White Matter Microstructural Integrity and Neurobehavioral Outcome of HIV-Exposed Uninfected Neonates - PubMed (original) (raw)

Observational Study

White Matter Microstructural Integrity and Neurobehavioral Outcome of HIV-Exposed Uninfected Neonates

Linh T Tran et al. Medicine (Baltimore). 2016 Jan.

Abstract

The successful implementation of prevention programs for mother-to-child human immunodeficiency virus (HIV) transmission has dramatically reduced the prevalence of infants infected with HIV while increasing that of HIV-exposed uninfected (HEU) children. Neuropsychological assessments indicate that HEU children may exhibit differences in neurodevelopment compared to unexposed children (HUU). Pathological mechanisms leading to such neurodevelopmental delays are not clear. In this observational birth cohort study we explored the integrity of regional white matter microstructure in HEU infants, shortly after birth. Microstructural changes in white matter associated with prenatal HIV exposure were evaluated in HEU infants (n = 15) and matched controls (n = 22) using diffusion tensor imaging and tract-based spatial statistics. Additionally, diffusion values were extracted and compared for white matter tracts of interest, and associations with clinical outcomes from the Dubowitz neonatal neurobehavioral tool were investigated. Higher fractional anisotropy in the middle cerebellar peduncles of HEU compared to HUU neonates was found after correction for age and gender. Scores on the Dubowitz abnormal neurological signs subscale were positively correlated with FA (r = 0.58, P = 0.038) in the left uncinate fasciculus in HEU infants. This is the first study to present data suggesting that prenatal HIV exposure without infection is associated with altered white matter microstructural integrity in the neonatal period. Longitudinal studies of HEU infants as their brains mature are necessary to understand further the significance of prenatal HIV and antiretroviral treatment exposure on white matter integrity and neurodevelopmental outcomes.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1

FIGURE 1

White matter tracts superimposed on a 3D brain template: analysis by regions of interest. Diffusion anisotropy was higher in the middle cerebellar peduncles (blue) of HIV-exposed uninfected infants compared to controls as seen in sagittal (A), coronal (B), and axial (C) views. HIV = human immunodeficiency virus.

FIGURE 2

FIGURE 2

Variability of FA values by the group in the middle cerebellar peduncle. FA = fractional anisotropy.

FIGURE 3

FIGURE 3

White matter tracts superimposed on a 3D brain template: tracts associated with neurobehavior. Scores on the Dubowitz abnormal neurological signs subscale was positively correlated with FA in the left uncinate fasciculus (green), negatively correlated with MD and AD in the right inferior cerebellar peduncle (yellow), negatively correlated with MD and AD in the left hippocampal cingulum (pink), and negatively correlated with MD in the right hippocampal cingulum (blue) of HIV-exposed uninfected infants, as seen in the sagittal (A), coronal (B), and axial (C) views. AD = axial diffusivity, FA = fractional anisotropy, HIV = human immunodeficiency virus, MD = mean diffusivity.

References

    1. Mutevedzi PC, Newell ML. The changing face of the HIV epidemic in Sub-Saharan Africa. Trop Med Int Health 2014; 19:1015–1028. -PubMed
    1. Victoria M, Granich R, Gilks CF, et al. The global fight against HIV/AIDS, tuberculosis, and malaria current status and future perspectives. Am J Clin Pathol 2009; 131:844–848. -PubMed
    1. UN Joint Programme on HIV/AIDS (UNAIDS). Global report: UNAIDS report on the global AIDS epidemic: 2014. Geneva, Switzerland:2014.
    1. Barron P, Pillay Y, Doherty T, et al. Eliminating mother-to-child HIV transmission in South Africa. Bull World Health Organ 2013; 91:70–74. -PMC -PubMed
    1. Goga AE, Dinh TH, Jackson DJ, et al. First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa. J Epidemiol Community Health 2014; 69:240–248. -PMC -PubMed

Publication types

MeSH terms

LinkOut - more resources