Antiretroviral therapy and its influence on the stage of brain damage in patients with HIV – 1H MRS evaluation
Eugeniusz Tarasów, Alicja Wiercińska-Drapało, Jerzy Jaroszewicz, Agnieszka Orzechowska-Bobkiewicz, Wojciech Dzienis, Danuta Prokopowicz, Jerzy Walecki
Med Sci Monit 2004; 10(3): 101-106
Background: MR proton spectroscopy (1H MRS) enables early detection of metabolic changes, which occur in the course of AIDS Dementia Complex Syndrome (ADC). The goal of the study was the evaluation of highly active antiretroviral therapy (HAART) and its influence on the character and intensity of metabolic changes in brain 1H MRS spectra in clinically asymptomatic HIV-infected patients as well as search for correlation between the treatment and 1H MR spectroscopy results and immune deficit degree.
Material and Methods: In the group of 20 HIV+ patients, the examination of the central nervous system (CNS), MR and 1H MRS were conducted twice: before HAART treatment and during the therapy; on average after 6 months (4–9 months of treatment).
Results: The levels of NAA/Cr in the control MRS examination were close to the values observed before treatment. However, statistically significant increase in NAA/Cho ratio (p<0.05) was noticed. The control examination showed statistically decrease of Cho/Cr and mI/Cr ratios, though statistically insignificant (p>0.05). NAA and Cr contents in reference to the signal of non-suppressed water increased insignificantly in the follow-up examination. However, statistically significant decrease in Cho/H2O and mI/H2O levels (p<0.05) was observed.
Conclusion: The therapy with HAART affects normalization of metabolite levels in the central nervous system in clinically asymptomatic HIV+ patients and diminishes the risk of ADC occurrence. Myoinositol and choline levels estimated in 1H MRS might be the indices for antiretroviral treatment efficacy.
Keywords: highly active retroviral therapy, brain damage, MR spectroscopy, AIDS Dementia Complex - pathology, Adult, Antiretroviral Therapy, Highly Active, Aspartic Acid - metabolism, Brain - pathology, Choline - metabolism, Creatine - metabolism, Female, Humans, Inositol - metabolism, Magnetic Resonance Spectroscopy - methods, Male