Frequency and Risk Factors for Cerebral Arterial Disease in a HIV/AIDS Neuroimaging Cohort

Abstract

Background: Infection with HIV predisposes patients to a myriad of neurologic disorders, including cerebrovascular disease. The pathophysiology is likely multifactorial, with proposed mechanisms including infectious vasculitis, HIV-induced endothelial dysfunction and adverse effects of combination antiretroviral therapy (cART). Epidemiologic data on clinically evident cerebral vasculopathy in HIV-infected adults is scarce, even though stroke hospitalizations are rising in this patient population. Methods: A total of 6,298 HIV-infected adults (San Francisco General Hospital, 2000-2013) were screened to generate a cohort of patients with dedicated neuroimaging of the intra- and extracranial cerebral vasculature. We extracted information regarding the extent of HIV disease (including serial viral load and CD4 counts), cardiovascular disease risk factors and exposure to cART (cross-referenced with pharmacy records) and performed multivariate logistic regression analysis to identify predictors of vasculopathy. Results: Of 144 patients, 55 patients (38.2%) had radiographic evidence of cerebral vasculopathy. Twenty (13.9%) had a vasculopathy characterized by vessel dolichoectasia and intracranial aneurysm formation. Thirty-five patients (24.3%) had intra- and or extracranial stenosis/occlusion. cART use (OR 2.27, 95% CI 1.03-5) and tobacco abuse (OR 2.35, 95% CI 1.04-5.25) were independently associated with the development of any vasculopathy, whereas cART use was also an independent risk factor for the stenosis/occlusion subtype specifically (OR 2.87, 95% CI 1.11-7.45). Conclusions: There was a high frequency of cerebral arterial disease in this neuroimaging cohort of HIV/AIDS patients. A history of cART use and a history of tobacco abuse were independent risk factors for vasculopathy, though these findings should be confirmed with large-scale prospective studies.

Considerations on the Relevance of Cerebral Fusiform Aneurysms Observed During HIV Infection

“…We here-in report 5 new cases of HIV-AECV, among the largest original case series in adults [5,9]. A first adult case was reported in 2006 [1] and only 32 adult cases had been reported since then [5,9].…”

Intracranial vascular complications in AIDS

“…У 20 (13,9%) больных васкулопатия характеризовалась долихоэктазией и формированием интракраниальных аневризм, а у 35 (24,3%) -интра-и экстракраниальным стенозом или окклюзией. Длительное использование АРВТ в сочетании с курением ассоциировалось с васкуло-патией иного типа, что увеличивало риск стеноза и окклюзии [32].…”

“…Таким образом, патогенез ВИЧ-ассоциированной церебральной васкулопатии является многофактор-ным: вирусная инвазия стенки сосуда, эндотели-альное повреждение ВИЧ-протеинами, хроническая иммунная дисфункция и воспаление стенки сосудов, токсичность АРВТ, инфекционный (Varicella zoster) церебральный васкулит [22,32,[42][43][44][45].…”

Enfermedad cardiovascular y metabólica en pacientes infectados por el virus de la inmunodeficiencia humana

“…Los individuos con ictus, que son VIH positivos, son pacientes más jóvenes que los individuos con ACV que no tienen la infección, lo que podría ser el resultado de la edad de la población en riesgo de infección por VIH o una señal de que el mecanismo de ACV en el VIH es en gran parte independiente de los factores de riesgo vasculares clásicos 50 . Sin embargo, la aparición de ictus y de la infección por VIH puede a menudo ser una coincidencia.…”