BRAIN LESIONS IN HIV PATIENTS: CLINICAL, LABORATORY, AND RADIOLOGICAL COMPARISONS

The wide use of highly active antiretroviral therapy (HAART) significantly alters the structure of secondary manifestations of HIV infection, including neurocognitive impairments and opportunistic infections resulting in brain lesions. Study objective: To characterize the radiological semiotics of brain lesions of HIV patients having different immunological conditions and HIV activities upon HAART. Material and methods: Study group comprised 70 HIV patients. HIV infection was confirmed with standard laboratory tests. All patients were tested for CD4 cell counts and viral loads and subjected to brain MRI. Subgroups were defined according to HAART regimens, immunosuppression levels, and opportunistic infection-caused brain lesions. The results were treated using statistical procedures available in MS Excel. Results: Most patients were found to have MRI-visualized brain lesions ponding to HIV-associated encephalopathy and secondary infectious brain lesions. The mean blood CD4 cell counts in these patients was 237 mL -1, and the prevalence of such opportunistic infections as toxoplasmosis and cryptococcosis was high. Subcortical and subependymal brain structures and basal ganglia were most involved in brain pathology. Among patients who did not receive HAART, brain lesions were found in 74% of cases, and the mean blood CD4 cell count and viral load were 245 mL 1 and 154 548 RNA copies per 1 mL, respectively. No HAART was associated with more severe brain lesions, including gliosis and demyelination. Conclusions: Structural changes in the brain visualized with MRI are frequent manifestations of opportunistic infections in HIV patients. The course, localization and severity of the changes depend on immunosuppression and viral load. Clinical and radiological comparisons of HIV patients suggest that MRI is indispensable for clinic-diagnostic examination of HIV patients.

HIV infection, HAART, brain, MRI