Small-Vessel Vascular Disease in Human Immunodeficiency Virus Infection: The Hawaii Aging with HIV Cohort Study

Abstract

Background: This study is designed to determine the relationship between age and occurrence of cerebral manifestations of small-vessel ischemic vascular disease in human immunodeficiency virus (HIV)-seropositive individuals. Methods: Periventricular leukoaraiosis severity and white matter lesion volume were determined by magnetic resonance imaging of the brain of 57 HIV-seropositive individuals. Results: Cerebral small-vessel ischemic vascular disease manifestations correlated with age and systolic blood pressure, but not with HIV infection-related parameters. Conclusions: These findings suggest that, in the era of highly active antiretroviral therapy, leukoaraiosis severity and white matter lesion volume may be more indicative of small-vessel ischemic vascular disease than HIV-related CNS pathology, and support the need for aggressive treatment of vascular risk factors in HIV-seropositive individuals.

Cross-Sectional Study of Unexplained White Matter Lesions in HIV Positive Individuals Undergoing Brain Magnetic Resonance Imaging

“…White matter hyperintensities of presumed vascular origin 21 were also commonly seen. Our findings are important given the paucity of published data on cerebral small vessel disease in HIV, 28,29 the growing proportion of older adults with HIV in many regions, and the frequent difficulties encountered when interpreting the clinical and Suppressed on ART = HIV-1 viral load (VL) less than 50 copies/mL; early treatment = VL greater than 50 copies/mL but duration of antiretroviral therapy (ART) less than 3 months; failed treatment = VL greater than 50 copies/mL and duration of ART greater than 3 months.…”

“…The Hawaii Aging with HIV Cohort has produced the only published work on cerebral small vessel disease to date and describes a 48% prevalence of moderate WM disease among HIV + patients without neurological disease, 29 with a strong association with age and a modest association with hypertension. 28,29 The association between NCI and cerebrovascular risk factors in HIV + patients 37,38 and the similarity between the domains affected in vascular dementia and HIV-associated neurocognitive disorders 35,[38][39][40] raise the intriguing possibility that NCI in HIV is in some way vascular in etiology. Previous work has established the high burden of large-vessel atherosclerotic disease in HIV, including ischemic stroke, [41][42][43][44] subclinical endothelial dysfunction, and increased carotid intima-media thickness, 45 femoral and carotid artery plaques detectable on ultrasound, 46 and coronary artery disease.…”

Cortical Atrophy and White Matter Hyperintensities in HIV: The Hawaii Aging with HIV Cohort Study

“…Two neurologists (A.M. and B.N.) classified the severity and distribution of white matter hyperintensities according to the Rotterdam Scan Study (RSS) scale (15,16). At the time of reviewing the MRI images, the raters were blinded to the patient's identity, demographic factors including ethnicity, sex, hypertension, diabetes, and had not participated in the patients' clinical care.…”

HIV protease inhibitor exposure predicts cerebral small vessel disease

“…Nonetheless, the potential impact of HAART exposure on the development of ischemic cerebrovascular disease, including CSVD, remains controversial [20, 21, 24, 25, 29–31]. In a community-based study [32], the presence of punctate white matter (WM) lesions (hyperintensities) on magnetic resonance imaging (MRI) was found to be associated with older age and higher systolic blood pressure; moreover, there was a trend toward the direct association between WM lesions and HAART exposure. Whereas in the general population MRI WM lesions are thought to represent ischemic lesions caused by CSVD [33], the similar lesions in HIV-infected patients may also reflect foci of HIV-associated or inflammatory WM injury [34–37].…”