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George Dooneief, MD; Jacqueline Bello, MD; George Todak, MSW; In K. Mun, PhD; Karen Marder, MD; Renée Malouf, MD; Jack Gorman, MD; Sadek Hilal, MD, PhD; Yaakov Stern, PhD; Richard Mayeux, MD

Arch Neurol. 1992;49(1):38-43.

Abstract
• 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.

Author Affiliations
From the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute (Drs Dooneief, Marder, Malouf, Gorman, Stern, and Mayeux and Mr Todak), and the Departments of Neurology (Drs Dooneief, Marder, Malouf, Stern, and Mayeux), Radiology (Drs Bello, Mun, and Hilal), and Psychiatry (Drs Gorman, Stern, and Mayeux), Columbia University College of Physicians and Surgeons, New York, NY.

Footnotes
Accepted for publication June 4, 1991.

Reprint requests to Neurological Institute, 710 W 168th St, New York, NY 10032 (Dr Mayeux).

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