Silent Cerebral Small-Vessel Disease Is Twice as Prevalent in Middle-Aged Individuals With Well-Controlled, Combination Antiretroviral Therapy–Treated Human Immunodeficiency Virus (HIV) Than in HIV-Uninfected Individuals

Background Silent cerebral small-vessel disease (CSVD) is defined as white matter hyperintensities, silent brain infarction, or microbleeds. CSVD is responsible for future vascular events, cognitive impairment, frailty, and shorter survival. CSVD prevalence among middle-aged people living with well-...

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Published in:	Clinical infectious diseases 2018-05, Vol.66 (11), p.1762-1769
Main Authors:	Moulignier, Antoine, Savatovsky, Julien, Assoumou, Lambert, Lescure, François-Xavier, Lamirel, Cédric, Godin, Ophelia, Valin, Nadia, Tubiana, Roland, Canestri, Ana, Roux, Pascal, Sadik, Jean-Claude, Salomon, Laurence, Abrivard, Marie, Katlama, Christine, Yazdanpanah, Yazdan, Pialoux, Gilles, Girard, Pierre-Marie, Costagliola, Dominique
Format:	Article
Language:	eng
Subjects:	Acquired immune deficiency syndrome Age AIDS Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Brain CD4 antigen Cerebral infarction Cognitive ability Disease control Health risk assessment Health risks Hepatitis HIV Human immunodeficiency virus Hypertension Infarction Magnetic resonance imaging Medical imaging Microvasculature Middle age Neuroimaging Older people Regression models Retina Risk analysis Risk factors Sexually transmitted diseases STD Substantia alba Viruses
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Summary:	Background Silent cerebral small-vessel disease (CSVD) is defined as white matter hyperintensities, silent brain infarction, or microbleeds. CSVD is responsible for future vascular events, cognitive impairment, frailty, and shorter survival. CSVD prevalence among middle-aged people living with well-controlled human immunodeficiency virus (HIV) infection (PLHIV) is unknown. Methods The French National Agency for Research on AIDS and Viral Hepatitis (ANRS) EP51 Microvascular Brain Retina and Kidney Study (MicroBREAK; NCT02082574) is a cross-sectional study with prospective enrollment of treated PLHIV, ≥50 years old with viral load controlled for ≥12 months, and frequency age- and sex-matched HIV-uninfected controls (HUCs). It was designed to estimate CSVD prevalence on 3T magnetic resonance imaging (3D fluid-attenuated inversion recovery, transversal T2-weighted gradient-echo imaging and diffusion-weighted imaging), as diagnosed by 2 blinded neuroradiologists. A logistic regression model was used to assess the impact of HIV on CSVD after adjustment for traditional risk factors. Results Between June 2013 and May 2016, 456 PLHIV and 154 HUCs were recruited. Median age was 56 and 58 years, respectively (P = .001), among whom 84.9% and 77.3%, respectively (P = .030), were men. CSVD was detected in 51.5% of PLHIV and 36.4% of HUCs with an adjusted odds ratio (aOR) of 2.3. The HIV impact differed according to age, with aOR values of 5.3, 3.7, and 1.0 for age groups 60 years, respectively (P = .022). Older age, hypertension, and lower CD4 cell count nadir were independently associated with a higher risk of CSVD among PLHIV. Conclusions HIV is an independent risk factor for CSVD. Despite sustained immunovirological control, the CSVD prevalence was twice as high among middle-aged PLHIV than HUCs.
ISSN:	1058-4838 1537-6591