Abstract Details

Title Ferumoxytol-Enhanced Neuroimaging in HIV-Associated Neurocognitive Disorder

Topic Infections/AIDS/Prion Disease

Presentation(s) P06 - (-)

Poster/Presentation
Number 176

Objective

Background BACKGROUND: Monocytes/Macrophages (M/M[Phi]) have a key role in the pathogenesis of HIV-Associated Neurocognitive Disorders (HAND). Ferumoxytol is a MRI contrast agent avidly taken up by circulating M/M[Phi].

Design/Methods DESIGN/METHODS: Aviremic HIV+ subjects who received uninterrupted combination antiretroviral therapy > 6 months, had HIV DNA levels >[frasl]= 10 copies/10^6 CD14+ cells, and cognitive impairment on neuropsychological testing were recruited. Cognitive impairment was defined as a global composite z-score <[frasl]= -0.5 or composite z-score <[frasl]= -0.5 involving a cognitive domain typically impacted by HIV. Brain MRIs were obtained on a 3.0 Tesla Phillips Acheiva scanner [axial 2D T1-weighted spin echo, T2-weighted turbo spin echo, dynamic T2*-weighted GRE, and susceptibility-weighted imaging (SWI) 3D venous BOLD images] before and 48 hours after ferumoxytol infusion. Subjects were monitored for adverse events during and one month after ferumoxytol infusion.

Results RESULTS: Four HIV+ subjects were recruited (4 males; mean age 60.25+/-5.85 years; mean current CD4 count 631+/-128 cells/mm3; mean nadir CD4 count 158+/-64 cells/mm3). No subject had hepatitis C co-infection. Mean HIV DNA was 576+/-749 copies/10^6 CD14+ cells. Three subjects had global cognitive impairment (mean NPZglobal = -1.4+/-0.52). One subject had memory/learning efficiency impairment (NPZmem/learn = -1.03). SWI performed 48 hours after ferumoxytol infusion demonstrated increased vascular caliber with a "tram track" appearance suggesting perivascular ferumoxytol uptake in macrophages in or adjacent to the arterial and venous intracranial vessel walls of the peripheral cortical and deep white matter vasculature. No subject had ferumoxytol-enhancement in the brain parenchyma. There were no adverse events.

Conclusions CONCLUSIONS: Our preliminary results suggest ferumoxytol-enhanced MRIs demonstrate perivascular macrophages on SWI and may have a potential role in imaging patients with HAND. Ferumoxytol appears to be safe and well tolerated in HIV-infected patients.

Authors/Disclosures
Beau Nakamoto, MD, PhD, MBA, FAAN (Straub Medical Center) PRESENTER	Dr. Nakamoto has nothing to disclose.
	No disclosure on file
	No disclosure on file
Michael R. Edwards, PhD (Ionis)	No disclosure on file
	No disclosure on file
	No disclosure on file
Edward A. Neuwelt, MD (Oregon Health Science Univ)	No disclosure on file
	No disclosure on file
	No disclosure on file
Cecilia M. Shikuma, MD (University of Hawaii at Manoa)	No disclosure on file

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