title: Frequency and Risk Factors for Cerebral Arterial Disease in a HIV/AIDS Neuroimaging Cohort.
abstract: BACKGROUND
  Infection with HIV predisposes patients to a myriad of neurologic disorders, including cerebrovascular disease. The pathophysiology is likely multifactorial, with proposed mechanisms including infectious vasculitis, HIV-induced endothelial dysfunction and adverse effects of combination antiretroviral therapy (cART). Epidemiologic data on clinically evident cerebral vasculopathy in HIV-infected adults is scarce, even though stroke hospitalizations are rising in this patient population.
  
  
  METHODS
  A total of 6,298 HIV-infected adults (San Francisco General Hospital, 2000-2013) were screened to generate a cohort of patients with dedicated neuroimaging of the intra- and extracranial cerebral vasculature. We extracted information regarding the extent of HIV disease (including serial viral load and CD4 counts), cardiovascular disease risk factors and exposure to cART (cross-referenced with pharmacy records) and performed multivariate logistic regression analysis to identify predictors of vasculopathy.
  
  
  RESULTS
  Of 144 patients, 55 patients (38.2%) had radiographic evidence of cerebral vasculopathy. Twenty (13.9%) had a vasculopathy characterized by vessel dolichoectasia and intracranial aneurysm formation. Thirty-five patients (24.3%) had intra- and or extracranial stenosis/occlusion. cART use (OR 2.27, 95% CI 1.03-5) and tobacco abuse (OR 2.35, 95% CI 1.04-5.25) were independently associated with the development of any vasculopathy, whereas cART use was also an independent risk factor for the stenosis/occlusion subtype specifically (OR 2.87, 95% CI 1.11-7.45).
  
  
  CONCLUSIONS
  There was a high frequency of cerebral arterial disease in this neuroimaging cohort of HIV/AIDS patients. A history of cART use and a history of tobacco abuse were independent risk factors for vasculopathy, though these findings should be confirmed with large-scale prospective studies.
authors.affiliation: Departments of Neurology and Neurosurgery, University of Texas Health Science at Houston, Houston, Tex., USA.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Edwards
authors.forename: Marie F
authors.initials: MF
authors.lastname: Grill
authors.forename: H Alex
authors.initials: HA
authors.lastname: Choi
authors.forename: Nerissa U
authors.initials: NU
authors.lastname: Ko
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects* / Q000379:methods; D002539:Cerebral Arterial Diseases / Q000139:chemically induced / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors