Neuroimaging (n = 150) (OPTION PERIOD)

Although highly active antiretroviral therapy (HAART) has made a major impact on the course of HIV-related illnesses, neurological complications continue to occur and several syndromes of mild to moderate neurocognitive impairment, as well as occasional frank dementia, continue to be described in HAART-treated individuals. Imaging studies have shown that these symptoms are often accompanied by various forms of brain tissue damage; however, the mechanisms by which this damage occurs are still not understood, the links between tissue damage and functional impairment have not been clearly delineated, and the basis for the neuropathological heterogeneity within the treated population is not known. The proposed studies would address these questions by charting the development of tissue damage over time in individuals with evolving central nervous system (CNS) disease and attempting to link specific human immunodeficiency virus (HIV) disease factors and comorbidities to the tissue alterations. In addition, tissue alterations would be linked to changes in specific cognitive functions, and the role of genetic and disease interaction effects in mediating neurocognitive heterogeneity would be examined.

100 participants with evidence of significant white matter damage and 50 participants with apparently unaffected white matter.

100 participants with evidence of significant white matter damage. In order to control for the relationship between age and white matter, an white matter-age residual will be used to determine eligibility. The affected group will be those 20 participants at each site with the highest white matter-age residuals. 50 subjects who have apparently unaffected white matter (those 10 participants at each site with the lowest white-matter-age residuals)

  Cross-sectional 1st Longitudinal
Age 44.4 (7.8) 45.1 (7.8)
Education 12.9 (2.4) 12.9 (2.4)
Gender (% male) 82% 82%
Caucasian 41% 41%
Hispanic 8% 8%
African American 50% 50%
Other 1% 1%
% AIDS 70% 71%
CD4 464 (290 - 615) 463 (306 - 603)
Log 10 Plasma HIV RNA 2.29 (1.70 - 3.95) 2.04 (1.70 - 4.04)
Log10 CSF HIV RNA 1.70 (1.70 - 2.05) 1.70 (1.70 - 1.86)
NP Impairment (% impaired) 49% 38%

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