Neurocognitive decline in asymptomatic HIV patients and its correlation with metabolic changes in brain has not been studied in developing countries like India. In the present study we aim to examine the correlation between cognitive decline and changes in brain metabolites using MRS.
HIVpositive patients, in the age group 2050 years attending ART center of the
July to December 2016 were included in the study. All patients underwent evaluation using MRS of left frontal white matter (FWM) and left basal ganglia (BG). Levels of Nacetyl aspartate (tNAA), choline (tCho), creatine (tCr), lipids and macromolecules at 0.9ppm (Lip09+MM09) were measured. Cognition was tested using a battery validated for Indian population. Locally normalized zscores were used to calculate brain dysfunction score. Spearman correlation coefficient was used to assess the correlation between two continuous variables. There were 28 (29% female and 71% male) cases and 30 (37% female and 63% male) controls
The mean age was comparable in the 2 groups (33 and 34 years). There was a significant difference (p< 0.05) in the concentration (mmol/kg) of tNAA (9.29±311 vs 7.45±0.64), tCho (2.08±0.70 vs 1.74±0.25), tCr (6.95±2.56 vs 5.43±0.61), in the FWM and Lip09 + MM09 (5.87±1.05 vs 4.80±0.35) in BG, with higher levels in controls. There was no significant correlation between CD4 count and metabolites or overall dysfunction score and metabolites except Cr in FWM with more dysfunction associated with lower concentration [see Table 1 for summary]
Graph 1: MR spectrum acquired from FWM of a patient.
results show that HIV-associated changes are present in asymptomatic people
which may be
contributing to the early neurocognitive decline. Knowledge of metabolic changes within studied brain regions can help understand the pathology and design interventions to cater to this unmet need in people living with HIV.
S. Sinha, None