on assay results. High-resolution neuroanatomical images were acquired. Automated image analysis was used to derive measurements for total brain, ventricular volume, and for tissue classes (total and cortical gray matter, white matter, and CSF). A separate image analysis algorithm was used to calculate measurements for individual brain regions. Cognitive function was assessed by neuropsychological evaluation.
  
  
  RESULTS
  Reductions were quantified in total (p = 0.0547) and cortical (p = 0.0109) gray matter in the HIV group. Analysis of individual brain regions with a separate image analysis algorithm revealed consistent findings of reductions in cerebral cortex (p = 0.042) and expansion of third ventricle (p = 0.046). The early HIV group also demonstrated weaker performance on several neuropsychological tests, with the most pronounced difference in psychomotor speed (p = 0.001).
  
  
  CONCLUSIONS
  This cross-sectional brain volumetric study indicates structural alterations early in HIV infection. The findings challenge the prevailing assumption that the brain is spared in this period. Revisiting the question of the brain's vulnerability to processes unfolding in the initial virus-host interaction and the early natural history may yield new insights into neurologic injury in HIV infection and inform neuroprotection strategies.
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA. ann-ragin@northwestern.edu
authors.forename: Ann B
authors.initials: AB
authors.lastname: Ragin
authors.forename: Hongyan
authors.initials: H
authors.lastname: Du
authors.forename: Renee
authors.initials: R
authors.lastname: Ochs
authors.forename: Ying
authors.initials: Y
authors.lastname: Wu
authors.forename: Christina L
authors.initials: CL
authors.lastname: Sammet
authors.forename: Alfred
authors.initials: A
authors.lastname: Shoukry
authors.forename: Leon G
authors.initials: LG
authors.lastname: Epstein
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D003071:Cognition / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology; D006679:HIV Seropositivity / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D009929:Organ Size