Study: Diffuse White Matter Signal Abnormalities May Suggest HIV Replication

A recent study found that diffuse white matter signal abnormality (DWMSA) shown on magnetic resonance imaging (MRI) scans was associated with cerebrospinal fluid discordance and escape in HIV-infected patients presenting with diverse neurological problems.

For their study, researchers retrospectively examined data from 146 HIV-infected patients undergoing a lumbar puncture. Researchers used hospital and clinic electronic databases to collect patient characteristics, including HIV viral load (VL) in plasma and cerebrospinal fluid (CSF), CD4 count, MRI brain findings, antiretroviral therapy (ART), clinical penetration effectiveness (CPE) scores for the ART regimen, and clinical indication for the lumbar puncture.
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Researchers found that 24 (14.7%) of the lumbar punctures in 22 patients showed CSF discordance, and 10 (6.1%) of the lumbar punctures in 9 patients showed CSF escape. Seven patients with CSF escape had been diagnosed with HIV less than 7 years before the lumbar puncture, and 6 patients with resistance data had documented evidence of drug-resistant virus in their plasma.

Both CSF discordance and escape were associated with DWMSAs on cranial MRI (adjusted odds ratio, 10.3 [95% confidence interval {CI}, 2.3–45.0], P = .007 and 56.9 [95% CI, 4.0–882.8], P = .01, respectively). In addition, the subgroup analysis showed that individuals with CSF escape had normal (>350 cells/µL) CD4 count at the time of the lumbar puncture, highlighting that a normal CD4 count does not exclude CSF escape.

“In summary, this study adds to the body of knowledge by demonstrating an association between MRI diffuse white matter signal abnormalities and both HIV discordance and escape. Physicians should be aware that the presence of DWMSAs on MRI in a peripherally suppressed individual with neurological symptoms may suggest HIV replication in CSF and that a normal CD4 count does not exclude this phenomenon,” the researchers concluded. “Longitudinal studies with serial MRI findings correlated with peripheral and CSF VL will be needed to further evaluate this association.”

—Melissa Weiss

Reference:

Kugathasan R, Collier DA, Haddow LJ, et al. Nervous system among patients with neurological symptoms [published online March 13, 2017]. Clin Infect Dis. doi: doi.org/10.1093/cid/cix035.