Original Contributions |

11C-PiB Imaging of Human Immunodeficiency Virus–Associated Neurocognitive Disorder

Beau M. Ances, MD, PhD; Tammie L. Benzinger, MD, PhD; Jon J. Christensen, BS; Jewell Thomas, BA; Rohit Venkat, BA; Mengesha Teshome, MD; Patricia Aldea, BS; Anne M. Fagan, PhD; David M. Holtzman, MD; John C. Morris, MD; David B. Clifford, MD
Arch Neurol. 2012;69(1):72-77. doi:10.1001/archneurol.2011.761.
Text Size: A A A
Published online

Objective To evaluate whether the amyloid-binding agent carbon 11–labeled Pittsburgh Compound B (11C-PiB) could differentiate Alzheimer disease (AD) from human immunodeficiency virus (HIV)–associated neurocognitive disorder (HAND) in middle-aged HIV-positive participants.

Design 11C-PiB scanning, clinical assessment, and cerebrospinal fluid (CSF) analysis were performed. Both χ2 and t tests assessed differences in clinical and demographic variables between HIV-positive participants and community-living individuals observed at the Knight Alzheimer’s Disease Research Center (ADRC). Analysis of variance assessed for regional differences in amyloid-β protein 1-42 (Aβ42) using 11C-PiB.

Setting An ADRC and HIV clinic.

Participants Sixteen HIV-positive participants (11 cognitively normal and 5 with HAND) and 19 ADRC participants (8 cognitively normal and 11 with symptomatic AD).

Main Outcome Measures Mean and regional 11C-PiB binding potentials.

Results Participants with symptomatic AD were older (P < .001), had lower CSF Aβ42 levels (P < .001), and had higher CSF tau levels (P < .001) than other groups. Regardless of degree of impairment, HIV-positive participants did not have increased 11C-PiB levels. Mean and regional binding potentials were elevated for symptomatic AD participants (P < .001).

Conclusions Middle-aged HIV-positive participants, even with HAND, do not exhibit increased 11C-PiB levels, whereas symptomatic AD individuals have increased fibrillar Aβ42 deposition in cortical and subcortical regions. Observed dissimilarities between HAND and AD may reflect differences in Aβ42 metabolism. 11C-PiB may provide a diagnostic biomarker for distinguishing symptomatic AD from HAND in middle-aged HIV-positive participants. Future cross-sectional and longitudinal studies are required to assess the utility of 11C-PiB in older individuals with HAND.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Magnetic resonance imaging (MRI) and carbon 11–labeled Pittsburgh Compound B (11C-PiB) imaging in 4 representative study participants. Representative structural MRIs and 11C-PiB images for a cognitively normal human immunodeficiency virus (HIV)–positive participant (A), an HIV-positive participant with HIV-associated neurocognitive disorder (HAND) (B), a cognitively normal Alzheimer’s Disease Research Center (ADRC) participant (C), and ADRC participant with symptomatic Alzheimer disease (AD) (D). Only the symptomatic AD participants had increased fibrillar amyloid deposition using 11C-PiB.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Mean cortical binding potential (MCBP) and regional binding potential for the 4 clinical groups. A, MCBP. A 2 × 2 matrix is created using cerebrospinal fluid (CSF) amyloid-β protein 1-42 (Aβ42) (<500 pg/mL) and MCBP (>0.18 arbitrary units). All human immunodeficiency virus (HIV)–positive participants, regardless of their degree of cognitive impairment, had normal carbon 11–labeled Pittsburgh Compound B imaging results (<0.18 arbitrary units). B, Regional cortical binding potential. For each region, symptomatic Alzheimer’s Disease Research Center (ADRC) participants had higher binding potentials. AD indicates Alzheimer disease; HAND, human immunodeficiency virus–associated neurocognitive disorder; and asterisk, P < .001.




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles