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Neuroimaging of HIV in the Brain
Beau M. Ances,Washington Univ in St. Louis, St. Louis, MO, USA
HIV enters the brain soon after seroconversion and can cause HIV associated neurocognitive disorders (HAND). While the more severe and progressive forms of HAND are now less prevalent due to combination antiretroviral therapy (cART), ~ 40% of HIV-infected (HIV+) patients continue to have cognitive impairment. Some HIV+ individuals who have effective plasma HIV-1 RNA suppression with cART still develop HAND due HIV reservoirs in the central nervous system. It is often difficult to diagnose HAND in the outpatient setting as detailed neuropsychological performance testing is required. Additional biomarkers that are relatively easy to obtain and are clinically relevant are needed for assessing HIV associated immune activation. Recently developed non-invasive magnetic resonance imaging (MRI) techniques have great potential to serve as biomarkers. This talk will review the application of advanced neuroimaging techniques [e.g. volumetric MRI, diffusion tensor imaging (DTI), functional MRI (fMRI)] in HIV+ individuals. Each neuroimaging methods can offer unique insight into mechanisms underlying neuroHIV, could monitor disease progression, and may assist in evaluating the efficacy of cART regimens in the CNS. It is hoped that continued development of neuroimaging methods will allow them to be easily incorporated across multiple sites and included in future HAND guidelines.