Background

Human immunodeficiency virus–positive (HIV+) individuals have higher rates of cognitive impairment and cerebrovascular disease compared with uninfected populations. We hypothesize that cerebrovascular disease, specifically brain large artery disease, may play a role in HIV-associated neurocognitive disorders (HAND).

Methods

Participants (N = 94) in the Manhattan HIV Brain Bank study were followed on average 32 ± 33 months with repeated neuropsychological examinations until death. We used five cognitive domains (motor, processing speed, working memory, verbal fluency, and executive functioning) to assess ante mortem performance. We quantified the diameter of the lumen and arterial wall thickness obtained during autopsy. The diagnoses of HAND were attributed using the American Academy of Neurology nosology. We used generalized linear mixed model to account for repeated measures, follow-up time, and codependence between arteries. Models were adjusted for demographics, viral loads, CD4 counts, history of opportunistic infections, and vascular risks.

Results

We included 94 HIV+ individuals (mean age 56 ± 8.3, 68% men, 54% African American). In adjusted models, there was an association between arterial wall thickness and global cognitive score (B = −0.176, P value = .03), processing speed (B = −0.175, P = .05), and verbal fluency (B = −0.253, P = .02). Participants with incident or worsening HAND had thicker brain arterial walls (B = 0.523 ± 0.234, P = .03) and smaller arterial lumen (B = −0.633 ± 0.252, P = .01).

Conclusions

We report here a novel association between brain arterial wall thickening and poorer ante mortem cognitive performance and diagnosis of incident or worsening HAND at death. Strategies to preserve the arterial lumen or to prevent wall thickening may impact HAND.

中文翻译：

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人类免疫缺陷病毒个体的脑动脉病理与神经认知能力之间的关系

背景

与未感染人群相比，人类免疫缺陷病毒阳性（HIV +）个体认知障碍和脑血管疾病的发生率更高。我们假设脑血管疾病，特别是脑大动脉疾病，可能在HIV相关的神经认知障碍（HAND）中起作用。

方法

曼哈顿HIV脑库研究的参与者（N = 94）平均随访32±33个月，反复进行神经心理学检查直至死亡。我们使用了五个认知领域（运动，处理速度，工作记忆，口语流利度和执行功能）来评估事前的表现。我们对尸体解剖过程中获得的管腔直径和动脉壁厚度进行了量化。HAND的诊断是使用美国神经病学学会的病因学进行的。我们使用广义线性混合模型来考虑重复测量，随访时间以及动脉之间的相互依赖性。对人口统计学，病毒载量，CD4计数，机会感染史和血管风险进行了调整。

结果

我们纳入了94名HIV +患者（平均年龄56±8.3，男性68％，非裔美国人54％）。在调整后的模型中，动脉壁厚度与整体认知评分（B = -0.176，P值= .03），处理速度（B = -0.175，P = .05）和口语流利度（B =- 0.253，P = .02）。HAND发生或恶化的参与者的脑动脉壁较厚（B = 0.523±0.234，P = 0.03）和较小的动脉腔（B = -0.633±0.252，P = 0.01）。

结论

我们在这里报告脑动脉壁增厚和较差的事前认知能力与死亡事件或病情恶化的诊断之间的新型关联。保留动脉管腔或防止壁增厚的策略可能会影响HAND。