Imaging correlates of the Blood Brain Barrier disruption in HIV associated neuro cognitive disorder and therapeutic implications

Neurocognitive impairment in HIV infection, known as HIV associated neurocognitive disorder (HAND), in the context of suppressive combination antiretroviral therapy still occurs. We hypothesized that ongoing chronic systemic inflammation, a feature of HIV disease despite viral suppression, causes blood brain barrier (BBB) disruption thereby allowing entry of neurotoxic cytokines/chemokines or HIV itself (in very low levels because of suppression) thereby causing HAND or at least worsening it. To test this hypothesis, we have used dynamic contrast enhancement derived metrics (K-trans) to measure the capillary permeability as, a direct indicator for possible BBB disruption and correlated it with neuro inflammatory markers in the cerebrospinal fluid (CSF ) MR spectroscopy derived metabolites as well as with clinical indices of neurocognition (neuropsychological scores).