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Cardiovascular risk factors and the rate of change in brain structure in HIV disease
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Reported by Jules Levin
CROI 2016 Feb 22-24 Boston
James T. Becker, Mikhail Popov, Lawrence Kingsley, Francine Barrington, Andrew Levine, Eileen Martin, Eric Miller, Cynthia Munro, Ann Ragin, Ned Sacktorfor the Neuropsychology Working Group of the Multicenter AIDS Cohort Study
Program Abstract
Since the introduction of cART, factors not directly associated with HIV disease are now having a significant impact on brain structure and function. In particular, cardiovascular disease (CVD) is known to affect brain structure and performance on cognitive tests. The purpose of this analysis was to identify associations between CVD risk factors and change in brain structure over time.
122 men (56% HIV-infected) participating in the Multicenter AIDS Cohort Study (age: 55.8 + 4.9) underwent two brain MRI scans 3.2 years apart (T1 weighted magnetization-prepared rapid gradient-echo sequence). Gray matter, white matter, and CSF volumes (expressed as percent of total intracranial volume) were measured using FMRIB's Automated Segmentation Tool, and an annualized rate of change was calculated. Correlation analyses identified hypertension, diabetes, urine protein/creatinine ratio (as an index of small vessel disease) and age as having significant associations with the outcome variables. Lipid levels and illicit drug use were not linked to rate of change. Linear regression models evaluated the associations between change in the three tissue class volumes and the significant predictor variables (from the unadjusted analysis), as well as CD4+ cell counts and plasma HIV RNA viral load (among infected men only).
After adjusting for age, race, and cohort of entry, HIV serostatus was unrelated to rate of change in any of the three brain tissue compartments. The rate of expansion of the CSF compartment was significantly faster among individuals with diabetes; no other CVD-related variable predicted brain volume change. Among the HIV-infected men only, nadir CD4+ cell count was associated with changes in gray and white matter volumes. CSF expansion was significantly greater among individuals in the most recent enrollment cohort, and among individuals with diabetes.
In the cART era, CVD risk factors are at least as important as HIV-associated factors in predicting rate of change of brain tissue compartments. Finally, among HIV-infected individuals, factors associated with HIV treatment history are likely critical for predicting subsequent brain health.
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