Proton MRS and quantitative MRI assessment of the short term neurological response to antiretroviral therapy in AIDS

Objective—To investigate MRI and proton spectroscopy changes in five patients with HIV associated dementia complex (HADC) treated with antiretroviral therapy. Methods—Three markers were evaluated: (1) CSF/intracranial volume ratio; (2) T2 weighted signal ratio between parietooccipital white and subcortical grey matter; and (3) metabolite ratios from long echo time (TE=135 ms) single voxel proton spectra of parieto-occipital white matter. Results—Spectroscopic changes indicated initial increases in N-acetyl/(N-acetyl + choline + creatine) ratio (NA/(NA+ Cho+Cr)) and progression of atrophy after initiation of antiretroviral therapy in four of five patients. When the neurological status of the patients subsequently deteriorated (two offive patients), the NA/(NA+Cho+Cr) ratio also declined. Conclusions—spectroscopic changes mirror reversible neuronal dysfunction. These objective, non-invasive techniques may be used for monitoring the neurological eVects of antiretroviral drug therapy in patients with HADC. (J Neurol Neurosurg Psychiatry 1997;63:477‐482)