MRI Scans Can Help Identify HIV Persistence in the Brain After Treatment

With 36.7 million individuals across the globe living with HIV, researchers everywhere are seeking to better understand the virus in the hopes of findings ways to control it and ultimately cure those who are infected. Many of the methods used to learn more about the virus can be invasive for the patients; however, new research from the University College London (UCL) has provided another piece to the puzzle that is HIV, with minimal invasion on the patient.

Published in the journal Clinical Infectious Diseases, the new study shows that UCL scientists have found a way to use MRI scans to detect when HIV persists in the brain “despite effective drug treatment,” according to a recent press release.

Senior author Ravindra K. Gupta, professor of infection and immunity at UCL, honorary consultant in Infectious Diseases at The Hospital for Tropical Diseases, UCLH NHS Foundation Trust, explained the significance of detecting HIV in the brain, “Before we had effective treatments for HIV, AIDS often led to dementia and other problems in the brain.”

In addition, the University of California, San Francisco, reports that not only can HIV infect the brain, but it can also harm the central nervous system. With the help of antiretroviral therapy, however, the most severe forms of HIV-related dementia have seen a significant decrease in prevalence, but HIV-related neurocognitive disorders are still common.

“Up to half of HIV patients still report cognitive problems,” said Dr Gupta. “We see evidence that HIV has spread to the brain in around 10-15% of these patients, but in most cases the symptoms are down to other causes.” He continued, “At the moment, we have to perform a lumbar puncture to confirm this, which involves inserting a needle into the back to draw out the spinal fluid and test it for HIV. This is quite an invasive procedure that requires patients to stay in hospital for several hours.”

However, things may be looking up.

According to Dr. Gupta, “Our new study shows that MRI scans could help to identify high-risk individuals to further follow-up tests.” And, MRI scans are arguably less invasive than lumbar puncture.

For the single-center retrospective study, the research team looked at 146 HIV-positive patients and examined them for cognitive problems between 2011 to 2015. Their findings? In 22 patients (15%), HIV was active in the brain, and “patients whose brains showed definite signs of change in the white matter were ten times more likely to have HIV in the brain than those with normal white matter appearance.”

The aforementioned changes are called diffuse white matter signal abnormalities, according to the press release, which are “linked” to cognitive problems; they can be “triggered” by HIV-related brain inflammation.

“HIV treatments have come a long way, but patients whose HIV is suppressed by drugs can still have cognitive problems due to HIV-related inflammation,” said Dr. Gupta. “MRI scans can help to diagnose these patients, whether showing an elevated risk of HIV-related problems or findings a different cause that can then be treated. Where HIV has spread to the brain, we can change the treatment regime to add drugs that cross the blood-brain barrier more effectively to control the infection.”