title: Accelerated aging of selective brain structures in human immunodeficiency virus infection: a controlled, longitudinal magnetic resonance imaging study.
abstract: Advances in treatment have transformed human immunodeficiency virus (HIV) infection from an inexorable march to severe morbidity and premature death to a manageable chronic condition, often marked by good health. Thus, infected individuals are living long enough that there is a potential for interaction with normal senescence effects on various organ systems, including the brain. To examine this interaction, the brains of 51 individuals with HIV infection and 65 uninfected controls were studied using 351 magnetic resonance imaging and a battery of neuropsychological tests collected 2 or more times over follow-up periods ranging from 6 months to 8 years. Brain tissue regions of interest showed expected age-related decrease in volume; cerebrospinal fluid-filled spaces showed increase in volume for both groups. Although HIV-infected individuals were in good general health, and free of clinically-detectable dementia, several brain regions supporting higher-order cognition and integration of functions showed acceleration of the normal aging trajectory, including neocortex, which extended from the frontal and temporal poles to the parietal lobe, and the thalamus. Beyond an anticipated increase in lateral ventricle and Sylvian fissure volumes and decrease in tissue volumes (specifically, the frontal and sensorimotor neocortices, thalamus, and hippocampus) with longer duration of illness, most regions also showed accelerated disease progression. This accelerated loss of cortical tissue may represent a risk factor for premature cognitive and motor compromise if not dementia. On a more promising note, HIV-infected patients with increasing CD4 counts exhibited slower expansion of Sylvian fissure volume and slower declines of frontal and temporoparietal cortices, insula, and hippocampus tissue volumes. Thus, attenuated shrinkage of these brain regions, likely with adequate pharmacologic treatment and control of further infection, has the potential of abating decline in associated higher-order functions, notably, explicit memory, executive functions, self-regulation, and visuospatial abilities.
authors: Biosciences Division, Neuroscience Program, SRI International, Menlo Park, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors: Adolf
authors: A
authors: Pfefferbaum
authors: Department of Education, Stanford University, Stanford, CA, USA; Department of Biostatistics, Stanford University, Stanford, CA, USA.
authors: David A
authors: DA
authors: Rogosa
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors: Margaret J
authors: MJ
authors: Rosenbloom
authors: Biosciences Division, Neuroscience Program, SRI International, Menlo Park, CA, USA.
authors: Weiwei
authors: W
authors: Chu
authors: Biosciences Division, Neuroscience Program, SRI International, Menlo Park, CA, USA.
authors: Stephanie A
authors: SA
authors: Sassoon
authors: Division of Infectious Diseases, Santa Clara Valley Medical Center, Santa Clara, CA, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors: Carol A
authors: CA
authors: Kemper
authors: Division of Infectious Diseases, Santa Clara Valley Medical Center, Santa Clara, CA, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors: Stanley
authors: S
authors: Deresinski
authors: Biosciences Division, Neuroscience Program, SRI International, Menlo Park, CA, USA.
authors: Torsten
authors: T
authors: Rohlfing
authors: Biosciences Division, Neuroscience Program, SRI International, Menlo Park, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors: Natalie M
authors: NM
authors: Zahr
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: edie@stanford.edu.
authors: Edith V
authors: EV
authors: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000473:pathology* / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D009929:Organ Size; D012927:Social Control, Informal; D013997:Time Factors; D055815:Young Adult
keywords: AIDS; Brain structure; Cortex; HIV; Longitudinal; MRI; Ventricles