Early Antiretroviral Therapy in HIV-Infected Children Is Associated with Diffuse White Matter Structural Abnormality and Corpus Callosum Sparing.
Early Antiretroviral Therapy in HIV-Infected Children Is Associated with Diffuse White Matter Structural Abnormality and Corpus Callosum Sparing.
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DOI：
10.3174/ajnr.a4921
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发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Meintjes EM
中科院分区：
文献类型：
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作者：
Ackermann C;Andronikou S;Saleh MG;Laughton B;Alhamud AA;van der Kouwe A;Kidd M;Cotton MF;Meintjes EM
HIV阳性成人的额叶白质、胼胝体和内囊的分数各向异性是异常的。我们描述了一组在一岁内开始接受 ART 的儿童中白质异常的分布和性质，以及使用 DTI 测量（分数各向异性、平均、轴向和径向扩散）进行早期治疗的益处。在艾滋病毒儿童早期抗逆转录病毒 (CHER) 试验的一项神经发育子研究中，对儿童进行了 DTI。进行基于体素的组比较，以确定 HIV+ 和未感染儿童之间分数各向异性和平均扩散不同的区域。检查了 DTI 参数与 ART 启动时间的关联。对 39 名 HIV + 儿童（15 名男性，平均年龄 5.4 岁）和 13 名对照者（5 名男性，平均年龄 5.7 岁）进行了成像。在 HIV+ 组中发现了 2 个分数各向异性较低的簇和 7 个平均扩散增加的簇，其对称分布主要是由于径向扩散增加，表明髓鞘形成减少。主要涉及皮质脊髓束而不是胼胝体。与接受持续治疗的儿童相比，接受早期中断 ART 的儿童的各向异性分数较低。尽管进行了早期抗逆转录病毒治疗，但通过分数各向异性测量，5 岁时 HIV 阳性儿童的白质仍存在异常，这表明早期抗逆转录病毒治疗并不能完全保护白质免受围产期或子宫内感染。与成人相比，皮质脊髓束主要受累，而不是胼胝体，这可能是由于早期 ART 所致。持续的早期 ART 可以限制白质损伤。
Fractional anisotropy in the frontal white matter, corpus callosum and internal capsule are abnormal in HIV+ adults. We describe the distribution, nature of white matter abnormalities in a cohort of children who started ART within the first year of life - and benefit of early treatment using DTI measures (fractional anisotropy, mean, axial and radial diffusion). DTI was performed on children in a neurodevelopmental sub study from the Children with HIV Early Antiretroviral (CHER) trial. Voxel-based group comparisons were performed to determine regions where fractional anisotropy and mean diffusion differed between HIV+ and uninfected children. Associations of DTI parameters with timing of ART initiation were examined. 39 HIV+ children (15 male, mean age 5.4 years) and 13 controls (5 male, mean age 5.7 years) were imaged. 2 Clusters with lower fractional anisotropy and 7 clusters with increased mean diffusion were identified in the HIV+ group with symmetrical distribution predominantly due to increased radial diffusion, suggestive of decreased myelination. Corticospinal tracts rather than the corpus callosum were predominantly involved. Children on early interrupted ART had lower fractional anisotropy compared to those receiving continuous treatment. HIV+ children at 5 years have white matter abnormalities measured by fractional anisotropy, despite early ART, suggesting that early ART does not fully protect the white matter either from peripartum or in utero infection. In contrast to adults, the corticospinal tracts are predominantly involved rather than the corpus callosum, possibly due to early ART. Continuous early ART can limit white matter damage.