The aim of this study is to ascertain the burden of pre-clinical atherosclerotic changes in the brains of young adult males with HIV and explore the impact of anti-retroviral therapy (ART). The study design is case-control, cross-sectional. Histological sections from HIV-positive post-mortem brain samples, with no associated opportunistic infection, from the MRC Edinburgh brain bank were evaluated. These were age and sex matched with HIV-negative controls. Immunohistochemical stains were performed to evaluate characteristics of atherosclerosis. The pathological changes were graded blinded to the HIV status and a second histopathologist reassessed 15%. Univariable models were used for statistical analyses; p≤0.05 was considered significant. Nineteen HIV-positive post-mortem cases fulfilled our inclusion criteria. Nineteen HIV-negative controls were selected. We assessed mostly small- to medium-sized vessels. For inflammation (CD45), 7 (36%) of the HIV+ had moderate/severe changes compared with none for the HIV− group (p<0.001). Moderate/severe increase in smooth muscle remodeling (SMA) was found in 8 (42%) HIV+ and 0 HIV− brains (p<0.001). Moderate/severe lipoprotein deposition (LOX-1) was found in 3 (15%) and 0 HIV− brains (p<0.001). ART was associated with less inflammation [5 (63%) no ART versus 2 (18%) on ART (p=0.028)] but was not associated with reduced lipid deposition or smooth muscle damage. In HIV infection, there are pre-clinical small- to medium-sized vessel atherosclerotic changes and ART may have limited impact on these changes. This could have implications on the increasing burden of cerebrovascular disease in HIV populations and warrants further investigation.

本研究的目的是确定感染 HIV 的年轻成年男性大脑临床前动脉粥样硬化变化的负担，并探讨抗逆转录病毒疗法 (ART) 的影响。研究设计为病例对照、横断面研究。评估了来自 MRC 爱丁堡脑库的 HIV 阳性死后脑样本的组织学切片，没有相关的机会性感染。这些是与 HIV 阴性对照相匹配的年龄和性别。进行免疫组织化学染色以评估动脉粥样硬化的特征。病理变化在不知道 HIV 状态的情况下进行分级，第二位组织病理学家重新评估了 15%。单变量模型用于统计分析；p≤0.05 被认为是显着的。19 例 HIV 阳性验尸病例符合我们的纳入标准。选择了 19 个 HIV 阴性对照。我们主要评估中小型船只。对于炎症 (CD45)，7 (36%) 个 HIV+ 有中度/重度变化，而 HIV- 组则没有 ( p <0.001)。在 8 个 (42%) HIV+ 和 0 个 HIV- 大脑中发现平滑肌重塑 (SMA) 中度/重度增加 ( p <0.001)。在 3 个 (15%) 和 0 个 HIV- 大脑中发现中度/重度脂蛋白沉积 (LOX-1) ( p <0.001)。ART 与较少的炎症相关 [5 (63%) 无 ART 对比 2 (18%) ART ( p=0.028)] 但与脂质沉积减少或平滑肌损伤无关。在 HIV 感染中，存在临床前中小血管动脉粥样硬化的变化，而 ART 对这些变化的影响可能有限。这可能会对 HIV 人群中日益增加的脑血管疾病负担产生影响，并需要进一步调查。