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Publications

Journal Article Epublish

PubMed: 42434387 DOI: 10.1093/ofid/ofag382

Predictors of Cerebral Small-Vessel Disease in Middle-Aged, Virologically Controlled People Living With HIV.

Open Forum Infect Dis 13(7):ofag382

Authors: Antoine Moulignier, Cédric Lamirel, Arbnor Zenuni, Patricia Koskas, Corinne Amiel, Roland Tubiana, Christine Katlama, Soraya Fellahi, Jean-Philippe Bastard, Jacqueline Capeau, Dominique Costagliola, Amélie Yavchitz, Augustin Lecler, Lambert Assoumou

Affiliations

  • Fédération de Neurologie, Hôpital Fondation Adolphe de Rothschild, Paris, France.
  • Institut du Nerf Optique et du Glaucome (INOG), Hôpital Fondation Adolphe de Rothschild, Paris, France.
  • Institut Pierre-Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France.
  • Service d'Imagerie Médicale, Hôpital Fondation Adolphe de Rothschild, Paris, France.
  • Service de Virologie, APHP, Hôpital Saint Antoine, Paris, France.
  • Service de Maladies Infectieuses et Tropicales, APHP, Hôpital Pitié-Salpêtrière, Paris, France.
  • INSERM UMR_S938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-Métabolisme et Nutrition (ICAN), Sorbonne Université, Paris, France.
  • Département de Biochimie et de Pharmacologie, INSERM UMR U955 et Université Paris Est (UPEC), APHP, Hôpital Henri Mondor, Créteil, France.
  • Unité de Recherche Clinique, Hôpital Fondation Adolphe de Rothschild, Paris, France.

Abstract

BACKGROUND

Despite durable viral suppression with antiretroviral therapy (ART), non-AIDS comorbidities remain frequent in aging people with HIV (PWH). Cerebral small-vessel disease (CSVD), a major contributor to stroke and cognitive decline, is up to twice as prevalent in middle-aged ART-treated PWH. Mechanisms underlying this excess risk remain unclear.

OBJECTIVE

This study aims to identify inflammatory, viral, renal, and retinal vascular factors independently associated with CSVD in virologically controlled PWH.

METHODS

The case-control MicroBREAK-2 study (NCT02210130), nested in the PWH group of the MicroBREAK-1 study, included 80 ART-treated (≥5 years) PWH aged ≥50 years with MRI-defined CSVD and 80 matched CSVD-free controls (age ± 5 years, sex, year of HIV diagnosis ± 5 years). Participants underwent brain MRI, renal, carotid, and orbital color Doppler ultrasonography, and comprehensive ophthalmologic assessment. Circulating inflammatory and coagulation biomarkers, Epstein-Barr virus plasma load, and antiretroviral exposure were measured. Independent associations were identified using conditional logistic regression with LASSO selection and bootstrap resampling.

RESULTS

Hypertension was the strongest independent correlate of CSVD (OR 4.92, 95% CI 1.23-19.62; P = .02). Markers of persistent inflammatory and coagulative activity were also independently linked to CSVD, including higher white blood cell count (OR 1.58; 1.17-2.14; P = .003) and elevated D-dimer levels (OR 1.52; 1.09-2.12; P = .01). Increased intraocular pressure was independently related to CSVD (OR 6.37; 1.38-29.4; P = .02). In contrast, HIV-specific parameters showed no independent relationship with CSVD.

CONCLUSIONS

In virologically suppressed PWH, CSVD is primarily associated with hypertension and persistent low-grade inflammation rather than HIV-specific factors, underscoring the need for aggressive cardiovascular risk management.

MeSH

Hypertension, Risk Management, Aged, Hiv, Heart Disease Risk Factors, Cerebral Small Vessel Diseases