Imperial College London

Dr Jonathan Underwood

Faculty of MedicineDepartment of Infectious Disease

Honorary Clinical Research Fellow



+44 (0)20 3312 1466jonathan.underwood Website CV




Winston Churchill WingSt Mary's Campus






BibTex format

author = {Underwood, J and Cole, JH and Caan, M and De, Francesco D and Leech, R and van, Zoest RA and Su, T and Geurtsen, GJ and Schmand, BA and Portegies, P and Prins, M and Wit, FW and Sabin, CA and Majoie, C and Reiss, P and Winston, A and Sharp, DJ and Co-morBidity, in Relation to Aids COBRA Collaboration},
doi = {cid/cix301},
journal = {Clinical Infectious Diseases},
pages = {422--432},
title = {Grey and white matter abnormalities in treated HIV-disease and their relationship to cognitive function.},
url = {},
volume = {65},
year = {2017}

RIS format (EndNote, RefMan)

AB - Background: Long-term comorbidities such as cognitive impairment remain prevalent in otherwise effectively treated people-living-with-HIV. We investigate the relationship between cognitive impairment and brain structure in successfully treated patients using multi-modal neuroimaging from the Co-morBidity in Relation to AIDS (COBRA) cohort. Methods: Cognitive function, brain tissue volumes and white matter microstructure were assessed in 134 HIV-positive patients and 79 controls. All patients had suppressed plasma HIV RNA at cohort entry. In addition to comprehensive voxelwise analyses of volumetric and diffusion tensor imaging, we used an unsupervised machine learning approach to combine cognitive, diffusion and volumetric data, taking advantage of the complementary information they provide. Results: Compared to the highly comparable control group, cognitive function was impaired in four out of the six cognitive domains tested (median global T-scores: 50.8 vs. 54.2, p<0.001). Patients had lower grey but not white matter volumes, observed principally in regions where structure generally did not correlate with cognitive function. Widespread abnormalities in white matter microstructure were also seen, including reduced fractional anisotropy with increased mean and radial diffusivity. In contrast to the grey matter, these diffusion abnormalities correlated with cognitive function. Multivariate neuroimaging analysis identified a neuroimaging phenotype associated with poorer cognitive function, HIV-infection and systemic immune activation. Conclusions: Cognitive impairment, lower grey matter volume and white matter microstructural abnormalities were evident in HIV-positive individuals despite fully suppressive antiretroviral therapy. White matter abnormalities appear to be a particularly important determinant of cognitive dysfunction seen in well-treated HIV-positive individuals.
AU - Underwood,J
AU - Cole,JH
AU - Caan,M
AU - De,Francesco D
AU - Leech,R
AU - van,Zoest RA
AU - Su,T
AU - Geurtsen,GJ
AU - Schmand,BA
AU - Portegies,P
AU - Prins,M
AU - Wit,FW
AU - Sabin,CA
AU - Majoie,C
AU - Reiss,P
AU - Winston,A
AU - Sharp,DJ
AU - Co-morBidity,in Relation to Aids COBRA Collaboration
DO - cid/cix301
EP - 432
PY - 2017///
SN - 1537-6591
SP - 422
TI - Grey and white matter abnormalities in treated HIV-disease and their relationship to cognitive function.
T2 - Clinical Infectious Diseases
UR -
UR -
VL - 65
ER -