Early single voxel spectroscopy (SVS) studies in children with HIV encephalopathy (HIVE) found lower NAA/Cr ratios in the basal ganglia compared to HIV+ children without encephalopathy and controls (Pavlakis et al., 1995; Lu et al., 1996). In earlier studies where most HIV+ children did not have encephalopathy, no alterations in basal ganglia NAA were found (Lu et al., 1996; Keller et al., 2004; Prado et al., 2011). More recently, Mbugua et al. (2016) reported higher absolute NAA levels in HIV+ children initiating ART before 12 weeks compared to a control group comprising mostly (80%) HIV-exposed uninfected (HEU) children.