Date Published:
2018 03

Publication Type:
Journal Article

Authors:

J. Robinson-Papp
A. Navis
M.S. Dhamoon
U.S. Clark
J. Gutierrez-Contreras
S. Morgello

Secondary:
J Neuroimaging

Volume:
28

Pagination:
217-224

Issue:
2

PMID:
28833868

URL:
https://pubmed.ncbi.nlm.nih.gov/28833868

DOI:
10.1111/jon.12466

Keywords:
Adult;Brain;Female;HIV Infections;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Neuropsychological Tests;Reproducibility of Results;White Matter

Abstract:
<p>BACKGROUND AND PURPOSE: Human immunodeficiency virus (HIV)-infected patients commonly have abnormalities in cerebral white matter that are visible on magnetic resonance imaging (MRI) as hyperintensities (WMHs). Visual rating scales (VRSs) have been used to quantify WMH in other diseases such as cerebral small vessel disease (CSVD), but not in HIV. Such scales are advantageous because they are applicable to routinely acquired MRIs and so are suitable for large-scale studies and clinical care. We sought to establish the utility of three VRSs (the Fazekas, Scheltens, and van Sweiten scales) in HIV.METHODS: The Manhattan HIV Brain Bank (MHBB) is a longitudinal cohort study that performs serial neurologic examinations and neuropsychological testing. All brain MRIs (n = 73) performed for clinical purposes on MHBB participants were scored using the three VRSs. We assessed reliability, validity, and correlation of the VRS with clinical factors relevant to HIV and CSVD.RESULTS: The VRSs all showed acceptable internal consistency and interrater reliability and were highly correlated with one another (r = 0.836-0.916, P < .001). The Fazekas and Scheltens scales demonstrated more WMH in periventricular regions, and the Scheltens scale also suggested a frontal to occipital gradient, with greater WMH frontally. All three VRSs correlated significantly with cognitive impairment (global T score). Age and hepatitis C virus antibody serostatus were the strongest clinical/demographic correlates of WMH, followed by African-American race.CONCLUSIONS: VRSs reliably quantify WMH in HIV-infected individuals and correlate with cognitive impairment. Future studies may find routinely acquired brain MRI quantified by VRS to be an accessible and meaningful neurologic outcome measure in HIV.</p>