Abstract T MP112: Cerebral Infarction and Brain Arterial Pathology in Hiv: Results From the Brain Arterial Remodeling Study (bars)
INTRODUCTION: Individuals with HIV live longer since the advent of antiretroviral (ARV) drugs. However, aging with HIV is now associated with vascular disease. Mechanisms underlying this association have not been fully elucidated. We explored arterial correlates that might lead the association between HIV and cerebral infarction.
Methods: The Brain Arterial Remodeling Study (BARS) is a collection of 336 brains from donors in the US (69%) and Macedonia (31%) from which large brain arteries have been collected, cut, embedded and stained with H&E and van Gieson. Atherosclerosis and stenosis were graded using Glagov’s method. Cerebral infarction was identified in autopsy. For this analysis, HIV cases (n=138) were age- and sex-matched to controls without HIV. Multivariate logistic and linear regressions were used to determine odds ratios and 95% confidence intervals (OR, 95% CI) assessed associations at P< 0.05.
Results: Those with HIV (mean age 48.8 ± 9.1 years, 75% men) were more likely to be black (OR 5.0, 2.4-10.4) or Hispanic (OR 2.2, 1.2-3.9), hypertensive (OR 2.2, 1.3-3.5), dyslipidemic (OR 3.5, 1.1-11.0), cocaine users (OR 10.1, 4.6-22.4) and have cardiac disease (OR 2.0, 1.2-3.5). Cerebral infarction was more common with HIV (adjusted OR 2.8, 1.1-6.8). HIV brains were less likely to have atherosclerosis (OR 0.4, 0.3-0.7) or any stenosis > 25% (OR 0.4, 0.1-1.0). Among those with HIV, after adjusting for demographic and vascular risks, cerebral infarction was more prevalent with prior opportunistic infections (5.3, 1.2-22.9), higher CD4 count (OR 1.2, 1.0-1.4 per every 50 CD4 cell increment), and in those with intimal thickening in more than 75% of the lumen circumference (OR 4.0, 1.1-14.5). Predictors of circumferential intimal thickening in the HIV group included ARV at death (Beta 0.17, P=0.007), internal elastic lamina (IEL) gaps, Beta 0.22, P=0.02), and IEL duplication (Beta 0.28, P=0.001).
CONCLUSIONS: Individuals with HIV in this study have a greater prevalence of vascular risks and cerebral infarction, yet the increased infarction prevalence is not associated with atherosclerosis. Patients with HIV have a non-atherosclerotic arterial phenotype consisting of circumferential intimal thickening with disruption of the internal elastic lamina.
Author Disclosures: J. Gutierrez: Research Grant; Significant; American Heart Association #13CRP14800040. M.S. Elkind: None. M. Pizzirusso: None. J. Goldman: None. C. Chon: None. J. Murray: None. A.J. Dwork: None. S. Morgello: Research Grant; Significant; NIH/NIMH R25MH080663. R.S. Marshall: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2014 by American Heart Association, Inc.