Dissociable Contributions of Precuneus and Cerebellum to Subjective and Objective Neuropathy in HIV

J Neuroimmune Pharmacol. 2019 Sep;14(3):436-447. doi: 10.1007/s11481-019-09837-2. Epub 2019 Feb 11.


Neuropathy, typically diagnosed by the presence of either symptoms or signs of peripheral nerve dysfunction, remains a frequently reported complication in the antiretroviral (ART)-treated HIV population. This study was conducted in 109 healthy controls and 57 HIV-infected individuals to investigate CNS regions associated with neuropathy. An index of objective neuropathy was computed based on 4 measures: deep tendon ankle reflex, vibration sense (great toes), position sense (great toes), and 2-point discrimination (feet). Subjective neuropathy (self-report of pain, aching, or burning; pins and needles; or numbness in legs or feet) was also evaluated. Structural MRI data were available for 126/166 cases. The HIV relative to the healthy control group was impaired on all 4 signs of neuropathy. Within the HIV group, an objective neuropathy index of 1 (bilateral impairment on 1 measure) or 2 (bilateral impairment on at least 2/4 measures) was associated with older age and a smaller volume of the cerebellar vermis. Moderate to severe symptoms of neuropathy were associated with more depressive symptoms, reduced quality of life, and a smaller volume of the parietal precuneus. This study is consistent with the recent contention that ART-treated HIV-related neuropathy has a CNS component. Distinguishing subjective symptoms from objective signs of neuropathy allowed for a dissociation between the precuneus, a brain region involved in conscious information processing and the vermis, involved in fine tuning of limb movements. Graphical Abstract In HIV patients, objective signs of neuropathy correlated with smaller cerebellar vermis (red) volumes whereas subjective symptoms of neuropathy were associated with smaller precuneus (blue) volumes.

Keywords: Aesthesiometer; Magnetic resonance imaging (MRI); Position sense; Reflex; Vibration.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Brain Mapping*
  • Cerebellar Vermis / diagnostic imaging
  • Cerebellar Vermis / physiopathology*
  • Depression / etiology
  • Female
  • Gyrus Cinguli / diagnostic imaging
  • HIV Infections / complications*
  • HIV Infections / psychology
  • Humans
  • Leg / innervation
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Neuralgia / diagnostic imaging
  • Neuralgia / etiology
  • Neuralgia / physiopathology
  • Neuralgia / psychology
  • Organ Size
  • Pain Perception
  • Paresthesia / diagnostic imaging
  • Paresthesia / etiology
  • Paresthesia / physiopathology
  • Parietal Lobe / diagnostic imaging
  • Parietal Lobe / physiopathology*
  • Perceptual Disorders / diagnostic imaging
  • Perceptual Disorders / etiology
  • Perceptual Disorders / physiopathology
  • Peripheral Nervous System Diseases / diagnostic imaging
  • Peripheral Nervous System Diseases / etiology
  • Peripheral Nervous System Diseases / physiopathology*
  • Peripheral Nervous System Diseases / psychology
  • Quality of Life
  • Reflex, Abnormal
  • Self Report
  • Somatosensory Disorders / diagnostic imaging
  • Somatosensory Disorders / etiology
  • Somatosensory Disorders / physiopathology
  • Thalamus / diagnostic imaging
  • Vibration