Introduction: By introducing antiretroviral therapy, the prevalence of most neurological diseases that accompany HIV infection has been reduced, with the exception of the HIV associated neurocognitive disorder (HAND), whose prevalence continues to rise. Conventional MR imaging has proven insufficiently sensitive in detecting subcellular damage to the central nervous system in HIV infection.
Purpose: The objective of this study was to determine the neurodegenerative effect of HIV infection on the brain by comparing the volume of brain structures in HIV positive patients to a healthy control group, and to determine whether there is a correlation between the obtained volumetric dimensions of brain structures with the level of CD4 T lymphocytes and the duration of therapy.
Material/methods: In this study we included 40 HIV positive patients on antiretroviral therapy and 25 healthy subjects. Conventional MRI was performed in all subjects, with the subsequent determination of volumetric dimensions of brain structures (intracranial cavity, cerebrum, cerebellum, brainstem, lateral ventricles, deep gray matter structures and white matter). The differences between the two groups were compared with the Student`s t-test, and the relationship between the variables was determined using the Pearson correlation coefficient.
Results: Comparing the volume of brain structures it was found that there was a statistically significant decrease in the total volume of the putamen (p< 0.05), thalamus (p <0.05) and nucleus accumbens (p< 0.05), as well as statistically significant increase in the total volume of the lateral ventricles (p< 0.05) and the cerebrospinal fluid (p< 0.05) in the HIV positive group compared to the healthy controls. Correlation analysis showed a positive correlation between CD4 + lymphocytes count and the total volume of nucleus accumbens, as well as correlation between the duration of therapy and the total volume of lateral ventricles. A negative correlation between the total volume of the putamen and the duration of therapy was also found.
Conclusions: Reduction in volume of subcortical structures is in favor of HAND as a type of subcortical dementia, and the increase in volume of cerebrospinal fluid is also expected due to existing atrophy in HIV + patients. Positive correlation of the CD4 + count and the total volume of nucleus accumbens reflects the process of neurodegeneration caused by the activation of immune mechanisms, while positive correlations between the duration of therapy and the increase in lateral ventricular volume is a reflection of the greater impact of the years of life on brain atrophy than the HIV infection itself.
