Antoine Moulignier1, Julien Savatovsky2, Lambert Assoumou3, François-Xavier Lescure4, Cédric Lamirel5, Ophelia Godin3, Nadia Valin6, Roland Tubiana3,7, Ana Canestri8, Pascal Roux2, Jean-Claude Sadik2, Laurence Salomon9, Marie Abrivard9, Christine Katlama3,7, Yazdan Yazdanpanah4, Gilles Pialoux8, Pierre-Marie Girard3,6, Dominique Costagliola3. 1. Department of Neurology, Fondation Adolphe de Rothschild. 2. Department of Radiology, Fondation Adolphe de Rothschild. 3. Sorbonne Universités, Institut national de la santé et de la recherche médicale (INSERM), UPMC Université Paris 06, Institut Pierre-Louis d'Epidémiologie et de Santé Publique (UMRS 1136). 4. IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Department of Infectious and Tropical Diseases, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP). 5. Fondation Adolphe de Rothschild, Department of Ophthalmology, Hôpital Bichat-Claude Bernard, AP-HP. 6. Department of Infectious and Tropical Diseases, Hôpital Saint-Antoine, AP-HP. 7. Department of Infectious and Tropical Diseases, Hôpital Pitié-Salpêtrière, AP-HP. 8. Department of Infectious and Tropical Diseases, Hôpital Tenon, AP-HP. 9. Clinical Research Unit, Fondation Adolphe de Rothschild, Paris, France.
Abstract
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 <54, 54-60, and >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. Clinical Trials Registration: NCT02082574.
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 <54, 54-60, and >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. Clinical Trials Registration: NCT02082574.
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