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Background: Effective highly active antiretroviral therapy (HAART) could prevent progression of white matter (WM) injury. However, prolonged use of HAART may induce neurotoxicity. This study investigated the efficacy and neurotoxicity of HAART by evaluating WM injury using diffusion tensor magnetic resonance imaging (DTI) in patients with HIV-associated neurocognitive disorders (HAND). Methods: Forty-six patients with HAND underwent DTI before and every six months during HAART treatment. DTI data, including fractional anisotropy (FA) and mean diffusivity (MD) values of structural WM before and after HAART, were compared. The relationship between DTI values and plasma viral loads was also evaluated. Findings: MD was more sensitive than FA for evaluating WM injury in HAND-positive patients. Following 12 months of HAART, increased MD values (compared to 6 months of HAART) were observed in the right temporal lobe, right parietal lobe, right occipital lobe, right anterior limb of the internal capsule, right lenticular nucleus, right cerebral pedunculus, left caudate nucleus, left dorsal thalamus, and left posterior limb of the internal capsule. MD values in the left genu of the internal capsule (r = 0.350, P < 0.05) and left corona radiata (r = 0.338, P < 0.05) were positively correlated with plasma viral loads. Interpretation: DTI may be useful for assessing efficacy and neurotoxicity of HAART in HAND-positive patients. Initiating HAART may halt WM injury; however, prolonged HAART could worsen WM injury, highlighting the importance of optimal HAART duration. Funding: Guangxi Science and Technology Department Key Research and Development Programs, Youth Science Foundation of Guangxi Medical University and International Communication of Guangxi Medical University Graduate Education. Declaration of Interest: None. Ethical Approval: All experiments performed are endorsed by the Ethics Committee of Guangxi Medical University and complied with the Declaration of Helsinki. |
