De Alwis Paba M, Smith Bryan R, Wu Tianxia, Artrip Cristah, Steinbach Sally, Morse Caryn, Lau Chuen-Yen, Rapoport Stanley I, Snow Joseph, Tramont Edmund, Reich Daniel S, Nair Govind, Nath Avindra
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
Clinical Center, National Institutes of Health, Bethesda, MD, United States.
Front Neurol. 2019 Jun 26;10:687. doi: 10.3389/fneur.2019.00687. eCollection 2019.
To characterize cerebral arterial remodeling in HIV-infected (HIV+) individuals , and to study its clinical and immunological associations. T2-weighted magnetic resonance imagining sequences was used to determine cross-sectional area (vascular caliber) of the anterior (A1 segment) and middle (M1 segment) cerebral arteries in HIV- (control) and HIV+ subjects on antiretroviral therapy. Correlations of A1 caliber with clinical, demographic parameters, and immunological markers in cerebrospinal fluid (CSF) were determined using multivariable analyses. A1 and M1 calibers from 22 HIV- control subjects (age: median 48.5 years, range 22-60 years, 55% male) and 61 HIV+ subjects (age: median 53 years, range 25-60 years, 67% male) were studied. ANCOVA, adjusting for ethnicity and sex (age was not correlated with M1 or A1 caliber in either group), revealed that HIV+ subjects had larger caliber in the A1 segment than HIV- subjects (4.95 ± 0.14 mm, and 4.47 ± 0.21 mm respectively, = 0.048), but caliber of the M1 segment did not differ among the groups (7.21 ± 0.14 mm and 7.09 ± 0.23 mm respectively, = 0.65). In the HIV+ cohort, longer disease duration and higher current CD4 T-cell count were associated with reduced A1 caliber ( =-0.42 and -0.33 respectively, < 0.05). In addition, increase in cardiovascular disease risk (CVD risk) was associated with a decrease in A1 caliber in the HIV group ( = -0.35, < 0.05). This cross-sectional study reveals an increase in A1 caliber in the HIV+ cohort, compared to control subjects, which is especially prominent in early phase of the disease. This increase in caliber may be associated with acute pathological processes in HIV during the initial stages of infection resulting in loss of compliance or thinning of the arterial wall. At later stages, such changes may be confounded by arteriosclerotic changes that are common in later stages of HIV infection. This study suggests there is extensive vessel remodeling in various stages of infection. Long-term longitudinal follow-up of this cohort is planned to further verify this hypothesis and to better understand this MRI marker of intracranial vascular caliber.
为了描述HIV感染（HIV+）个体的脑动脉重塑情况，并研究其临床和免疫学关联。使用T2加权磁共振成像序列来确定接受抗逆转录病毒治疗的HIV阴性（对照）和HIV+受试者的大脑前动脉（A1段）和中动脉（M1段）的横截面积（血管管径）。通过多变量分析确定A1管径与临床、人口统计学参数以及脑脊液（CSF）中的免疫学标志物之间的相关性。研究了22名HIV阴性对照受试者（年龄：中位数48.5岁，范围22 - 60岁，55%为男性）和61名HIV+受试者（年龄：中位数53岁，范围25 - 60岁，67%为男性）的A1和M1管径。在对种族和性别进行校正的协方差分析（年龄在两组中均与M1或A1管径无关）显示，HIV+受试者的A1段管径大于HIV阴性受试者（分别为4.95±0.14毫米和4.47±0.21毫米，P = 0.048），但M1段管径在两组之间没有差异（分别为7.21±0.14毫米和7.09±0.23毫米，P = 0.65）。在HIV+队列中，疾病持续时间较长和当前CD4 T细胞计数较高与A1管径减小相关（分别为r = -0.42和-0.33，P < 0.05）。此外，HIV组中心血管疾病风险（CVD风险）增加与A1管径减小相关（r = -0.35，P < 0.05）。这项横断面研究表明，与对照受试者相比，HIV+队列中A1管径增加，在疾病早期尤为明显。这种管径增加可能与感染初期HIV的急性病理过程有关，导致血管顺应性丧失或动脉壁变薄。在后期阶段，这种变化可能会被HIV感染后期常见的动脉硬化变化所混淆。这项研究表明在感染的各个阶段都存在广泛的血管重塑。计划对该队列进行长期纵向随访，以进一步验证这一假设，并更好地理解这种颅内血管管径的MRI标志物。
