Brain arterial remodeling contribution to nonembolic brain infarcts in patients with HIV.

TitleBrain arterial remodeling contribution to nonembolic brain infarcts in patients with HIV.
Publication TypeJournal Article
Year of Publication2015
AuthorsGutierrez, J, Goldman, J, Dwork, AJ, Elkind, MSV, Marshall, RS, Morgello, S
Date Published2015 Sep 29
KeywordsAdult, Brain Infarction, Cerebral Arterial Diseases, Comorbidity, Female, HIV Infections, Humans, Internal, Intracranial Arteriosclerosis, Male, Middle Aged, Vascular Remodeling

BACKGROUND: Cerebrovascular disease is a cause of morbidity in HIV-infected populations. The relationship among HIV infection, brain arterial remodeling, and stroke is unclear.METHODS: Large brain arteries (n = 1,878 segments) from 284 brain donors with and without HIV were analyzed to obtain media and wall thickness and lumen-to-wall ratio, and to determine the presence of atherosclerosis and dolichoectasia (arterial remodeling extremes). Neuropathologic assessment was used to characterize brain infarcts. Multilevel models were used to assess for associations between arterial characteristics and HIV. Associations between arterial characteristics and brain infarcts were examined in HIV+ individuals only.RESULTS: Adjusting for vascular risk factors, HIV infection was associated with thicker arterial walls and smaller lumen-to-wall ratios. Cerebral atherosclerosis accounted for one-quarter of the brain infarcts in HIV+ cases, and was more common with aging, diabetes, a lower CD4 nadir, and a higher antemortem CD4 count. In contrast, a higher lumen-to-wall ratio was the only arterial predictor of unexplained infarcts in HIV+ cases. Dolichoectasia was more common in HIV+ cases with smoking and media thinning, and with protracted HIV infection and a detectable antemortem viral load.CONCLUSIONS: HIV infection may predispose to inward remodeling compared to uninfected controls. However, among HIV+ cases with protracted immunosuppression, outward remodeling is the defining arterial phenotype. Half of all brain infarcts in this sample were attributed to the extremes of brain arterial remodeling: atherosclerosis and dolichoectasia. Understanding the mechanisms influencing arterial remodeling will be important in controlling cerebrovascular disease in the HIV-infected population.

Alternate JournalNeurology
PubMed ID26320196
PubMed Central IDPMC4603890
Grant ListU24 MH100929 / MH / NIMH NIH HHS / United States
U01 MH083500 / MH / NIMH NIH HHS / United States
U24 MH100931 / MH / NIMH NIH HHS / United States
U24MH100931 / MH / NIMH NIH HHS / United States
R25 MH080663 / MH / NIMH NIH HHS / United States
R25MH080663 / MH / NIMH NIH HHS / United States
R01MH64168 / MH / NIMH NIH HHS / United States
N271201300028C / / PHS HHS / United States