Altered Diffusion Tensor Image Analysis Along the Perivascular Space in People With Human Immunodeficiency Virus: Association With Cognition and Diagnostic Utility for Asymptomatic Neurocognitive Impairment.

BACKGROUND

This aim of this work was to investigate glymphatic function in people with human immunodeficiency virus type 1 (HIV-1) using diffusion tensor image analysis along the perivascular space (DTI-ALPS) and to explore its associations with cognition and clinical status, as well as its diagnostic utility in identifying asymptomatic neurocognitive impairment (ANI).

METHODS

Forty people with HIV (PWH) with ANI (PWH-ANI), 44 PWH with normal cognition (PWH-NC), and 29 age-, sex-, and education-matched persons without HIV underwent MRI and neuropsychological assessments. DTI-ALPS indices were calculated and their group differences were evaluated using general linear models. Partial correlation and multivariate regression analyses were conducted to assess associations between DTI-ALPS indices and cognitive or clinical variables. Mediation analyses were used to examine whether DTI-ALPS mediated the effect of HIV on cognition. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance.

RESULTS

DTI-ALPS indices were significantly lower in PWH-ANI than persons without HIV and PWH-NC (all P < .01), with no differences between persons without HIV and PWH-NC. Among PWH, lower DTI-ALPS was associated with higher cognitive T scores (ie, poorer performance) in attention/working memory, speed of information processing, and abstract/executive function (all false discovery rate-adjusted P < .05). DTI-ALPS for the bilateral hemisphere (DTI-ALPS_B) emerged as the only independent predictor and partially mediated the relationship between HIV status and these cognitive domains. ROC analysis showed that the combined model of DTI-ALPS_B and Montreal Cognitive Assessment (MoCA) outperformed MoCA alone (AUC, 0.782 and 0.619, respectively; P = .001).

CONCLUSIONS

Reduced DTI-ALPS is evident in PWH-ANI and was associated with and mediated cognitive impairment. DTI-ALPS may serve as a noninvasive biomarker facilitating early detection of PWH-ANI.