A prospective controlled study of magnetic resonance imaging of the brain in gay men and parenteral drug users with human immunodeficiency virus infection
G. Dooneief, J. Bello, G. Todak, I. K. Mun, K. Marder, R. Malouf, J. Gorman, S. Hilal, Y. Stern and R. Mayeux
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute.
To detect the earliest structural changes in the brain in human
immunodeficiency virus (HIV) infection, 118 gay men and 115 parenteral drug
users enrolled in a study of the natural history of HIV infection underwent
magnetic resonance imaging evaluations. Routine T2-weighted and heavily
T2-weighted scans for quantification of brain water were obtained, blinded
to HIV serostatus. Atrophy and foci of increased signal did not correlate
with any medical, immunologic, neurologic, or neuropsychologic parameters
in the group as a whole, or in the gay men or parenteral drug user
subgroups. Three subjects had progressive multifocal leukoencephalopathy
and one had central nervous system lymphoma. In a subgroup in whom
intracranial water percent was calculated, correlations were found with CD4
counts and CD4/CD8 ratios. We conclude that standard magnetic resonance
imaging of the brain does not differentiate asymptomatic and mildly
symptomatic HIV-positive individuals from HIV-negative individuals,
regardless of risk group. However, intracranial water percent may
distinguish HIV-positive from HIV-negative individuals because it
correlates with raw CD4 counts and CD4/CD8 ratios.
