Abstract TP479: Early Effect of Human Immunodeficiency Virus on Cerebral Blood Flow and Autoregulation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Souvik Sen ◽  
Hongyu An ◽  
William J Powers
Keyword(s):  
Human Immunodeficiency Virus ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
White Matter ◽  
Antiretroviral Therapy ◽  
High Risk ◽  
Cerebral Autoregulation ◽  
Immunodeficiency Virus ◽  
Treatment Naïve

Introduction: Human immunodeficiency virus (HIV)-infected individuals are at high risk for ischemic stroke. We measured cerebral blood flow (CBF), oxygen extraction fraction (OEF), and autoregulation in HIV infected subjects and controls. Methods: In treatment-naive HIV infected subjects and age-, gender-, and race-matched controls, OEF was measured by using MRI T2*-weighted echo-planar imaging sequences and CBF was measured by MRI pulsed arterial spin labeling (PASL) approach. Static cerebral autoregulation was determined by measuring changes in CBF and OEF, in response to ≈10% reductions in MAP induced by using IV Nicardipine infusion. All images were acquired using a Siemens 3T MR scanner (Treo, Siemens Medical Systems Inc). Cerebral autoregulation was measured globally and regionally in gray matter (GM), white matter (WM) and subcortical GM. Autoregulatory Index (AI) was computed using the equation AI = %CBF change/% MAP change supplemented by CBF associated OEF changes. Nominal p-values are uncorrected for multiple comparisons. Results: Forty-one treatment naive HIV-infected subjects and 47 age-, gender-, race-matched controls participated. HIV-infected subjects had higher CBF in cortical GM compared to the controls (76.8± 12 mL/100 g/min versus 71.6 ± 11 mL/100 g/min; p= 0.04), but not in white matter (30.9± 8 mL/100 g/min versus 30.0 ± 8 mL/100 g/min; p = 0.60) or subcortical GM (62.8± 13 mL/100 g/min versus 61.3 ± 13 mL/100 g/min; p = 0.57). Whole brain (WB), GM, WM, and subcortical GM, OEF were similar between the groups (p > .05). The median AI were similar between cases and controls in WB (0.40 vs 0.18, p=0.86), GM (0.10 vs. 0.16, p=0.87), WM (0.80 vs. 0.87, p=0.31), and subcortical GM (1.65 vs. 1.77, p=0.26). A 12-month follow-up (N=30) in HIV-subjects on antiretroviral therapy did not produce a significant change in CBF or OEF in the WB, GM, WM, or subcortical GM (Paired sample t test p>0.05). Similarly, no changes were noted on the AI (Wilcoxon Match Rank test p>0.05). Conclusions: AI was similar between HIV cases and control and remained so after 12-months of antiretroviral therapy. We found no evidence of a defect in autoregulation to explain the high-risk of ischemic stroke documented in other studies.

scholarly journals Predicting poor adherence to antiretroviral therapy among treatment-naïve veterans infected with human immunodeficiency virus

Medicine ◽  
2018 ◽  
Vol 97 (2) ◽  
pp. e9495 ◽  
Author(s):  
Yan Cheng ◽  
Nancy A. Nickman ◽  
Christine Jamjian ◽  
Vanessa Stevens ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Poor Adherence ◽  
Immunodeficiency Virus ◽  
Treatment Naïve

scholarly journals A Novel Method to Derive Separate Gray and White Matter Cerebral Blood Flow Measures from MR Imaging of Acute Ischemic Stroke Patients

2005 ◽  
Vol 25 (9) ◽  
pp. 1236-1243 ◽  
Author(s):  
Jessica E Simon ◽  
Michael S Bristow ◽  
Hong Lu ◽  
M Louis Lauzon ◽  
Robert A Brown ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Spin Echo ◽  
Statistical Significance ◽  
Mean Transit Time ◽  
Inversion Recovery ◽  
Normal Brain

Perfusion-weighted imaging (PWI) measures can predict tissue outcome in acute ischemic stroke. Accuracy might be improved if differential tissue susceptibility to ischemia is considered. We present a novel voxel-by-voxel analysis to characterize cerebral blood flow (CBF) separately in gray (GM) and white matter (WM). Ten patients were scanned with inversion-recovery spin-echo EPI (IRSEPI), diffusion-weighted imaging (DWI), PWI<6 h from onset and fluid attenuated inversion-recovery (FLAIR) at 30 days. Image processing included coregistration to PWI, automatic segmentation of IRSEPI into GM, WM and CSF and semiautomatic segmentation of DWI/FLAIR to derive the acute and 30-day lesions. Five tissue compartments were defined: (1) ‘Core’ (abnormal acutely and at 30 days), (2) ‘Growth’ (or ‘infarcted penumbra', abnormal only at 30 days), (3) ‘Reversed’ (abnormal acutely but normal at 30 days), (4) ‘MTT-Delayed ‘ (tissue with delayed mean transit time but not part of the acute or 30-day lesion), and (5) ‘Normal’ brain. Cerebral blood flow in GM and WM of each compartment was obtained from quantitative maps. Gray matter and WM mean CBF in the growth region differed by 5.5 mL/100 g min ( P = 0.015). Mean CBF also differed significantly within normal and MTT-Delayed compartments. The difference in the reversed region approached statistical significance. In core, GM and WM CBF did not differ. The results suggest separate ischemic thresholds for GM and WM in stroke penumbra.

scholarly journals Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clara Gregori-Pla ◽  
Rickson C. Mesquita ◽  
Christopher G. Favilla ◽  
David R. Busch ◽  
Igor Blanco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Autoregulation ◽  
Cerebrovascular Disorders ◽  
Blood Flow Response ◽  
Flow Response ◽  
Ica Stenosis

Abstract Background The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Methods Transcranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol. Results After elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p < 0.001) or ICA stenosis (8.6% [3.1,14.0], p = 0.003)). MAP in AIS patients did not return to baseline values (2.6 mmHg [0.5, 4.7], p = 0.018), but in ICA stenosis patients and controls did. Instead ipsilesional but not contralesional CBF was correlated with MAP (AIS 6.0%/mmHg [− 2.4,14.3], p = 0.038; ICA stenosis 11.0%/mmHg [2.4,19.5], p < 0.001). Conclusions The observed associations between ipsilateral CBF and MAP suggest that short HOB position changes may elicit deficits in cerebral autoregulation in cerebrovascular disorders. Additional research is required to further characterize this phenomenon.

Human Immunodeficiency Virus Type 1 Vpu Inhibitor, BIT225, in Combination with 3-Drug Antiretroviral Therapy: Inflammation and Immune Cell Modulation

2020 ◽  
Author(s):  
Carolyn A Luscombe ◽  
Anchalee Avihingsanon ◽  
Khuanchai Supparatpinyo ◽  
Sivaporn Gatechompol ◽  
Win Min Han ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Clinical Trials ◽  
Antiretroviral Therapy ◽  
Immune Cell ◽  
Combined Treatment ◽  
Standard Of Care ◽  
Immunodeficiency Virus ◽  
Treatment Naïve ◽  
Clinical Trials Registry

Abstract BIT225 is a first-in-class inhibitor of human immunodeficiency virus (HIV) type 1 Vpu. A phase II trial enrolled 36 HIV-1–infected, treatment-naive participants in Thailand to receive standard-of-care antiretroviral therapy (ART), tenofovir disoproxil fumarate/emtricitabine/efavirenz (Atripla), with 100 or 200 mg of BIT225 or placebo (daily) for 12 weeks. Combined treatment with BIT225 and ART was found to be generally safe and well tolerated, with antiviral efficacy comparable to that of ART alone. The secondary end point—soluble CD163, a marker of monocyte/macrophage inflammation—was noted to be significantly decreased in the BIT225 arm. Plasma-derived activated CD4+ and CD8+ T cells, natural killer cells, and interleukin 21 were increased in those treated with BIT225. These findings are consistent with inhibition of the known effects of HIV Vpu and may reflect clinically important modulation of inflammatory and immune function. Further clinical study is planned to both confirm and extend these important findings in treatment-naive, and treatment-experienced individuals. Clinical Trials Registration. Australian New Zealand Clinical Trials Registry (Universal Trial Number U1111-1191-2194).

scholarly journals Antiretroviral Therapy–Induced Bone Loss Is Durably Suppressed by a Single Dose of Zoledronic Acid in Treatment-Naive Persons with Human Immunodeficiency Virus Infection: A Phase IIB Trial

2019 ◽  
Vol 71 (7) ◽  
pp. 1655-1663 ◽  
Author(s):  
Ighovwerha Ofotokun ◽  
Lauren F Collins ◽  
Kehmia Titanji ◽  
Antonina Foster ◽  
Caitlin A Moran ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Single Dose ◽  
Lumbar Spine ◽  
Zoledronic Acid ◽  
Antiretroviral Therapy ◽  
Bone Resorption ◽  
Bone Loss ◽  
Phase Iii ◽  
Immunodeficiency Virus ◽  
Treatment Naïve

Abstract Background Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are associated with bone loss leading to increased fracture rate among persons with HIV (PWH). We previously showed long-acting antiresorptive zoledronic acid (ZOL) prevented ART-induced bone loss through 48 weeks of therapy and here investigate whether protection persisted. Methods We randomized 63 nonosteoporotic, treatment-naive adult PWH initiating ART to ZOL (5 mg) versus placebo in a double-blinded, placebo-controlled, phase IIb trial. Here we analyzed the long-term outcome data (144 weeks). Plasma bone turnover markers and bone mineral density (BMD) were quantified at weeks 0, 12, 24, 48, 96, and 144. Primary outcome was change in bone resorption marker C-terminal telopeptide of collagen (CTx). Repeated-measures analyses using mixed linear models were used to estimate and compare study endpoints. Results At 96 weeks, mean CTx was 62% lower with ZOL relative to placebo (n = 46; CTx = 0.123 vs 0.324 ng/mL; P &lt; .001); at 144 weeks a 25% difference between arms was not statistically significant. At 48 weeks, lumbar spine BMD with ZOL was 11% higher than placebo (n = 60; P &lt; .001) and remained 9–11% higher at 96 (n = 46) and 144 (n = 41; P &lt; .001) weeks. 144 weeks after ZOL infusion, BMD did not change at the lumbar spine (P = .22) but declined at the hip (P = .04) and femoral neck (P = .02). Conclusions A single dose of ZOL administered at ART initiation blunts bone resorption and BMD loss at key fracture-prone anatomical sites in treatment-naive PWH for 3 years. A multicenter randomized phase III clinical trial validating these results in a larger population is needed. Clinical Trials Registration NCT01228318.

Stroke in a young patient with neurosyphilis and HIV

2016 ◽  
Vol 28 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Riddhi Patira ◽  
Sarah Smith-Benjamin ◽  
Jijo J Wang
Keyword(s):  
Human Immunodeficiency Virus ◽  
Ischemic Stroke ◽  
High Risk ◽  
Drug Users ◽  
Risk Groups ◽  
Intravenous Drug Users ◽  
Immunodeficiency Virus ◽  
Cranial Neuropathies ◽  
Sex With Men ◽  
Morbid Conditions

Syphilis has long been known as the great imitator. Its heterogeneity can manifest in the form of meningitis, space occupying gummas, vasculitis, strokes, cranial neuropathies, myelopathy, dementia, and seizures. The incidence has been rising with each year, mainly in men who have sex with men accounting for 83% of cases. With the coexistence of immunocompromised states, especially HIV (human immunodeficiency virus), the usually chronic and insidious course of tertiary neurosyphilis can be accelerated. Stroke can occur as a result of neurosyphilis in its meningovascular form, and the likelihood of this increases with HIV co-infection, especially in high-risk groups such as intravenous drug users and men who have sex with men. Here, we discuss a case of a young man who presented with an ischemic stroke found to have neurosyphilis and HIV and consider the management of these co-morbid conditions.

Reduced Cerebral Blood Flow in Early Stages of Human Immunodeficiency Virus Infection

1990 ◽  
Vol 47 (12) ◽  
pp. 1342-1345 ◽  
Author(s):  
E. Schielke ◽  
K. Tatsch ◽  
H. W. Pfister ◽  
C. Trenkwalder ◽  
G. Leinsinger ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Virus Infection ◽  
Human Immunodeficiency Virus Infection ◽  
Early Stages ◽  
Immunodeficiency Virus
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