HIV infected patients can have the virus in their brains, even when the disease is being controlled by treatment, according to a study conducted by scientists at University College London (UCL).

Before we had effective treatments for HIV, AIDS often led to dementia and other problems in the brain,” explains senior author Professor Ravi Gupta (UCL Infection & Immunity). “Thankfully this is less common now that we can treat HIV, but up to half of HIV patients still report cognitive problems. We see evidence that HIV has spread to the brain in around ten to fifteen percent of these patients, but in most cases the symptoms are down to other causes. 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. Our new study shows that MRI scans could help to identify high-risk individuals for further follow-up tests.”

For the study, published in Clinical Infectious Diseases, the team developed a way to use MRI scans to identify cases when HIV persists in the brain despite effective drug treatment. They analysed data from 146 HIV patients with cognitive problems between 2011 and 2015, of which 22 patients (15%) had proven active HIV in their brains.

The scientists found that patients who showed definite signs of change in their brain’s white matter were ten times more likely to have HIV than those whose white matter appeared normal. Those changes in white matter, called diffuse white matter signal abnormalities, may be triggered by inflammation caused by the infection.

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,” says Professor Gupta. “MRI scans can help to diagnose these patients, whether showing an elevated risk of HIV-related problems or finding 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.”

 

Source: UCL News