Initiation of combined antiretroviral therapy confers suboptimal beneficial effects on neurovascular function in people with HIV.
Initiation of combined antiretroviral therapy confers suboptimal beneficial effects on neurovascular function in people with HIV.
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DOI：
10.3389/fneur.2023.1240300
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发表时间：
2023
影响因子：
3.4
通讯作者：
中科院分区：
文献类型：
--
作者：
由于联合抗逆转录病毒治疗（cART）的进展，艾滋病毒感染者（PWH）患与年龄相关的脑血管疾病（CBVD）的负担增加。潜在的中枢神经系统损伤可以通过测量脑血流（CBF）和脑血管反应性（CVR）来评估。35例treatment-naïve PWH和53例HIV阴性对照（HC）纳入本研究。研究参与者接受了t1加权解剖、伪连续动脉自旋标记和静息状态功能MRI，以获得cART开始治疗前和cART开始后两个时间点（12周和2年）的CBF和CVR测量。对照在基线和2年随访时进行扫描。我们还测量了内皮细胞和神经胶质细胞起源的微粒和众所周知的内皮炎症标志物ICAM-1和VCAM-1的血浆水平，以评估hiv相关的内皮炎症以及这些外周标志物与脑神经血管功能的相互作用。研究发现，在cART开始之前，HIV感染与CVR降低和内皮细胞和神经胶质微粒（MPs）水平升高有关。此外，CVR与PWH外周MP水平呈负相关。我们的研究结果表明，虽然cART治疗在开始后对神经血管功能有有益的影响，但随着时间的推移，这些益处并不理想。
Due to advances in combined anti-retroviral treatment (cART), there is an increased burden of age-related cerebrovascular disease (CBVD), in people living with HIV (PWH). The underlying CNS injury can be assessed by measuring cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). 35 treatment-naïve PWH and 53 HIV negative controls (HC) were enrolled in this study. Study participants underwent T1-weighted anatomical, pseudo-continuous arterial spin labeling, and resting-state functional MRI to obtain measures of CBF and CVR prior to starting cART treatment and at two-time points (12 weeks and 2 years) post-cART initiation. Controls were scanned at the baseline and 2-year visits. We also measured plasma levels of microparticles of endothelial and glial origin and well-known endothelial inflammation markers, ICAM-1 and VCAM-1, to assess HIV-associated endothelial inflammation and the interaction of these peripheral markers with brain neurovascular function. HIV infection was found to be associated with reduced CVR and increased levels of endothelial and glial microparticles (MPs) prior to initiation of cART. Further, CVR correlated negatively with peripheral MP levels in PWH. Our results suggest that while cART treatment has a beneficial effect on the neurovascular function after initiation, these benefits are suboptimal over time.
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