Predictors of cerebral small-vessel disease in middle-aged, virologically-controlled people living with HIV

Antoine Moulignier; C. Lamirel; Arbnor Zenuni; P. Koskas; Corinne Amiel; Roland Tubiana; Christine Katlama; Soraya Fellahi; Jean‐Philippe Bastard; Jacqueline Capeau; Dominique Costagliola; Amélie Yavchitz; Augustin Lecler; L. Assoumou; for the Microvascular Brain Retina And Kidney (MicroBREAK) Study Group; A Moulignier; A Moulignier; C Amiel; L Assoumou; A Canestri; I Cochereau; J Capeau; D Costagliola; O Godin; PM Girard; C Katlama; C Lamirel; F-X Lescure; L Marchand; M Mazighi; M Obadia; M Paques; G Pialoux; E Plaisier; R Tubiana; N Valin; Y Yazdanpanah; P Yeni; A Moulignier; M Abrivard; A-S Alonso; I Cochereau; P Koskas; C Lamirel; L Lopes; M Mazighi; M Obadia; P Roux; J -C Sadik; L Salomon; J Savatovsky; V Vasseur; F-X Lescure; M Chansombat; R Landman; B Phung; D Rahli; Y Yazdanpanah; P Yeni; C Katlama; L Lenclume; R Tubiana; M Valantin; PM Girard; J -L Meynard; M Sebire; N Valin; G Pialoux; A Adda Liévin; C Amiel; Bastard Jp; A Canestri; J Capeau; S Fellahi; M -G Lebrette; E Plaisier; P Thibaut; D Costagliola; L Assoumou; G Dos Santos; O Godin; L Marchand; P Girard; J -P Vincensini

doi:10.1093/ofid/ofag382

Predictors of cerebral small-vessel disease in middle-aged, virologically-controlled people living with HIV

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ID: 319159

2026

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Abstract

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Abstract Background Despite durable viral suppression with antiretroviral therapy (ART), non-AIDS comorbidities remain frequent in aging people with HIV (PWH). Cerebral small-vessel disease (CSVD), a major contributor to stroke and cognitive decline, is up to twice as prevalent in middle-aged ART-treated PWH. Mechanisms underlying this excess risk remain unclear. Objective To identify inflammatory, viral, renal, and retinal vascular factors independently associated with CSVD in virologically-controlled PWH. Methods The case–control MicroBREAK-2 study (NCT02210130), nested in the PWH group of the MicroBREAK-1 study, included 80 ART-treated (≥5 years) PWH aged ≥50 years with MRI-defined CSVD and 80 matched CSVD-free controls (age ±5 years, sex, year of HIV diagnosis ±5 years). Participants underwent brain MRI, renal, carotid, and orbital color Doppler ultrasonography, and comprehensive ophthalmologic assessment. Circulating inflammatory and coagulation biomarkers, Epstein–Barr virus plasma load, and antiretroviral exposure were measured. Independent associations were identified using conditional logistic regression with LASSO selection and bootstrap resampling. Result Hypertension was the strongest independent correlate of CSVD (OR 4.92, 95% CI 1.23–19.62; p=0.02). Markers of persistent inflammatory and coagulative activity were also independently linked to CSVD, including higher white blood cell count (OR 1.58; 1.17–2.14; p=0.003) and elevated D-dimer levels (OR 1.52; 1.09–2.12; p=0.01). Increased intraocular pressure was independently related to CSVD (OR 6.37; 1.38–29.4; p=0.02). In contrast, HIV-specific parameters showed no independent relationship with CSVD. Conclusion In virologically-suppressed PWH, CSVD is primarily associated with hypertension and persistent low-grade inflammation rather than HIV-specific factors, underscoring the need for aggressive cardiovascular risk management.

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Authors	Antoine Moulignier, C. Lamirel, Arbnor Zenuni, P. Koskas, Corinne Amiel, Roland Tubiana, Christine Katlama, Soraya Fellahi, Jean‐Philippe Bastard, Jacqueline Capeau, Dominique Costagliola, Amélie Yavchitz, Augustin Lecler, L. Assoumou, for the Microvascular Brain Retina And Kidney (MicroBREAK) Study Group, A Moulignier, A Moulignier, C Amiel, L Assoumou, A Canestri, I Cochereau, J Capeau, D Costagliola, O Godin, PM Girard, C Katlama, C Lamirel, F-X Lescure, L Marchand, M Mazighi, M Obadia, M Paques, G Pialoux, E Plaisier, R Tubiana, N Valin, Y Yazdanpanah, P Yeni, A Moulignier, M Abrivard, A-S Alonso, I Cochereau, P Koskas, C Lamirel, L Lopes, M Mazighi, M Obadia, P Roux, J -C Sadik, L Salomon, J Savatovsky, V Vasseur, F-X Lescure, M Chansombat, R Landman, B Phung, D Rahli, Y Yazdanpanah, P Yeni, C Katlama, L Lenclume, R Tubiana, M Valantin, PM Girard, J -L Meynard, M Sebire, N Valin, G Pialoux, A Adda Liévin, C Amiel, Bastard Jp, A Canestri, J Capeau, S Fellahi, M -G Lebrette, E Plaisier, P Thibaut, D Costagliola, L Assoumou, G Dos Santos, O Godin, L Marchand, P Girard, J -P Vincensini
Journal	Open forum infectious diseases
Year	2026
DOI	10.1093/ofid/ofag382 Searching for DOI...
URL	https://doi.org/10.1093/ofid/ofag382 https://doi.org/10.1093/ofid/ofag382
Keywords	Keywords not found

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