Advanced MRI in the Co-occurrence of Liver Disease and HIV Infection

This project examines how non-alcoholic fatty liver disease (NAFLD) and HIV infection—both independently and jointly—affect brain structure, function, and microvascular health. Despite the benefits of antiretroviral therapy, liver-related complications remain common among people living with HIV. NAFLD affects up to half of this population, driven by both viral factors and long-term treatment effects. The coexistence of HIV and NAFLD may amplify systemic and neurological vulnerability, yet their combined impact on the brain remains poorly understood. We hypothesize that individuals with both conditions face an elevated risk of persistent blood–brain barrier disruption, metabolic dysfunction, and microcirculatory impairment, leading to more pronounced brain injury and cognitive decline—particularly in aging populations.

To investigate these mechanisms, we integrate a comprehensive set of advanced multimodal MRI techniques, blood biomarkers, and cognitive assessments to map the complex interactions between chronic liver disease and viral infection within the central nervous system.

Our imaging approach includes cutting-edge brain MRI modalities such as:

• Chemical Exchange Saturation Transfer (CEST): detecting subtle changes in brain metabolism and protein content.
• Diffusion Prepared Pseudo-continuous Arterial Spin Labeling (DP-pCASL): assessing perfusion and blood brain barrier dysfunction, and
• Intravoxel Incoherent Motion (IVIM): quantifying microvascular and diffusion-driven tissue features.

To evaluate liver health, we incorporate advanced liver MRI including:

• Magnetic Resonance Elastography (MRE) and Proton Density Fat Fraction (PDFF) to measure liver stiffness and fat accumulation,
• Additional CEST and IVIM to capture biochemical and microvascular alterations within hepatic tissue.

The study includes three participant groups: Healthy controls, HIV without NAFLD, and HIV with NAFLD. Across all groups, we collect blood markers of inflammation, metabolic status, and viral control, alongside detailed cognitive testing. By evaluating associations between imaging metrics, biological markers, and cognitive performance, this work aims to uncover previously unrecognized pathways of brain injury and clarify how liver disease may intensify neurocognitive risk in HIV.

We also employ deep learning models to differentiate brain abnormalities associated with NAFLD from those linked to HIV, addressing their significant clinical and imaging overlap. Ultimately, insights from this research have the potential to advance our understanding of broader brain-related disorders and inform early diagnostic and therapeutic strategies.