Cortical folding pattern of asymptomatic HIV-associated neurocognitive disorders

Subtle alterations in cortical morphology among people living with HIV (PLWH) who exhibit milder or no cognitive impairment remain poorly understood. This study investigated changes in cortical morphology in PLWH using multidimensional structural parameters. High-resolution three-dimensional T1 structural images were acquired from 23 PLWH with asymptomatic neurocognitive impairment (ANI), 26 PLWH with intact cognition (IC), and 25 healthy controls (HCs) matched for age and sex. Cortical morphology features, including the sulci depth, mean curvature, and gyrification index, were computed utilizing surface-based morphometric method. Correlation analyses were conducted to assess relationships between cortical morphological parameters and clinical scales, as well as neuropsychological assessments. No significant differences in sulcal depth were observed among HIV-ANI, HIV-IC, and HCs groups. Compared to HCs, increased cortical mean curvature was noted in the left angular gyrus and right subcentral gyrus in HIV-ANI, and in the right subcentral gyrus in HIV-IC. Both HIV groups exhibited higher gyrification indices in the bilateral frontal cortex, family-wise error (FWE) corrected. HIV-ANI showed trends toward increased cortical folding compared to HIV-IC, though these were not significant after FWE correction. Correlations were found between brain folding measures and cognitive outcomes: right subcentral curvature was inversely related to fine motor skills in HIV-ANI; higher gyrification index in the right fronto-marginal area was linked to poorer learning and recall scores. These findings suggest that alterations in cortical folding patterns, particularly mean curvature and gyrification index, may serve as promising biomarkers for elucidating the neurobiological mechanisms underlying HIV-related neurocognitive impairment.