Neurocognitive Impairment in HIV: Anatomo-Clinical Correlation through Functional Neuroimaging

HIV-associated neurocognitive impairment persists despite the widespread use of highly active antiretroviral therapy (HAART) and sustained viral suppression, remaining a clinically relevant manifestation in people living with HIV and suggesting the involvement of complex neurobiological mechanisms and specific neural networks associated with higher cognitive functions. This study aimed to describe and compare cortical and subcortical neurofunctional alterations in people living with HIV presenting HIV-associated neurocognitive impairment and to correlate these neuroanatomical findings with clinical manifestations and neurocognitive stage. A total of 72 men living with HIV, aged 24–72 years and with sustained viral suppression under HAART, were evaluated. Neuropsychological and neuropsychiatric assessments were performed using standardized instruments, with neurocognitive impairment classified according to the Frascati criteria, the International HIV Dementia Scale (IHDS), and the HIV Dementia Scale (HDS). Functional neuroimaging was performed using ^99mTc-ECD single-photon emission computed tomography (SPECT), followed by semi-quantitative analysis of cerebral perfusion. A high prevalence of neurofunctional abnormalities was observed, with their extent and distribution associated with disease stage. The most significant alterations involved the anterior cingulate gyrus, left dorsolateral prefrontal cortex, and basal ganglia. Perfusion abnormalities in the left anterior insula were associated with ipsilateral caudate nucleus and anterior cingulate involvement, suggesting alterations within interconnected frontostriatal and salience-related networks. More extensive perfusion abnormalities were associated with greater clinical severity and more prominent apathetic symptoms. These findings indicate that HIV-associated neurofunctional alterations persist despite sustained viral suppression and exhibit specific cortical and subcortical anatomical patterns related to clinical severity, supporting the potential value of functional neuroimaging as a tool for anatomo-clinical correlation in HIV-associated neurocognitive impairment.