The regional pattern of abnormal cerebrovascular reactivity in HIV-infected, virally suppressed women
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The regional pattern of abnormal cerebrovascular reactivity in HIV-infected, virally suppressed women Andrew L. Callen 1 & Sara M. Dupont 2 & Jeffrey Pyne 3 & Jason Talbott 1 & Phyllis Tien 4 & Evan Calabrese 1 & David Saloner 1 & Felicia C. Chow 5 & Jared Narvid 1 Received: 26 February 2020 / Revised: 23 April 2020 / Accepted: 19 May 2020 # Journal of NeuroVirology, Inc. 2020
Abstract The purpose of this study was to assess whole brain and regional patterns of cerebrovascular reactivity (CVR) abnormalities in HIVinfected women using quantitative whole brain arterial spin labeling (ASL). We hypothesized that HIV-infected women would demonstrate decreased regional brain CVR despite viral suppression. This cross-sectional study recruited subjects from the Bay Area Women’s Interagency Health Study (WIHS)—a cohort study designed to investigate the progression of HIV disease in women. In addition to conventional noncontrast cerebral MRI sequences, perfusion imaging was performed before and after the administration of intravenous acetazolamide. CVR was measured by comparing quantitative ASL brain perfusion before and after administration of intravenous acetazolamide. In order to validate and corroborate ASL-based whole brain and regional perfusion, phase-contrast (PC) imaging was also performed through the major neck vessels. FLAIR and susceptibility weighted sequences were performed to assess for white matter injury and microbleeds, respectively. Ten HIV-infected women and seven uninfected, age-matched controls were evaluated. Significant group differences were present in whole brain and regional CVR between HIV-infected and uninfected women. These regional differences were significant in the frontal lobe and basal ganglia. CVR measurements were not significantly impacted by the degree of white matter signal abnormality or presence of microbleeds. Despite complete viral suppression, dysfunction of the neurovascular unit persists in the HIV population. Given the lack of association between CVR and traditional imaging markers of small vessel disease, CVR quantification may provide an early biomarker of pre-morbid vascular disease. Keywords HIV . Cerebral vasoreactivity . MRI
Introduction The increasing availability of antiretroviral therapies (ART) has altered the phenotype of HIV infection to a chronic, treatable disease. Despite viral suppression and immune * Andrew L. Callen [email protected] 1
Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, Rm S257A, San Francisco, CA 94143, USA
2
Subtle Medical, Inc., Menlo Park, CA, USA
3
Department of Mechanical Engineering, University of California Berkeley, Berkeley, CA, USA
4
Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
5
Department of Neurology, and Division of Infectious Diseases, University of California San Francisco, Weill Institute for Neurosciences, San Francisco, CA, USA
reconstitution, individuals with HIV face increased rates of stroke and n
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