Featured Publication - Clinical Factors Related to Brain Structure in HIV: The CHARTER Study

Despite much improved survival and medical outcomes in the era of modern combination antiviral treatments [CART], some persons with HIV continue to experience disturbances in memory, attention, decision making and other neurocognitive functions suggesting a persisting effect of HIV on the brain. Investigators from UCSD’s HIV Neurobehavioral Research Program and the CHARTER Study recently reported the results of a brain imaging study of a large group of HIV+ individuals who participated in a nationwide study.  The study examined the clinical correlates of different forms of injury to brain structures.

The investigators used magnetic resonance imaging [MRI] to measure the volumes of various brain areas, including gray matter [the layer and regions with neuronal cell bodies], white matter [the area with axons, which serve to provide connections between one gray area and another], and volumes of cerebrospinal fluid [CSF: which surrounds the brain and is also within brain spaces - ventricles]. The results showed that there were volume losses and abnormalities especially in the white matter. Factors associated with white matter injury included history of more severe immunosuppresion at some point in time [i.e., lower nadir CD4], longer duration of antiviral drug treatment, persistence of detectable HIV in the CSF, and coinfection with hepatitis C virus. An unexpected finding was the tendency for those with higher current CD4 also to have more indication of white matter injury, but whether this simply reflects that these were cases on more extensive treatment, or perhaps experienced the injurious effects of a rebound inflammation that occasionally is seen when people's immune systems reconstitute, is unclear. The results confirm that the brain remains vulnerable in the era of CART, and indicates that the mechanisms of this vulnerability are quite complex, and perhaps change over time.

To Cite:

Jernigan TL, Archibald SL, Fennema-Notestine C, Taylor MJ, Theilmann RJ, Julaton MD, Notestine RJ, Wolfson T, Letendre SL, Ellis RJ, Heaton RK, Gamst AC, Franklin DR, Clifford DB, Collier AC, Gelman BB, Marra CM, McArthur JC, McCutchan JA, Morgello S, Simpson DM, Grant I, and for the CHARTER Group. (2011). Clinical factors related to brain structure in HIV: The CHARTER Study. 17, 248-257.