Altered Diffusion Tensor Image Analysis Along the Perivascular Space in People Living with HIV: Association with Cognition and Diagnostic Utility for Asymptomatic Neurocognitive Impairment

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ID: 314819
2026
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Abstract
BACKGROUND: To investigate glymphatic function in people living with HIV (PLWH) using the diffusion tensor image analysis along the perivascular space (DTI-ALPS), and explore its associations with cognition and clinical status, as well as its diagnostic utility in identifying asymptomatic neurocognitive impairment (ANI). MATERIALS AND METHODS: Forty PLWH with ANI (PLWH-ANI), 44 PLWH with normal cognition (PLWH-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 PLWH-ANI than persons without HIV and PLWH-NC (all p<0.01), with no differences between persons without HIV and PLWH-NC. Among PLWH, lower DTI-ALPS were associated with higher cognitive T scores (i.e., poorer performance) in attention/working memory, speed of information processing, and abstract/executive function (all FDR-p<0.05). 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 MoCA outperformed MoCA alone (AUC = 0.782, 0.619; p = 0.001). CONCLUSIONS: Reduced DTI-ALPS is evident in PLWH-ANI, and was associated with and mediated cognitive impairment. DTI-ALPS may serve as a non-invasive biomarker facilitating early detection of PLWH-ANI.
Reference Key
openalex_W7162198436 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Ke Xue, YuXin Shi, Yinwen Gan, Renfang Zhang, Xia Xu, Jay C. Buckey, Jili Wu, Fengxiang Song, Zhiyong Zhang, Fei Shan, Yi Zhan
Journal The Journal of infectious diseases
Year 2026
DOI
10.1093/infdis/jiag265
URL
https://doi.org/10.1093/infdis/jiag265
Keywords Keywords not found

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