Sex-Based Differences in Vasodilatory Flow Capacity Measured with 4D Flow MRI and White Matter Disease Burden Among PWH: A Preliminary Study

Motivation: Female individuals living with HIV (PWH) have a significantly higher risk of ischemic stroke than uninfected individuals, yet most studies on cerebrovascular health in PWH lack sex-specific focus. Differences in vasodilatory flow capacity (VFC) between sexes remain underexplored. Goal(s): To assess sex-stratified VFC differences and investigate its relationship with white matter disease burden in PWH. Approach: Using 4D Flow MRI, VFC was measured pre- and post-acetazolamide in 26 PWH patients, with correlation testing for white matter (WM) disease burden. Results: Higher median VFC was observed in female PWH, with regional variability, and an inverse association with WM disease burden in male PWH. Impact: Our findings underscore the need for sex-specific studies in cerebrovascular health for PWH, potentially guiding targeted interventions for neurovascular and cognitive health. Further research in larger cohorts could validate these preliminary observations and clarify their clinical implications.