A recently implemented 5D echo-planar J-resolved spectroscopic sequence using 8x acceleration and compressed sensing reconstruction was evaluated in 7 perinatally infected and 8 healthy youths. Selected metabolite ratios with respect to Cr were detected bilaterally in the basal ganglia, anterior insular cortex, posterior insular cortex, frontal white and occipital/frontal gray regions of the two groups. Statistically significant differences were found between metabolite ratios (/Cr) of HIV-infected youing adults and healthy control subjects in the occipital gray N-acetylaspartate, right basal ganglia glutamine/glutamate, left anterior insular cortex choline, and left posterior insular cortex. Also, our pilot findings suggest a possible difference in energy metabolism between perinatally HIV-infected young adults and controls without HIV. The metabolite ratios correlated with neuropsychological test scores showing cognitive impairment as result of HIV-infection and/or long term ART.