MRI Scans Can Identify HIV in the Brain

Brain scans could help diagnose patients with HIV-related cognitive issues.

MRI scans may help identify patients with HIV who are at high-risk of the virus spreading to their brain, according to a study published in Clinical Infectious Diseases.

For the study, scientists examined data from 146 patients with HIV who were investigated for cognitive problems between 2011 and 2015.

“Before we had effective treatments for HIV, AIDS often led to dementia and other problems in the brain,” said senior author Ravi Gupta. “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 10% to 15% 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 [the] hospital for several hours. Our new study shows that MRI scan could help to identify high-risk individuals for further follow-up tests.”

The results of the study showed that 22 patients had evidence of HIV activity in the brain. Patients who showed definite signs of change in the white matter, called diffuse white matter signal abnormalities, were 10 times more likely to have HIV of the brain than those with normal white matter appearances.

Diffuse white matter signal abnormalities are liked to cognitive problems and can be triggered by inflammation in the brain caused by the virus.

“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,” Gupta said. “MRI scans can help 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 regimen to add drugs that cross the blood-brain barrier more effectively to control the infection.”