Edouard Januel1, Ophelia Godin1, Antoine Moulignier2, François-Xavier Lescure3, Julien Savatovsky4, Cédric Lamirel5, Nadia Valin6, Roland Tubiana1,7, Ana Canestri8, Pascal Roux4, Jean-Claude Sadik4, Laurence Salomon9, Christine Katlama1,7, Yazdan Yazdanpanah3, Gilles Pialoux8, Pierre-Marie Girard1,6, Dominique Costagliola1, Lambert Assoumou1. 1. INSERM, Sorbonne Université, Institut Pierre-Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France. 2. Fondation Adolphe de Rothschild, Service de Neurologie, Paris, France. 3. Sorbonne Paris Cité, INSERM, Infection, Antimicrobials, Modelling, Evolution, UMR 1137, APHP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude-Bernard, Université Paris-Diderot, Paris, France. 4. Service de Radiologie, Fondation Adolphe de Rothschild, Paris, France. 5. Service d'Ophtalmologie, Fondation Adolphe de Rothschild, Paris, France. 6. APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France. 7. APHP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris, France. 8. APHP, Hôpital Tenon, Service de Maladies Infectieuses et Tropicales, Paris, France. 9. Fondation Adolphe de Rothschild, Unité de Recherche Clinique, Paris, France.
Abstract
BACKGROUND: Cerebral small-vessel disease (CSVD) is a chronic disease accounting for one-third of strokes and the second etiology of dementia. Despite sustained immunovirological control, CSVD prevalence is doubled in middle-aged persons living with HIV (PLHIVs), even after adjustment for traditional cardiovascular risk factors. We aimed to investigate whether exposure to any antiretroviral drug class could be associated with an increasing risk of CSVD. METHODS: The MicroBREAK-2 case-control study (NCT02210130) enrolled PLHIVs aged 50 years and older, treated with combined antiretroviral therapy for ≥5 years, with plasma HIV load controlled for ≥12 months. Cases were PLHIVs with radiologically defined CSVD, and controls were CSVD-free PLHIVs matched for age (±5 years), sex, and year of HIV diagnosis (±5 years). Multivariable conditional logistic regression analyses focused on cumulative exposure to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and/or exposure to integrase inhibitors (yes or no), adjusted for hypertension, CD4 nadir, current CD4/CD8 ratio, and HIV transmission group. RESULTS: Between May 2014 and April 2017, 77 cases and 77 controls (85.7% males) were recruited. PLHIVs' median age was 57.6 years, and median HIV diagnosis year was 1992. The increasing risk of CSVD was not associated with exposure to any ART class. CONCLUSION: No deleterious effect of ART class exposure on the risk of CSVD was found for middle-aged treated PLHIVs.
BACKGROUND:Cerebral small-vessel disease (CSVD) is a chronic disease accounting for one-third of strokes and the second etiology of dementia. Despite sustained immunovirological control, CSVD prevalence is doubled in middle-aged persons living with HIV (PLHIVs), even after adjustment for traditional cardiovascular risk factors. We aimed to investigate whether exposure to any antiretroviral drug class could be associated with an increasing risk of CSVD. METHODS: The MicroBREAK-2 case-control study (NCT02210130) enrolled PLHIVs aged 50 years and older, treated with combined antiretroviral therapy for ≥5 years, with plasma HIV load controlled for ≥12 months. Cases were PLHIVs with radiologically defined CSVD, and controls were CSVD-free PLHIVs matched for age (±5 years), sex, and year of HIV diagnosis (±5 years). Multivariable conditional logistic regression analyses focused on cumulative exposure to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and/or exposure to integrase inhibitors (yes or no), adjusted for hypertension, CD4 nadir, current CD4/CD8 ratio, and HIV transmission group. RESULTS: Between May 2014 and April 2017, 77 cases and 77 controls (85.7% males) were recruited. PLHIVs' median age was 57.6 years, and median HIV diagnosis year was 1992. The increasing risk of CSVD was not associated with exposure to any ART class. CONCLUSION: No deleterious effect of ART class exposure on the risk of CSVD was found for middle-aged treated PLHIVs.