Abstract Details

Title Prevalence and Characterization of Cerebral Vasculopathy in an HIV/AIDS Neuroimaging Cohort

Topic Infections/AIDS/Prion Disease

Presentation(s) S38 - (-)

Poster/Presentation
Number 002

Objective

Background HIV/AIDS predisposes patients to a myriad of neurologic disorders, including cerebrovascular disease. Descriptions of a cerebral vasculopathy have emerged in this patient population, including 1) dolichoectasia and aneurysm formation, and 2) stenotic and occluded vessels. The prevalence, nature, risk factors, and pathophysiologic mechanisms underlying HIV-associated vasculopathy are only beginning to be explored.

Design/Methods In this retrospective cohort study, we screened 5389 patients diagnosed with or treated for HIV/AIDS at San Francisco General Hospital during the past 15 years. Of these patients, 150 had undergone dedicated cerebrovascular imaging, 127 with CT, MR, or conventional angiography explicitly visualizing the intracranial vasculature. Our primary outcome measure was the presence of any vasculopathy.

Results Of the 127 HIV/AIDS patients with cerebrovascular imaging, 69 of these patients (54.3%) had normal vessel imaging whereas 58 patients (45.7%) had evidence of vascular disease. 37 patients (29.1%) had stenotic or occluded vessels. 16 (12.6%) had dolichoectatic vessels and/or the presence of an intracranial aneurysm. Two patients had cervical artery dissections; arteriovenous malformations were evident in three patients. Of the patients with the dolichoectatic/aneurysmal vasculopathy, 14 (87.5%) had concurrent vascular risk factors such as hypertension and/or toxicology-confirmed substance use (cocaine/methamphetamines). 12 (75%) were reportedly on HAART. In this subset, the nadir CD4 count ranged from 4 to 704 (median 99) and the peak serum HIV viral load from undetectable to 2509078 (median 28064 copies/mL).

Conclusions There was a high prevalence of vasculopathy in this cerebrovascular imaging cohort of HIV/AIDS patients. In those with dolichoectatic vessels and/or intracranial aneurysms, nadir CD4 counts were frequently less than 200 and a large proportion (87.5%) had concurrent vascular risk factors such as cocaine/methamphetamine use.

Authors/Disclosures
Nancy Edwards, MD PRESENTER	No disclosure on file
Marie F. Grill, MD (Mayo Clinic)	Dr. Grill has nothing to disclose.
Nerissa U. Ko, MD (UCSF Neurovascular Service)	The institution of Dr. Ko has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Route 92, Inc. The institution of Dr. Ko has received research support from American Heart Association. The institution of Dr. Ko has received research support from NIH. The institution of Dr. Ko has received research support from NIH.
Edward Fox, MD, PhD, FAAN	Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GW Pharmaceuticals. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squibb. The institution of Dr. Fox has received research support from Biogen. The institution of Dr. Fox has received research support from Genentech. The institution of Dr. Fox has received research support from Celgene - BMS. The institution of Dr. Fox has received research support from Chugai. The institution of Dr. Fox has received research support from Novartis. The institution of Dr. Fox has received research support from EMD-Serono. The institution of Dr. Fox has received research support from TG Therapeutics. The institution of Dr. Fox has received research support from AbbVie. The institution of Dr. Fox has received research support from Sanofi Genzyme. The institution of Dr. Fox has received research support from AbbVie.

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