Although at age 9 HIV+ children on ART show no difference in Cho level to control children, in HEU children Cho levels are lowered, suggesting that cell density may be reduced. In addition, we found reduced Cr, reflecting lowered energy metabolism, as well as reduced NAA and Glu, possibly reflecting loss of neurons or reduction in normal neurotransmission. Together, these neurometabolite reductions support the suggestion of loss of both neuronal and glial cells.