HIV-associated CD4/8 depletion in infancy is associated with neurometabolic reductions in the basal ganglia at age 5 years despite early antiretroviral therapy

OBJECTIVE: Investigating consequences of early or late antiretroviral therapy (ART) initiation in infancy on young brain development using magnetic resonance spectroscopy (MRS).
DESIGN: Most pediatric HIV/ART-related neurological studies are from neuropsychological/clinical perspectives. MRS can elucidate the mechanisms underpinning neurocognitive outcomes by quantifying the brain's chemical condition through localized metabolism to provide insights into health and development.
METHODS: Basal ganglia metabolite concentrations were assessed in thirty-eight 5-year-old HIV-infected children previously participating in a randomized trial comparing early limited ART to deferred continuous ART, as well as 15 uninfected controls (12 HIV exposed). Metabolite levels were compared between 26 infected children who initiated ART at/before 12 weeks and 12 who initiated afterwards, and were correlated with clinical HIV and treatment-related measures.
RESULTS: HIV-infected children initiating ART after 12 weeks had lower creatine, choline and glutamate (p's  CONCLUSIONS: Despite early ART (