The purpose of this study was to assess whole brain and regional patterns of cerebrovascular reactivity (CVR) abnormalities in HIV-infected 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.

本研究的目的是使用定量全脑动脉自旋标记 (ASL) 评估 HIV 感染妇女的脑血管反应性 (CVR) 异常的全脑和区域模式。我们假设，尽管病毒受到抑制，但感染 HIV 的女性仍会表现出局部脑 CVR 降低。这项横断面研究从湾区妇女机构间健康研究 (WIHS) 中招募了受试者，这是一项旨在调查女性 HIV 疾病进展的队列研究。除了常规的非对比脑 MRI 序列外，还在静脉注射乙酰唑胺之前和之后进行了灌注成像。通过比较静脉内乙酰唑胺给药前后的定量 ASL 脑灌注来测量 CVR。为了验证和证实基于 ASL 的全脑和区域灌注，还通过主要颈部血管进行了相位对比 (PC) 成像。分别执行 FLAIR 和磁敏度加权序列以评估白质损伤和微出血。评估了 10 名感染 HIV 的女性和 7 名未感染的、年龄匹配的对照。HIV 感染者和未感染者之间的全脑和区域 CVR 存在显着的组别差异。这些区域差异在额叶和基底神经节中很显着。CVR 测量值不受白质信号异常程度或微出血的影响。尽管病毒被完全抑制，但神经血管单元的功能障碍仍然存在于 HIV 人群中。