title: Brain arterial remodeling contribution to nonembolic brain infarcts in patients with HIV.
abstract: 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.
authors: From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY. jg3233@cumc.columbia.edu.
authors: Jose
authors: J
authors: Gutierrez
authors: From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY.
authors: James
authors: J
authors: Goldman
authors: From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY.
authors: Andrew J
authors: AJ
authors: Dwork
authors: From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY.
authors: Mitchell S V
authors: MS
authors: Elkind
authors: From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY.
authors: Randolph S
authors: RS
authors: Marshall
authors: From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY.
authors: Susan
authors: S
authors: Morgello
mesh_terms: D000328:Adult; D020520:Brain Infarction / Q000453:epidemiology / Q000473:pathology*; D002539:Cerebral Arterial Diseases / Q000453:epidemiology / Q000473:pathology*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D066253:Vascular Remodeling