Increased exposure to white matter hyperintensities in HIV patients

In patients with HIV with well-controlled infection who have received antiretroviral therapy for at least 1 year and who have a plasma virus load of less than 200 copies / ml, the extent of white matter hyperintensities (WMH) is higher compared to control patients without HIV according to study results published in Neurology.

Brain WMH are areas of hyperintense signal in the periventricular or deep white matter that are common on magnetic resonance imaging (MRI). Because brain MRI abnormalities are common in HIV patients, the aim of this study was to evaluate the effect of HIV serostatus on WMH exposure and to identify clinical variables associated with WMH in HIV patients.

Using Fazekas’ visual rating scale to assess WMH exposure, study researchers rated brain MRI scans of patients with well-controlled infection and appropriate controls. The primary result was increased WMH exposure as determined by a Fazekas total score of at least 2.

The sample included 203 (75% men; mean age 50 years) patients with HIV and 58 (53% men; mean age 49 years) controls without HIV with an MRI scan of the brain available between April 2014 and March 2019.

In the simple logistic regression, the prevalence of increased WMH exposure in HIV patients was three times higher than that in controls (odds ratio 3.0; 95% CI 1.6-5.6; P = 0.0006). In the multiple logistic regression analysis with age and tobacco consumption as covariates, the risk of increased WMH exposure in HIV patients was almost four times higher than in controls (adjusted odds ratio 3.7; 95% CI 1.8-7.5; P = 0.0004).

Age, male sex, history of tobacco use, high blood pressure, and hepatitis C virus co-infection were all associated with higher rates of WMH in patients with HIV. In addition, in a subset of 75 participants who had sufficient cerebrospinal fluid available, the presence of measurable tumor necrosis factor-alpha in cerebrospinal fluid was associated with a higher mean total Fazekas score.

The study had several limitations, including the lack of agreement for gender and comorbidities, the exploratory nature of the analysis, and the use of a single manual rating scale.

“[O]Our results suggest that HIV serostatus affects the level of WMH in the brain even with well-controlled infections. This contribution is possibly mediated through accelerated aging and changeable cardiovascular system [comorbidities]because few significant correlations were found with certain HIV disease parameters, ”the study’s researchers concluded.


Mina Y., Wu T., Hsieh HC. Et al. Association of white matter hyperintensities with HIV status and vascular risk factors. Neurology. Published online February 26, 2021. doi: 10.1212 / WNL.0000000000011702

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