BRAIN LESIONS IN HIV-INFECTED PATIENTS WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: CLINICAL AND RADIOLOGICAL COMPARISONS

Abstract



Background and Purpose There were more than 1 million people living with HIV at the end of 2015 in Russia. Only 230 thousand people among them were receiving antiretroviral therapy in 2015. In Saint-Petersburg approximately 6,5 thousand people became newly infected with HIV during 2015. The use of highly active antiretroviral therapy (HAART) significantly changes the structure of secondary manifestations of HIV infection, including neurocognitive impairments and opportunistic infections resulting in brain lesions. The purpose of our study is to characterize the HAART influence on radiological semiotics of brain lesions in HIV patients having different immune status and viral load. Design and Methods This is the retrospective cross-sectional study of HIV-infected patients receiving care at the Center for prevention and control of AIDS and infectious diseases in Saint-Petersburg. We have already collected the data of 125 HIV-patients, who underwent brain MRI. The data included markers of immunodeficiency, viral load, current antiretroviral therapy, duration of treatment, duration of HIV infection. For statistical analysis we used Pearson’s chi-squared test and calculated odd rates (OR) and 95% confidence intervals (CI). Figure 1. Investigation Design General group Treatment CD4 cell counts, mL 1 Ekaterina Bakulina, Tatiana Trofimova, MD, Ph.D, Vadim Rassokhin, MD, Ph.D Institute of Human Brain of Russian Academy of Sciences, St. Petersburg, Russia First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia Conclusions 1. Most patients with HIV revealed structural changes in brain visualized with MRI consistent with HIV encephalopathy and opportunistic neuroinfections. 2. The course, localization and severity of the changes depend on immunosuppression and viral load. 3. More severe lesions of brain were formed in patients without treatment. The early start of HAART may contribute to prevention of the brain involvement in HIV. 4. Clinical and radiological comparisons of HIV patients suggest that MRI is indispensable for clinic-diagnostic examination of HIV patients. 5. The future research includes evaluation of influence of HAART regimens on HIV infection course and neuroradiological findings. In addition, we suppose to supplement characteristic features of CNS-IRIS. Results In this study we found that 68 (54%) of HIV+ patients undergoing MRI had cerebral atrophy consis tent with HIV encephalopathy. Overall, 84 scans (67%) showed white matter abnormalities, and 35 patients (28%) had brain lesions associated with opportunistic neuroinfections. The presence of big asymmetrical focal lesions was more frequently observed ( in 21 cases) in the group of patients, who have never been treated or have just started HAART (61 patient), than in HIV infected upon HAART (3 patients from 47) (p-value <0,01 in Pearson’s chi- squared test; OR 7,7, 95% CI 2,134-27,785). 60 Figure 3. т Semiotics of Brain Lesions го Depending on Treatment Status □ Upon HAART, n=47_ □ Never treated or Start treatment, n=61 53 49 22 38 _10_ 13 8 10 19 28 5 Figure 4. Toxoplasmosis. MRI: a - T2-WI; b - T2 FLAIR; c - T1-WI; d - CE T1-WI. Figure 5. Cryptococcosis. MRI: a - T2-WI; b - T2 FLAIR; c,d- CE T1-WI. References:

Ekaterina Bakulina

Institute of Human Brain of Russian Academy of Sciences; First Pavlov State Medical University of St. Petersburg

St. Petersburg, Russia

Tatiana Trofimova

Institute of Human Brain of Russian Academy of Sciences; First Pavlov State Medical University of St. Petersburg

St. Petersburg, Russia MD, Ph.D

Vadim Rassokhin

Institute of Human Brain of Russian Academy of Sciences; First Pavlov State Medical University of St. Petersburg

St. Petersburg, Russia MD, Ph.D

  1. Беляков Н.А., Трофимова Т.Н., Рассохин В.В. Диагностика и механизмы поражения центральной нервной системы при ВИЧ-инфекции // Медицинский академический журнал.- 2012.- Т. 12, №2.- С. 56-67.
  2. Трофимова Т.Н., Беляков Н.А. Многоликая нейрорадиология ВИЧ-инфекции // Лучевая диагностика и терапия.- 2010.- Т. 1.- № 3.- С. 3-12.
  3. Majda M. Thumher, et al. Highly Active Antiretroviral Therapy for patients with AIDS dementia complex: effect on MR imaging findings and clinical course // Am J Neuroradiol.- 2000.- Vol. 21.- P. 670-678.

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