Increased Cortical Cerebral Blood Flow in Asymptomatic Human Immunodeficiency Virus-Infected Subjects

Sen, Souvik; An, Hongyu; Menezes, Prema; Oakes, Jonathan; Eron, Joseph J.; Lin, Weili; Robertson, Kevin

doi:10.1016/j.jstrokecerebrovasdis.2016.03.045

Cited by 11 publications

(9 citation statements)

References 40 publications

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“…As already noted, 18 F‐FDG, as opposed to CMRO 2 , can be a marker of increased inflammatory cell activity [22,23]. A statistically significant increase in cortical GM blood flow was previously reported based on data from the initial 26 controls and 27 PLHIV treatment‐naïve subjects in this study [46]. In the larger groups reported here, a slight trend was still present in the baseline studies but not for the 12‐month data.…”

Section: Discussionsupporting

confidence: 69%

Reduction in cerebral oxygen metabolism in subcortical regions may be a biomarker of cognitive decline in people living with human immunodeficiency virus

Sen

Sollman

et al. 2021

Euro J of Neurology

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Background and purpose: Regional cerebral blood flow (rCBF) and oxygen metabolism (rCMRO 2 ) in whole brain, white matter, gray matter and lenticular nuclei were studied in people living with human immunodeficiency virus (PLHIV) as well as HIV-associated neurocognitive disorder (HAND).Methods: Treatment-naïve PLHIV underwent neurocognitive assessment and magnetic resonance (MR) measurement of rCBF and rCMRO 2 with repeat after 12 months of antiretroviral therapy (ART). Age-and sex-matched controls underwent single MR measurements. Regional CBF and rCMRO 2 were compared amongst symptomatic, asymptomatic, normal HAND and controls using analysis of variance. Longitudinal analysis of HAND worsening (≥1 category) was assessed after 12 months of ART and correlated with rCBF and rCMRO 2 measured by MR imaging using the paired-sample t test.Results: Thirty PLHIV completed baseline and 12-month assessments (29 with rCMRO 2 measurement). At baseline HAND assessment, 13% had no cognitive impairment, 27% had asymptomatic neurocognitive impairment, 60% had mild neurocognitive disorder and none had HIV-associated dementia. At 12 months, 13% had no cognitive impairment, 20% had asymptomatic neurocognitive impairment, 50% had mild neurocognitive disorder and 17% had HIV-associated dementia. In those without HAND worsening (N = 21) rCMRO 2 remained stable and in those with HAND worsening (N = 8) rCMRO 2 measurement declined from baseline to 12 months in white matter (2.05 ± 0.40 to 1.73 ± 0.51, p = 0.03) and lenticular nuclei (4.32 ± 0.39 to 4.00 ± 0.51, p = 0.05). Conclusions:In recently diagnosed PLHIV, no association was found between rCBF or rCMRO 2 and cognitive impairment at baseline. There was a reduction in rCMRO 2 in those with worsening of cognitive function at 12 months on ART. Reduction in rCMRO 2 may be a biomarker of cognitive decline in PLHIV.

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Section: Discussionsupporting

confidence: 69%

Reduction in cerebral oxygen metabolism in subcortical regions may be a biomarker of cognitive decline in people living with human immunodeficiency virus

Sen

Sollman

et al. 2021

Euro J of Neurology

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“…We demonstrate a significant effect of HIV + status on regional CBF compared to age, sex, and education matched controls. Based on prior work 22–25 , our primary hypothesis was that a pattern of regional cerebral hypoperfusion in HIV despite plasma viral suppression would discriminate HIV + participants from HIV − participants and from MCI participants. Our data suggests a pattern of hypoperfusion in HIV that involves bilateral temporal, and occipital regions previously noted to be affected by longitudinal volumetric reductions 17 in a larger sample of the same cohort ( UCSF HIV Over 60 Cohort) .…”

Section: Discussionmentioning

confidence: 99%

“…In this context, neuroimaging studies of HIV + participants consistently demonstrate increased white matter intensities 10–12 as well as altered cerebrovascular reactivity and autoregulation 13,14 . Given that small vessel ischemic disease is associated with reduced cerebral perfusion over time 19 and hypoperfusion acts as precursor to volume loss in other neurodegenerative diseases 20,21 , several investigators have found global cerebral perfusion abnormalities in the HIV + population 22–25 . This study evaluates the specific regional pattern of CBF abnormalities in older HIV + virally suppressed participants using quantitative whole-brain arterial spin labelling MRI (ASL).…”

Section: Introductionmentioning

confidence: 99%

Abnormal Cerebral Perfusion Profile in Older Adults with HIV-Associated Neurocognitive Disorder: Discriminative Power of Arterial Spin-Labeling

Narvid

McCoy

Callen

et al. 2018

AJNR Am J Neuroradiol

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Background and Purpose: The aging HIV+ population have increased vascular comorbidities, including stroke, and increased cognitive deficits compared to the general population. Arterial spin labelling (ASL) MRI is a technique to measure cerebral blood flow (CBF), and is more sensitive than regional volume loss in the assessing neurodegenerative diseases and cognitive aging. Previous studies have found global cerebral perfusion abnormalities in the HIV+ participants. In this study, we evaluated the specific regional pattern of CBF abnormalities in older HIV+ participants using quantitative whole-brain ASL. Methods: CBF data from the HIV Over 60 cohort and the Alzheimer’s Disease Neuroimaging Initiative were retrospectively evaluated to identify 19 HIV+ older adults, all with plasma viral suppression (including five with HIV-Associated Neurocognitive Disorder, or HAND), 13 healthy, aged matched controls (HC), and 19 participants with early Mild Cognitive Impairment (MCI). CBF values were averaged by region of interest (ROI) and compared between the three groups using generalized linear models. Results: Accounting for age, education, sex, and vascular risk factors, the HIV+ participants demonstrated alterations in regional cerebral perfusion including hypoperfusion of bilateral temporal, parietal, and occipital brain regions compared to both clinically normal and participants with MCI. ASL MRI shows reasonable test characteristics in distinguishing HIV-associated neurocognitive disorder (HAND) from HC and MCI participants. Conclusion: This study finds significant changes in specific CBF patterns associated with HIV status despite viral suppression; data which should animate further investigations as to the pathobiological basis of vascular and cognitive abnormalities in HAND.

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“…2 There is paucity of data on the brain imaging findings in PLWH vs HIV− stroke patients from LMICs, with most of the data from HICs. 13,15,17,23,24 A systematic review indicated that ischemic stroke type was proportionally greater in PLWH when compared with their HIV− counterparts. 2 Recent SSA data indicate that stroke type (i.e., ischemic or hemorrhagic) does not differ in PLWH.…”

mentioning

confidence: 99%

“…Most research on HIV-associated stroke originates from high-income countries (HICs), 12-19 and patient characteristics may differ from those in LMICs. Differences in the median age and traditional cardiometabolic risk factor prevalence have been highlighted between PLWH and stroke patients without HIV (HIV−) from different income settings.…”

mentioning

confidence: 99%

Prevalence and Characteristics of HIV-Associated Stroke in a Tertiary Hospital Setting in South Africa

et al. 2022

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Background and Objectives:Antiretroviral treatment (ART) era HIV-associated stroke data from Sub-Saharan Africa is limited. We determined the prevalence of HIV in patients presenting with acute symptomatic stroke, and compared risk factors, clinical characteristics, and brain imaging with age-matched stroke patients without HIV.Methods:We conducted a retrospective study of adults presenting with any type of stroke to Tygerberg Hospital in a 12-month period. Patients living with HIV (PLWH) and HIV-uninfected patients (HIV-) were matched on age group (1:2 ratio). Patients were identified by keyword search, while HIV status was ascertained from laboratory data. Clinical and imaging data were extracted from medical records.Results:Among 884 patients presenting with acute strokes, the minimum prevalence of HIV infection was 9.3% (95% CI: 7.4-11.2%), with 496 patients (56.1%) with negative HIV status and 306 patients with unknown HIV status (34.6%). Mean age at presentation in PLWH was 46 (± 11) years compared to 55 (± 14) years in HIV- (p<0.001). Smoking was less prevalent in PLWH with an adjusted relative risk of RR=0.58 (95% CI: 0.39–0.86). Concurrent infection was more prevalent in PLWH (25.6% vs 4.9%, p=<0.001) with an adjusted relative risk ratio of 2.07 (95% CI: 1.49–2.84), largely in patients with CD4 count <200 cells/mcL. PLWH with higher CD4 counts (≥200 cells/mcL, 51.3%) had more traditional risk factors and less concurrent infection. Among PLWH, 68.3% were on ART, and 39.3% of these had been started or restarted on ART within the past 6-months. Basal ganglia infarcts (35.6% vs 18.3%, p=0.014) and multiple vascular territory involvement (25.4% vs 7.7%, p=0.002) was more common in PLWH. Clinical presentation, ischaemic stroke type, and in-hospital outcomes did not differ between groups.Conclusion:Stroke patients with HIV were younger, had less traditional cardiovascular risk factors, and more concurrent infections than patients without HIV, especially those with a lower CD4 count. Recent ART initiation or reinitiation rates were high. Significant differences in CT brain imaging findings were seen. Understanding the multifactorial mechanisms underlying increased stroke risk, including associated infections and potential ART-associated immune reconstitution, is crucial and needs further study.

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Increased Cortical Cerebral Blood Flow in Asymptomatic Human Immunodeficiency Virus-Infected Subjects

Cited by 11 publications

References 40 publications

Reduction in cerebral oxygen metabolism in subcortical regions may be a biomarker of cognitive decline in people living with human immunodeficiency virus

Reduction in cerebral oxygen metabolism in subcortical regions may be a biomarker of cognitive decline in people living with human immunodeficiency virus

Abnormal Cerebral Perfusion Profile in Older Adults with HIV-Associated Neurocognitive Disorder: Discriminative Power of Arterial Spin-Labeling

Prevalence and Characteristics of HIV-Associated Stroke in a Tertiary Hospital Setting in South Africa

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