Middle-Aged Poz Folks at Greatest Risk For Brain Disease

Researchers in France have discovered a much higher prevalence of cerebral small-vessel disease (CSVD) among middle-aged HIV-positive people compared to the general population, reports NAM’s AIDSMap. Often called a “silent” disease because it can exist without obvious symptoms, CSVD is known to be a prominent precursor to other serious neurocognitive conditions like strokes or hemorrhages, as well as age-related cognitive impairment and dementia.

Published in Clinical Infectious Diseases, the study found that poz people between 50 and 54 had nearly five times the risk for developing CSVD. While comorbidities that come with aging (such as hypertension) are known risk factors, it was previously unclear whether being HIV-positive raised these risks. However, other studies have suggested that people living with HIV may age faster than the general population.

In this study, researchers conducted MRI scans on more than 600 people over 50, including 456 HIV-positive people who were all on antiretroviral therapy and undetectable. Results showed that 52 percent of poz participants were also living with CSVD, compared to 36 percent of their HIV-negative counterparts. Advanced stages of CSVD were found in 20 percent of the HIV-positive participants and 14 percent of HIV-negative participants.

Investigators found that “the HIV impact differed according to age.” Overall, the risk for having CSVD increased with age. But with HIV-positive participants, researchers unexpectedly discovered that the youngest (those between 50 and 54) showed five times greater risk of having CSVD than their HIV-negative counterparts of the same age; while those between 54 and 60 were only three times more likely to have CSVD.

When researchers adjusted the findings to account for age, sex, alcohol use, blood pressure, lipids, and cardiovascular history, CSVD remained more frequent in people living with HIV than in the general population.

“Our study results revealed a high CSVD prevalence among middle-aged [people living with HIV], despite ART-sustained immunovirological control,” the study authors commented, noting that even those whose HIV treatment had lowered their viral loads to undetectable levels are at risk for CSVD. “We confirmed classical risk factors, e.g. hypertension and advancing age, and identified a specific HIV-associated factor, the nadir CD4 cell count.”

In other words, researchers discovered that those who previously had less than 200 T-cells were at a higher risk for developing cerebral small-vessel disease. Most of the HIV-positive participants were long-term survivors, with nearly two-thirds of the poz group having been diagnosed before the introduction of highly-effective antiretroviral treatment in the 1990s. That meant they became positive during a period where treatment didn’t exist or wasn’t very effective and therefore, many in the study had seen their CD4 cell count drop below 200 (which is the point where HIV typically becomes classified as stage 3, or AIDS).

In light of the data, researchers say it’s more important than ever for “medical providers to search for CSVD in [people living with HIV], using a brief MRI.” Cerebral small-vessel disease is rarely diagnosed without the benefit of an MRI, and these results suggest doctors with HIV-positive patients over 50 should consider ordering the test for those who’ve previously had low T-cell counts.