Magnetic resonance imaging of cerebral small vessel disease in men living with HIV and HIV negative men aged 50 and above.

We assessed whether HIV status was associated with white matter hyperintensities (WMH), a neuroimaging correlate of cerebral small vessel disease, in men aged ≥50 years. A cross-sectional substudy was nested within a larger cohort study. Virologically suppressed men living with HIV (MLWH) and demographically matched HIV negative men aged ≥50 underwent magnetic resonance imaging (MRI) at 3 Tesla. Sequences included volumetric 3D T1-weighted, FLAIR and pseudocontinuous arterial spin labelling. Regional segmentation by automated image processing algorithms was used to extract WMH volume (WMHV) and resting cerebral blood flow (CBF). The association between HIV status and WMHV as a proportion of intracranial volume (ICV; log-transformed) was estimated using a multivariable linear regression model. Thirty-eight MLWH (median age 59 years [interquartile range, IQR 55, 64]) and 37 HIV negative (median 58 years [54, 63]) men were analyzed. MLWH had median CD4+ count 570 (470, 700) cells/microliter and a median time since diagnosis of 20 (14, 24) years. Framingham 10-year risk of cardiovascular disease was 6.5% in MLWH and 7.4% in controls. Two (5%) MLWH reported a history of stroke or transient ischaemic attack (TIA) and five (13%) reported coronary heart disease (CHD) compared to none of the controls. The total WMHV in MLWH was 1696 microliters (IQR 1229, 3268 microliters) or 0.10% of ICV compared to 1627 microliters (IQR 1032, 3077 microliters), also 0.10% of ICV, in the HIV negative group (p=0.43). In the multivariable model, WMHV/ICV was not associated with HIV status (p=0.86). There was an age-dependent decline in cortical CBF (-3.9 ml/100ml/min per decade of life [95% CI 1.1 to 6.7 ml]) but no association between CBF and HIV status (p>0.2 in all brain regions analyzed). In conclusion, we found no quantitative MRI evidence of an increased burden of cerebral small vessel disease in MLWH aged 50 years and over.