The following is a summary of “Imaging of Brain Structural and Functional Effects in People With Human Immunodeficiency Virus,” published in the March 2023 issue of Infectious Diseases by O’Connor et al.

For a study, researchers reviewed the existing and emerging neuroimaging tools that showed promise in detecting markers of HIV-associated brain pathology, focusing on detecting subtle brain structural and functional abnormalities in virally suppressed people living with HIV (PWH). Before the introduction of antiretroviral therapy, HIV infection was often accompanied by central nervous system (CNS) opportunistic infections and HIV encephalopathy. Although antiretroviral therapy has nearly eliminated CNS opportunistic infections, PWH still experiences neuropsychiatric impairment and peripheral nerve and organ damage, suggesting ongoing brain injury.

To detect these subtle brain abnormalities, neuroimaging research must use sensitive methods and allow for adjustments for potential confounders, such as age, sex, substance use, hepatitis C coinfection, cardiovascular risk, and others. The study emphasized the importance of using neuroimaging approaches that may be used in parallel to gather complementary information, allowing efficient detection and interpretation of altered brain structure and function associated with suboptimal clinical outcomes among virally suppressed PWH.

The study also explored the advantages of each imaging modality and systematic approaches in study design and analysis, including combining experimental and statistical control techniques to improve the sensitivity and specificity of biotype identification. Additionally, it considered the costs and benefits of aggregating data from multiple studies to achieve larger sample sizes, enabling emerging methods for combining and analyzing large, multifaceted data sets.

Overall, it highlighted the ongoing research initiatives to define the role of neuroimaging in emerging alternative approaches to identifying biotypes of CNS complications in PWH. The development of a standard neuroimaging protocol for researchers to use in future studies examining neurological changes in the brains of PWH may be an outcome of these considerations. It contributed to the understanding of the complex neurological changes associated with HIV infection and underscored the importance of ongoing research to improve the detection and treatment of brain pathology in PWH.

Reference: academic.oup.com/jid/article/227/Supplement_1/S16/7079924