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A total of 50 patients were enrolled in the study, and MRI brain with MRspectroscopy was done. Tuberculosis was the most common neurologic diseasefound in the HIV positive group, consisting of 9 patients. Seven of thesepatients had tuberculous meningitis amongst which a further 2 had vasculiticinfarcts.PML was seen in 6 patients. NAA to Cr ratio was found to be reduced inall the patients, and in fact the value was further reduced compared to the HIVpositive group as a whole. Raised choline and myoInositol peaks were also foundin all the patients. MR Spectroscopy showed lipid lactate peaks confirming thediagnosis. 2 patients had HIV encephalopathy on the imaging study. Theirspectra also revealed lowered NAA peaks along with raised choline peaks. 2patients with cryptococcosis showed characteristic imaging finding of enlargedVirchow Robin (perivascular) spaces. They revealed elevated choline peaks inaddition to reduced NAA. The values of NAA to Cr ratio were determined afterduly processing the spectroscopic data from both cases and controls. Each group(Cases and controls) were divided on the basis of age into two age groups:Lesser than or equal to 40 years, and greater than 40 years. In all threegroups the values of the mean NAA to Cr ratio ratio was significantly (p-valueless than 0.05) reduced in comparison to controls. An ancillary finding was thereduction of NAA to Cr ratio further in cases of PML. Combined use of both theconventional and advanced MRI sequences is advisable as spectroscopy helps inconfirming the diagnosis of opportunistic infection of the CNS in HIV positivepatients. NAA to Cr ratio ratio is reduced in HIV positive patients and is amarker for HIV infection of the brain even in the absence of imaging findingsof HIV encephalopathy or when the patient is symptomatic due to neurologicaldisease of other etiologies.

A Study of N-Acetyl aspartic acid/Creatine Ratio in the White Matter of HIV Positive Patients and Its Application