Abstract Details

Neurodevelopmental impairment is common in children with pHIV, but little is known about the cognitive profile of adults living with pHIV. Additionally, there is no singular imaging correlate of cognitive impairment in persons living with HIV (PLWH). Myelin water imaging (MWI) quantifies global and regional myelin content utilizing differences in relaxation times of water trapped within the myelin bilayer compared to free water. We determined the cognitive profile and examined the correlation between MWF, a metric of myelin content acquired on MWI, and cognition in virally suppressed adults living with pHIV.

To describe cognitive outcomes in virally suppressed adults living with perinatally acquired HIV (pHIV) and to demonstrate the association between myelin water fraction (MWF), a novel imaging biomarker of myelin content, and cognition in our cohort

Seventeen adults over 21 years of age with pHIV, virally suppressed on ART, underwent an 11-test cognitive battery covering seven domains. Raw scores were adjusted for age, education, sex, and race/ethnicity and domain specific z-scores were determined using normative data. GRASE acquisition sequence was used for MWI data processing to determine global and frontal lobe MWF values. Correlations were assessed using Spearman rank correlation coefficient.

Ten (58%) virally suppressed adults living with pHIV were cognitively impaired with the lowest scores in the gross motor (average z-score: -2.9) and verbal memory (average z-score: -1.5) domain. Executive function scores were significantly higher in those with higher global MWF (Spearman r: 0.762, p: 0.037).  

Cognitive impairment is common among our cohort of adults living with virally suppressed pHIV, particularly in the gross motor domain. This may be due to a legacy effect on motor development as individuals in this cohort were born during a period when access to ART was limited. Reduced MWF, a marker of demyelination, may be an imaging biomarker for HIV-related cognitive impairment.