Change in Brain Magnetic Resonance Spectroscopy after Treatment during Acute HIV Infection

Napapon Sailasuta, William Ross, Jintanat Ananworanich, Thep Chalermchai, Victor DeGruttola, Sukalaya Lerdlum, Mantana Pothisri, Edgar Busovaca, Silvia Ratto-Kim, Linda Jagodzinski, Serena Spudich, Nelson Michael, Jerome H. Kim, Victor Valcour*, Nittaya Phanuphak, Nipat Teeratakulpisarn, James L.K. Fletcher, Duanghathai Suttichom, Suteeraporn Pinyakorn, Somprartthana RattanamaneeNitiya Chomchey, Peeriya Mangum, Sasiwimol Ubolyam, Nijasri C. Suwanwela, Napasri Chaisinanunkul, Udom Suthiponpaisan, Chumpita Sutthapas, Mark deSouza, Viseth Ngauy, Rapee Trichavaroj, Siriwat Akapirat, Mary Marovich, Lauren Wendelken, Edgar Busovaca, Carol Liu, Elijah Mun, Bruce Miller

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

95 Scopus citations


Objective: Single voxel proton magnetic resonance spectroscopy (MRS) can be used to monitor changes in brain inflammation and neuronal integrity associated with HIV infection and its treatments. We used MRS to measure brain changes during the first weeks following HIV infection and in response to antiretroviral therapy (ART). Methods: Brain metabolite levels of N-acetyl aspartate (NAA), choline (tCHO), creatine (CR), myoinositol (MI), and glutamate and glutamine (GLX) were measured in acute HIV subjects (n = 31) and compared to chronic HIV+individuals (n = 26) and HIV negative control subjects (n = 10) from Bangkok, Thailand. Metabolites were measured in frontal gray matter (FGM), frontal white matter (FWM), occipital gray matter (OGM), and basal ganglia (BG). Repeat measures were obtained in 17 acute subjects 1, 3 and 6 months following initiation of ART. Results: After adjustment for age we identified elevated BG tCHO/CR in acute HIV cases at baseline (median 14 days after HIV infection) compared to control (p = 0.0014), as well as chronic subjects (p = 0.0023). A similar tCHO/CR elevation was noted in OGM; no other metabolite abnormalities were seen between acute and control subjects. Mixed longitudinal models revealed resolution of BG tCHO/CR elevation after ART (p = 0.022) with tCHO/CR similar to control subjects at 6 months. Interpretation: We detected cellular inflammation in the absence of measurable neuronal injury within the first month of HIV infection, and normalization of this inflammation following acutely administered ART. Our findings suggest that early ART may be neuroprotective in HIV infection by mitigating processes leading to CNS injury.

Original languageEnglish
Article numbere49272
JournalPLoS ONE
Issue number11
StatePublished - 16 Nov 2012
Externally publishedYes


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