HIV infection often results in MRI-detectable brain atrophy and white matter signal hyperintensities (WMSHs)

HIV infection often results in MRI-detectable brain atrophy and white matter signal hyperintensities (WMSHs).

 HIV+ patients compared to high-risk controls evidenced global atrophy, reduced caudate nuclei volume, and a trend to gray matter volume loss but no difference in white matter volume or in WMSHs. These effects were progressive with CDC clinical stage such that patients at CDC stage A had values very close to those of controls, while patients at CDC stage C had the most abnormal values. In contrast, the relationship between these MRI variables and severity of NP impairment was much less dramatic, with the mildly to moderately impaired HIV+ subjects showing MRI volume effects greater than or equal to those of the severely impaired HIV+ subjects. These results suggest that MRI-detectable brain atrophy secondary to HIV infection is not the primary substrate underlying the progressive NP impairment in HIV disease.

Neurocognitive disease associated with HIV infection has been separated into two categories: (1) a more severe form, HIV-1-associated dementia complex (HADC); and (2) a less severe form, HIV-1-associated minor cognitive-motor disorder.

 MRI-detectable brain atrophy is strongly associated with CDC stage of systemic HIV disease and much more weakly associated with severity of NP impairment. When HIV+ subjects were subgrouped by clinical stage, the MRI differences were directly and strongly associated with increasing severity of systemic disease.

 Opportunistic infections of the CNS remain the most common specifically identifiable source of neurologic disability