Abstract Details

Title Cerebrovascular Disease in Perinatally-infected Children with HIV in Zambia

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S37 - Stroke Epidemiology: Risk Factors, Incidence, and Unique Populations (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Objective To describe the clinical and cognitive assessment of seven HIV infected children with neuroimaging evidence of cerebrovascular disease.

Background High rates of cerebrovascular disease (CVD) have previously been described in pediatric HIV. However, there are little data in children with HIV in the era of antiretroviral therapy (ART). Contributing factors to CVD in this population may include HIV-associated vasculopathy, inflammation, opportunistic infections, and neurotoxic or metabolic effects of ARTs (in particular protease inhibitors and efavirenz).

Design/Methods Within the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ), 34 perinatally-infected children with HIV on ARTs and 17 HIV-exposed uninfected (HEU) children 8-17 years were imaged. Data included demographics, medical history, neurologic exam, and neuropsychological testing results. Brain MRIs (1.5 Tesla, sequences: T1, T2, FLAIR, DWI, ADC, and MRA) were read and annotated using NeuroInterp by a neuroradiologist blinded to HIV status and clinical course.

Results

CVD was identified in 7/34 children with HIV and no HEU participants (21% vs. 0%, p = 0.04). Age of ART initiation was not different between participants with and without CVD (median = 5 years, IQR = 4-6 vs. median = 4 years, IQR = 2-7). In subjects with CVD, 29% were treated with protease inhibitors and 86% were treated with efavirenz. Participants with CVD had significantly worse scores on a summary measure of cognition than those without CVD (-0.57 vs 0.33, p = 0.04). In participants with CVD, three had white matter changes suggestive of small vessel disease and four had prior ischemic infarcts in the cerebellum, cortex, or deep gray matter. Two participants with infarcts also had MRA suggestive of moyamoya phenomena.

Conclusions We demonstrate surprisingly high rates of CVD in HIV-infected children despite treatment with ART. Longitudinal imaging is needed to determine whether CVD begins before initiation of treatment and whether treatment mediates the burden of CVD.

Authors/Disclosures
Colleen L. Schneider (University of Rochester Medical Center) PRESENTER	Ms. Schneider has nothing to disclose.
Owen Dean	No disclosure on file
Alexandra Buda	Ms. Buda has nothing to disclose.
	No disclosure on file
Michael Potchen	Michael Potchen has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Jackson & Campbell, P.C.. Michael Potchen has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Rotezel & Andress.
Sylvia Mwanza-Kabaghe	No disclosure on file
Deanna Saylor, MD, MHS (Johns Hopkins Hospital)	Dr. Saylor has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ��ɫ��. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from ��ɫ��. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and ��ɫ��al Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.
Esau G. Mbewe	Esau G. Mbewe has received research support from Research was supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number K23NS117310. .
Pelekelo Kabundula	Pelekelo Kabundula has nothing to disclose.
Heather Adams	The institution of Heather Adams has received research support from Current: NIH; Past: Abeona; Batten Research Alliance; American University Centers on Disabilities. An immediate family member of Heather Adams has received publishing royalties from a publication relating to health care. Heather Adams has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Critical Path Institute.
Gretchen L. Birbeck, MD, MPH, DTMH, FAAN (University of Rochester/CHET)	An immediate family member of Dr. Birbeck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Birbeck has a non-compensated relationship as a Ambassador for Zambia with RSTMH that is relevant to AAN interests or activities.
David Bearden, MD (University of Rochester School of Medicine)	Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Praxis. Dr. Bearden has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for law firms.

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