ART-class drugs don't increase the risk of cerebral small-vessel disease in HIV


  • Daniela Ovadia - Agenzia Zoe
  • Actualités Médicales
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Key messages

  • The aim of this case-control study was to investigate if the exposure to any antiretroviral-drug class could be associated with the higher risk of cerebral small-vessel disease (CSVD) in middle-aged persons living with HIV (PLHIVs) compared to the general population.
  • After adjusting for traditional and HIV-specific cardiovascular risk factors, the analysis found no evidence of an ART-class deleterious effect on CSVD risk in middle-aged PLHIVs, but further research is needed.

Previous studies showed that the risk of CSVD is twofold higher in PLHIVs than in HIV-negative controls, after adjustment for classic cardiovascular risk factors. The reason is unknown, thus in this study the authors investigated if the antiretroviral-drug class could be a risk factor for CSVD, a condition associated with cognitive impairment, stroke, frailty and shorter survival of the elderly.

The MicroBREAK-2 case-control study enrolled PLHIVs ≥50 years old (median age 57.6 years, 85.7% males), with cART-suppressed viremia for ≥1 year, between 2014 and 2017.

77 PLHIVs with radiologically defined CSVD (cases) were matched with 77 CSVD-free PLHIVs (controls) for age (±5 years), sex and year of HIV diagnosis (±5 years). The median HIV-diagnosis year was 1992.

Exposure to ART class was modelled as cumulative years of use, except for integrase inhibitors, modelled by exposure (“yes” or “no”).

Multivariable analyses were adjusted for hypertension, CD4 nadir, current CD4/CD8 ratio, and HIV-transmission group.

The increasing risk of CSVD was not associated with exposure to any ART class: nucleoside reverse transcriptase inhibitors (adjusted Odds Ratio [aOR] 1.00), nonnucleoside reverse transcriptase inhibitors (aOR 0.94), protease inhibitors (aOR 0.96) and/or exposure to integrase inhibitors (aOR 0.55).

Limitations: the study-sample size is relatively small; too few cases were exposed to integrase inhibitors, thus its cumulative exposure was not assessed.