Alterations of brain metabolites in adults with HIV: a systematic meta-analysis of MRS studies

Objective. A meta-analysis of proton magnetic resonance spectroscopy (MRS) studies to investigate alterations in brain metabolites in people with HIV (PWH), as well as their relationship with combination antiretroviral therapy (cART) and cognitive impairment. 

Methods. The PubMed database was searched for studies published from 1997 to 2020. Twenty-seven studies were identified, which included 1255 PWH and 633 controls. Four metabolites (N-acetyl aspartate (NAA), myo-Inositol (mI), choline (Cho), and glutamatergic metabolites (Glx) from five brain regions (basal ganglia (BG), frontal gray and white matter (FGM, FWM), and parietal gray and white matter (PGM, PWM)) were pooled separately using random-effects meta-analysis.

Results. During early HIV infection, metabolite alterations were largely limited to the BG, including Cho elevation, a marker of inflammation. cART led to global mI and Cho normalization (i.e., less elevations), but improvement in NAA was negligible. In chronic PW...