Brain Magnetic Resonance Imaging Findings associated with Cognitive Impairment in Children and Adolescents with Human Immunodeficiency Virus in Zambia

Abstract Background Cognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain Magnetic Resonance Imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There is little published data on brain imaging in children with HIV in Sub-Saharan Africa. Methods Thirty-four perinatally-infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages of 9-17 were recruited from the Pediatric Center of Excellence in Lusaka, Zambia as part of the HIV-associated Neurocognitive Disorders in Zambia (HANDZ) study. Brain MRI sequences were acquired and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychological battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. Results We identified cerebrovascular disease in seven out of 34 subjects with HIV compared to zero out of 17 controls (21% vs. 0%, p=0.04). We also identified decreased total brain volumes (1036 vs. 1162 cm3, p=0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs. 3.29 mm; p=0.01) and right fusiform gyri (3.10 vs. 3.25 mm; p=0.02) of HIV-infected subjects with cognitive impairment. Conclusions These findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.