Without Treatment, Neurological Effects of HIV Start Early

New research gives more evidence about when and how quickly neurological deterioration occurs in patients with HIV.

Ryan Sanford, PhD candidate

New research is underscoring the important role early treatment of HIV plays in preventing neurological effects associated with the disease.

Researchers from McGill University, Washington University in St. Louis, and Yale University, wanted to know more about the phenomenon of reduced volume and reduced cortical thickness in some regions of the brains of patients with HIV. Specifically, the team sought more information about when these neurological effect start, and what role (if any) combination antiretroviral therapy (cART) plays in combating these effects.

To study the question, the team looked at MRI scans from 65 newly infected HIV patients who sought treatment at the University of California, San Francisco. All of the newly infected patients had contracted HIV within the past year. Those data were compared against the scans of 19 HIV-negative patients and 16 HIV-infected patients who had contracted HIV 3 or more years ago.

Ryan Sanford, a PhD candidate at McGill’s Montreal Neurological Institute, told MD Magazine that the study data showed a clear progression of neurological impacts.

“Based on the data that we have reported on, it appears that the volume loss and cortical thinning is ongoing in those that do not receive treatment,” said Sanford, the article’s first author. “This conclusion is also supported by data from the pre-cART era that demonstrated ongoing brain atrophy in those that did not receive treatment and had advance disease.”

Moreover, the study indicated that once cART therapy begins, the volume loss stops and cortical thinning began to reverse in the frontal and temporal lobes.

“The current debate in the literature is whether these cognitive deficits are due to poor penetrance of cART into the central nervous system or legacy effects from early infection,” Sanford said. “Given the results of this study, and a study published earlier this year in JAMA Neurology, it appears that the cognitive deficits that we see today are most likely legacy effects from early infection.”

Sanford said he and colleagues wanted to give physicians and patients a better understanding, and thus better strategies, for combating the neurological effects.

“I think the message we wanted to portray in our conclusion was that treatment does work in the brain and they should be treated as soon as possible,” he said.

The long-term impacts of HIV-associated neurological deterioration are well documented and can include memory loss, dementia, and vision and balance problems.

Sanford noted that his study was focused on cross-sectional analysis, and did not include longitudinal data, so it’s difficult to know from this research exactly what the neurological impacts might look like in the long term.

“If we look at the absolute rate of brain atrophy and compare those changes with normal aging cohorts from previous work, we do see that the rate of brain atrophy in this HIV cohort is higher than that of normal aging,” he said. “However, future work is warranted to verify that statement.”

The study is titled, “Longitudinal Trajectories of Brain Volume and Cortical Thickness in Treated and Untreated Primary HIV Infection.” It was published last month in Clinical Infectious Diseases.