The regional pattern of abnormal cerebrovascular reactivity in HIV-infected, virally suppressed women

J Neurovirol. 2020 Oct;26(5):734-742. doi: 10.1007/s13365-020-00859-8. Epub 2020 Jun 4.


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.

Keywords: Cerebral vasoreactivity; HIV; MRI.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acetazolamide / administration & dosage
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • Basal Ganglia / blood supply
  • Basal Ganglia / diagnostic imaging
  • Basal Ganglia / pathology*
  • Basal Ganglia / virology
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / pathology*
  • Cerebral Arteries / virology
  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / diagnostic imaging
  • Cerebrovascular Disorders / drug therapy
  • Cerebrovascular Disorders / pathology*
  • Cross-Sectional Studies
  • Disease Progression
  • Female
  • Frontal Lobe / blood supply
  • Frontal Lobe / diagnostic imaging
  • Frontal Lobe / pathology*
  • Frontal Lobe / virology
  • HIV / drug effects
  • HIV / pathogenicity
  • HIV Infections / complications
  • HIV Infections / diagnostic imaging
  • HIV Infections / drug therapy
  • HIV Infections / pathology*
  • Humans
  • Magnetic Resonance Angiography / methods
  • Middle Aged
  • RNA, Viral / genetics
  • Spin Labels
  • White Matter / blood supply
  • White Matter / diagnostic imaging
  • White Matter / pathology*
  • White Matter / virology


  • Anti-HIV Agents
  • RNA, Viral
  • Spin Labels
  • Acetazolamide