Silent Cerebral Small-Vessel Disease Twice as Prevalent in Middle-Aged Well-Controlled cART-Treated HIV-Infected Individuals Than HIV-Uninfected Individuals

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 persons living with well-controlled HIV infection (PLHIVs) is unknown.

Methods

ANRS EP51 MicroBREAK (NCT02082574) is a cross-sectional study with prospective enrollment of treated PLHIVs, ≥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 MRI (3D FLAIR, DWI and T2*), 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 PLHIVs and 154 HUCs were recruited. Respective median ages were 56 and 58 years (P=0.001), among whom 84.9% and 77.3% (P=.030) were men. CSVD was detected in 51.5% of PLHIVs 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 or lower CD4-cell nadir was independently associated with a higher risk of CSVD among PLHIVs.

Conclusions

HIV is an independent risk factor for CSVD. Despite sustained immunovirological control, the CSVD prevalence was twice as high among middle-aged PLHIVs than HUCs.