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Published on: January 12, 2016
Association of White Matter Hyperintensities With HIV Status and Vascular Risk Factors
Yair Mina1, Tianxia Wu1, Hsing-Chuan Hsieh1
1From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD.
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.
Insights
People living with HIV (PLWH) show significantly higher brain white matter hyperintensities (WMH) even with controlled infection. Aging and modifiable comorbidities are key factors associated with increased WMH in PLWH.
Area of Science:
- Neuroscience
- Infectious Diseases
- Radiology
Background:
- Brain white matter hyperintensities (WMH) are increasingly recognized in various aging populations.
- Understanding WMH in people living with HIV (PLWH), even with controlled infection, is crucial for long-term health.
- Previous research suggests potential neurological complications associated with HIV, necessitating further investigation into subclinical brain changes.
Purpose of the Study:
- To test the hypothesis that brain white matter hyperintensities (WMH) are more prevalent in people living with HIV (PLWH) compared to controls, irrespective of infection control.
- To identify clinical, MRI, and cerebrospinal fluid (CSF) markers associated with WMH in PLWH.
- To investigate the correlation between HIV serostatus and WMH load in a well-characterized cohort.
Main Methods:
- Cross-sectional analysis of brain MRI scans from 203 PLWH on long-term antiretroviral therapy and 58 HIV-negative controls.
- WMH load was quantified using the Fazekas visual rating scale.
- Multiple logistic regression was employed to assess the association between HIV status and WMH, controlling for covariates like age and tobacco use.
Main Results:
- PLWH had a significantly higher odds ratio (3.7) for increased WMH load (Fazekas score ≥2) compared to controls (p=0.0004).
- In PLWH, increased WMH load was associated with older age, male sex, tobacco use, hypertension, and hepatitis C virus coinfection.
- Measurable tumor necrosis factor α in CSF was also associated with increased WMH in the PLWH group.
Conclusions:
- HIV serostatus is an independent factor associated with increased brain white matter hyperintensities, even in treated individuals.
- The observed increase in WMH among PLWH is significantly influenced by aging and the presence of modifiable comorbidities.
- These findings highlight the importance of managing comorbidities in PLWH to potentially mitigate neurological complications.
