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Abstract
ObjectiveThe fractal dimension of retinal arteries and veins is a measure of the complexity of the vascular tree. We hypothesized that retinal fractal dimension would be associated with brain volume and white matter integrity in HIV-infected women.DesignNested case-control within longitudinal cohort study.MethodsWomen were recruited from the Brooklyn site of the Women’s Interagency HIV study (WIHS); 34 HIV-infected and 21 HIV-uninfected women with analyzable MRIs and retinal photographs were included. Fractal dimension was determined using the SIVA software program on skeletonized retinal images. The relationship between predictors (retinal vascular measures) and outcomes (quantitative MRI measures) were analyzed with linear regression models. All models included age, intracranial volume, and both arterial and venous fractal dimension. Some models were adjusted for blood pressure, race/ethnicity, and HIV-infection.ResultsThe women were 45.6 ± 7.3 years of age. Higher arterial dimension was associated with larger cortical volumes, but higher venous dimension was associated with smaller cortical volumes. In fully adjusted models, venous dimension was significantly associated with fractional anisotropy (standardized β = -0.41, p = 0.009) and total gray matter volume (β = -0.24, p = 0.03), and arterial dimension with mean diffusivity (β = -0.33,.p = 0.04) and fractional anisotropy (β = 0.34, p = 0.03). HIV-infection was not associated with any retinal or MRI measure.ConclusionsHigher venous fractal dimension was associated with smaller cortical volumes and lower fractional anisotropy, whereas higher arterial fractal dimension was associated with the opposite patterns. Longitudinal studies are needed to validate this finding.
Highlights
Effective combination antiretroviral therapy has transformed HIV into a chronic illness and markedly decreased the prevalence of HIV-associated dementia [1]
Venous dimension was significantly associated with fractional anisotropy and total gray matter volume (β = -0.24, p = 0.03), and arterial dimension with mean diffusivity (β = -0.33,.p = 0.04) and fractional anisotropy (β = 0.34, p = 0.03)
Higher venous fractal dimension was associated with smaller cortical volumes and lower fractional anisotropy, whereas higher arterial fractal dimension was associated with the opposite patterns
Summary
Effective combination antiretroviral therapy (cART) has transformed HIV into a chronic illness and markedly decreased the prevalence of HIV-associated dementia [1]. Many factors may contribute to cognitive impairment in such patients including brain vascular disease. Previous studies of the association between brain vascular health and cognition in HIV have focused on large vessels with ultrasound examination of the common carotid being the most frequent measure [3]. Small vessel disease contributes to brain dysfunction, and the relative severity of brain large and small vessel disease in any patient depends on many factors include age, race/ethnicity, and comorbid disease. For this reason, we hypothesized that measures of brain small vessel health would be associated with brain structure in patients with HIV
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