BACKGROUND Perinatal HIV infection negatively impacts cognitive functioning of children, main domains affected are working memory, processing speed and executive function. Early ART, even when interrupted, improves neurodevelopmental outcomes. Diffusion tension imaging (DTI) is a sensitive tool assessing white matter damage. We hypothesised that white matter measures in regions showing HIV-related alterations will be associated with lower neurodevelopmental scores in specific domains related to the functionality of the affected tracts. METHODS DTI was performed on children in a neurodevelopmental sub study from the Children with HIV Early Antiretroviral (CHER) trial. Voxel-based group comparisons to determine regions where fractional anisotropy and mean diffusion differed between HIV+ and uninfected children were done. Locations of clusters showing group differences were identified using the Harvard-Oxford cortical and subcortical and John Hopkins University WM tractography atlases provided in FSL. This is a second review of DTI data in this cohort, which was reported in a previous study. Neurodevelopmental assessments including GMDS and Beery-Buktenica tests were performed and correlated with DTI parameters in abnormal white matter. RESULTS 38 HIV+ children (14 male, mean age 64.7 months) and 11 controls (4 male, mean age 67.7 months) were imaged. Two clusters with lower fractional anisotropy and 7 clusters with increased mean diffusion were identified in the HIV+ group. The only neurodevelopmental domain with a trend of difference between the HIV+ children and controls (p = 0.08), was Personal Social Quotient which correlated to improved myelination of the forceps minor in the control group. As a combined group there was a negative correlation between visual perception and radial diffusion in the right superior longitudinal fasciculus and left inferior longitudinal fasciculus, which may be related to the fact that these tracts, forming part of the visual perception pathway, are at a crucial state of development at age 5. CONCLUSION Even directed neurodevelopmental tests will underestimate the degree of microstructural white matter damage detected by DTI. The visual perception deficit detected in the entire study population should be further examined in a larger study.

中文翻译：

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扩散张量成像表明在5岁的HIV感染儿童中仍存在功能障碍，使用标准的神经发育评估无法检测到。

背景技术围产期HIV感染会对儿童的认知功能产生负面影响，受影响的主要领域是工作记忆，处理速度和执行功能。早期抗逆转录病毒治疗即使被中断也能改善神经发育结果。扩散张力成像（DTI）是评估白质损害的灵敏工具。我们假设，在显示与HIV相关的改变的区域中，白质测量将与特定区域中与受影响管道功能相关的较低神经发育评分相关。方法DTI是在儿童HIV早期抗逆转录病毒（CHER）试验的神经发育子研究中对儿童进行的。基于体素的组比较，以确定HIV +和未感染儿童之间的分数各向异性和平均扩散不同的区域。使用FSL提供的哈佛-牛津皮层和皮层下层以及约翰·霍普金斯大学WM超声影像学地图集确定了显示群体差异的聚类位置。这是该队列中DTI数据的第二次综述，该研究在先前的研究中进行了报道。进行了包括GMDS和Beery-Buktenica测试在内的神经发育评估，并将其与异常白质中的DTI参数相关联。结果对38名HIV +儿童（14名男性，平均年龄64.7个月）和11名对照（4名男性，平均年龄67.7个月）进行了成像。在HIV +组中发现了两个具有较低的各向异性的簇和七个具有较高平均扩散的簇。HIV +儿童与对照组之间存在差异趋势的唯一神经发育区域（p = 0.08），是与对照组中未成年人钳子的髓鞘改善有关的个人社会商机。作为一个组合的群体，右上纵筋膜和左下纵筋膜的视觉感知与径向扩散之间呈负相关，这可能与以下事实有关：构成视觉感知路径一部分的这些束处于至关重要的位置结论5岁时的发育状态。结论即使直接的神经发育测试也将低估DTI检测到的微结构白质损害的程度。在整个研究人群中检测到的视觉知觉缺陷应在更大的研究中进一步检查。作为一个组合的群体，右上纵筋膜和左下纵筋膜的视觉感知与径向扩散之间呈负相关，这可能与以下事实有关：构成视觉感知路径一部分的这些束处于至关重要的位置结论5岁时的发育状态。结论即使直接的神经发育测试也将低估DTI检测到的微结构白质损害的程度。在整个研究人群中检测到的视觉知觉缺陷应在更大的研究中进一步检查。作为一个组合的群体，右上纵筋膜和左下纵筋膜的视觉感知与径向扩散之间呈负相关，这可能与以下事实有关：构成视觉感知路径一部分的这些束处于至关重要的位置结论5岁时的发育状态。结论即使直接的神经发育测试也将低估DTI检测到的微结构白质损害的程度。在整个研究人群中检测到的视觉知觉缺陷应在更大的研究中进一步检查。结论即使直接的神经发育测试也将低估DTI检测到的微结构白质损害的程度。在整个研究人群中检测到的视觉知觉缺陷应在更大的研究中进一步检查。结论即使直接的神经发育测试也将低估DTI检测到的微结构白质损害的程度。在整个研究人群中检测到的视觉知觉缺陷应在更大的研究中进一步检查。