RT Journal Article
SR Electronic
T1 Association of White Matter Hyperintensities With HIV Status and Vascular Risk Factors
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1823
OP e1834
DO 10.1212/WNL.0000000000011702
VO 96
IS 14
A1 Mina, Yair
A1 Wu, Tianxia
A1 Hsieh, Hsing-Chuan
A1 Hammoud, Dima A.
A1 Shah, Swati
A1 Lau, Chuen-Yen
A1 Ham, Lillian
A1 Snow, Joseph
A1 Horne, Elizabeth
A1 Ganesan, Anuradha
A1 Rapoport, Stanley I.
A1 Tramont, Edmund C.
A1 Reich, Daniel S.
A1 Agan, Brian K.
A1 Nath, Avindra
A1 Smith, Bryan R.
A1 ,
YR 2021
UL http://n.neurology.org/content/96/14/e1823.abstract
AB Objective To test the hypothesis that brain white matter hyperintensities (WMH) are more common in people living with HIV (PLWH), even in the setting of well-controlled infection, and to identify clinical measures that correlate with these abnormalities.Methods Research brain MRI scans, acquired within longitudinal studies evaluating neurocognitive outcomes, were reviewed to determine WMH load using the Fazekas visual rating scale in PLWH with well-controlled infection (antiretroviral therapy for at least 1 year and plasma viral load <200 copies/mL) and in sociodemographically matched controls without HIV (CWOH). The primary outcome measure of this cross-sectional analysis was increased WMH load, determined by total Fazekas score ≥2. Multiple logistic regression analysis was performed to evaluate the effect of HIV serostatus on WMH load and to identify MRI, CSF, and clinical variables that associate with WMH in the PLWH group.Results The study included 203 PLWH and 58 CWOH who completed a brain MRI scan between April 2014 and March 2019. The multiple logistic regression analysis, with age and history of tobacco use as covariates, showed that the adjusted odds ratio of the PLWH group for increased WMH load is 3.7 (95% confidence interval 1.8–7.5; p = 0.0004). For the PLWH group, increased WMH load was associated with older age, male sex, tobacco use, hypertension, and hepatitis C virus coinfection, and also with the presence of measurable tumor necrosis factor α in CSF.Conclusion Our results suggest that HIV serostatus affects the extent of brain WMH. This effect is mainly associated with aging and modifiable comorbidities.aOR=adjusted odds ratio; ASCVD=atherosclerotic cardiovascular disease; BDI-II=Beck Depression Inventory II; cART=combination antiretroviral therapy; CI=confidence interval; CSVD=cerebral small vessel disease; CWOH=controls without HIV; DoD=Department of Defense; FLAIR=fluid-attenuated inversion recovery; HCV=hepatitis C virus; INI=integrase inhibitor; NNRTI=non-nucleoside reverse transcriptase inhibitor; OR=odds ratio; PI=protease inhibitor; PLWH=people living with HIV; Tat=transactivator of transcription; TNF=tumor necrosis factor; WMH=white matter hyperintensities