title: White matter structure alterations in HIV-1-infected men with sustained suppression of viraemia on treatment.
abstract: OBJECTIVE
  Cognitive impairment is highly prevalent in HIV-1-infected (HIV+) patients, despite adequate suppression of viral replication by combination antiretroviral therapy (cART). Cerebral white matter structure alterations are often associated with cognitive impairment and have commonly been reported in the natural course of HIV infection. However, the existence of these alterations in adequately treated HIV+ patients remains unknown, as well as its possible association with cognitive impairment.
  
  
  METHODS
  We used diffusion tensor imaging (DTI) to investigate whether white matter structure alterations exist in HIV+ patients with sustained suppressed viral replication on cART, and if such alterations are related to HIV-associated cognitive deficits.
  
  
  METHODS
  We compared 100 aviraemic HIV+ men on cART with 70 HIV-uninfected, otherwise comparable men. Clinical and neuropsychological assessments were performed. From DTI data, white matter fractional anisotropy and mean diffusion were calculated. Subsequently, tract-based spatial statistics (TBSS) was performed, with and without masking out white matter lesions.
  
  
  RESULTS
  HIV+ patients showed diffuse white matter structure alterations as compared with HIV-uninfected controls, observed as widespread decreased fractional anisotropy and an increased mean diffusion. These white matter structure alterations were associated with the number of years spent with a CD4 cell count below 500 cells/μl, but not with HIV-associated cognitive deficits.
  
  
  CONCLUSIONS
  Cerebral white matter structure alterations are found in middle-aged HIV+ men with sustained suppression of viraemia on cART, and may result from periods with immune deficiency when viral toxicity and host-inflammatory responses were at their peak. These white matter structure alterations were not associated with the observed subtle HIV-associated cognitive deficits.
  .
authors.affiliation: aDepartment of Radiology, Academic Medical CenterbDepartment of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development (AIGHD)cDepartment of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA)dDepartment of Neurology, Academic Medical Center, Amsterdam, the NetherlandseThe Computational, Cognitive, and Clinical Neuroimaging Laboratory, Department of Medicine, Imperial College London, London, United KingdomfQuantitative Imaging Group, Delft University of Technology, DelftgCluster Infectious Diseases Research, Public Health Service of AmsterdamhDepartment of Neurology, OnzeLieveVrouweGasthuis (OLVG Hospital)iHIV Monitoring Foundation, Amsterdam, The Netherlands.
authors.forename: Tanja
authors.initials: T
authors.lastname: Su
authors.forename: Matthan W A
authors.initials: MW
authors.lastname: Caan
authors.forename: Ferdinand W N M
authors.initials: FW
authors.lastname: Wit
authors.forename: Judith
authors.initials: J
authors.lastname: Schouten
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Geurtsen
authors.forename: James H
authors.initials: JH
authors.lastname: Cole
authors.forename: David J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: Frans M
authors.initials: FM
authors.lastname: Vos
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.forename: Peter
authors.initials: P
authors.lastname: Portegies
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Charles B
authors.initials: CB
authors.lastname: Majoie
mesh_terms: D015526:AIDS Dementia Complex / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D056324:Diffusion Tensor Imaging; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D066127:White Matter / Q000473:pathology*
chemical_list: D019380:Anti-HIV Agents