Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco.
Department of Medicine, Division of Infectious Diseases, University of California, San Francisco.
AIDS. 2021 Feb 2;35(2):257-266. doi: 10.1097/QAD.0000000000002755.
Women may be disproportionately impacted by the negative effect of HIV on cerebrovascular risk. We examined the association of HIV, sex, menopause, and immune activation with cerebrovascular function among women with HIV (WWH) and at risk for HIV from the Women's Interagency HIV Study and men with HIV.
Cross-sectional.
Participants were aged at least 40 years with coronary heart disease or at least one cardiometabolic risk factor. All persons with HIV were on antiretroviral therapy with undetectable viral load. Cerebral vasoreactivity was assessed by the transcranial Doppler breath-holding test, with lower vasoreactivity corresponding to worse cerebrovascular function. Menopausal status was determined by anti-Müllerian hormone level. We used mixed effects linear regression to identify factors associated with cerebral vasoreactivity.
Mean cerebral vasoreactivity was similar in WWH (n = 33) and women at risk for HIV (n = 16). A trend toward higher cerebral vasoreactivity in WWH compared with men with HIV (n = 37) was no longer present after excluding women on estrogen replacement therapy (n = 3). In women, menopausal status was not significantly associated with cerebral vasoreactivity. WWH with higher cardiovascular risk (-0.14 for each additional cardiometabolic risk factor, P = 0.038), sCD163 (-0.20 per doubling, P = 0.033), and proportion of CD4+CX3CR1+ T cells (-0.14 per doubling, P = 0.028) had lower cerebral vasoreactivity.
Among older women at high cardiovascular risk, women with virologically suppressed HIV and women at risk for HIV had similar cerebrovascular function. Our findings, which must be interpreted in the context of the small sample, highlight the contribution of traditional cardiometabolic risk factors and immune activation to cerebrovascular risk in WWH.
艾滋病毒对脑血管风险的负面影响可能在女性中更为突出。我们研究了艾滋病毒、性别、绝经和免疫激活与艾滋病毒妇女（WHW）和有感染艾滋病毒风险的妇女（来自妇女艾滋病研究机构间工作组）以及男性艾滋病毒感染者的脑血管功能之间的关系。
横断面研究。
参与者年龄至少 40 岁，患有冠心病或至少有一种心血管代谢危险因素。所有艾滋病毒感染者均接受抗病毒治疗，病毒载量无法检测。通过经颅多普勒超声呼吸暂停试验评估脑血管反应性，较低的脑血管反应性对应于较差的脑血管功能。通过抗苗勒管激素水平确定绝经状态。我们使用混合效应线性回归来确定与脑血管反应性相关的因素。
WHW（n=33）和有感染艾滋病毒风险的女性（n=16）的平均脑血管反应性相似。在排除正在接受雌激素替代疗法的女性（n=3）后，WHW 与男性艾滋病毒感染者（n=37）相比，脑血管反应性较高的趋势不再存在。在女性中，绝经状态与脑血管反应性无显著相关性。心血管风险较高的 WHW（每增加一个心血管代谢危险因素，脑血管反应性降低 0.14，P=0.038）、sCD163（每增加一倍，脑血管反应性降低 0.20，P=0.033）和 CD4+CX3CR1+T 细胞比例（每增加一倍，脑血管反应性降低 0.14，P=0.028）的脑血管反应性较低。
在高心血管风险的老年女性中，病毒学抑制的艾滋病毒女性和有感染艾滋病毒风险的女性具有相似的脑血管功能。我们的研究结果必须在小样本的背景下进行解释，突出了传统心血管代谢危险因素和免疫激活对 WHW 脑血管风险的贡献。
