Increased White Matter Hyperintensities Load In Patients with HIV

HIV viruses infecting T-lymphocytes, computer illustration. The surface of the T-cell has a lumpy appearance with large irregular surface protrusions. Smaller spherical structures on the cell surface are HIV virus particles budding away from the cell membrane. The virus has infected the T-cell, and instructed the cell to reproduce many more viruses. This viral budding causes the T-cell to die. Depletion of the number of T-cells in the blood is the main reason for the destruction of the immune system in AIDS.
White matter hyperintensities may be more common in patients living with HIV, even if well-controlled, and may correlate with other clinical parameters.

Among patients living with HIV with well-controlled infection, defined as receiving antiretroviral therapy for at least 1 year and plasma viral-load of less than 200 copies/ml, the extent of white matter hyperintensities (WMH) is higher, compared with control patients without HIV, according to study results published in Neurology.

Brain WMH are areas of hyperintense signal in the periventricular or deep white matter, frequently seen on magnetic resonance imaging (MRI). As brain MRI abnormalities are common in patients living with HIV, the objective of this study was to evaluate the effect of HIV serostatus on WMH load, and to identify clinical variables associated with WMH in patients living with HIV.

Using the Fazekas visual rating scale to assess WMH load, study researchers assessed brain MRI scans of patients with well-controlled infection and matched controls. The primary outcome was increased WMH load, as determined by total Fazekas score of at least 2.

The study sample included 203 (75% men; mean age, 50 years) patients with HIV and 58 (53% men; mean age, 49 years) controls without HIV with an available brain MRI scan between April 2014 and March 2019.

In the simple logistic regression, the prevalence of increased WMH load was 3-fold higher for patients living with HIV, compared with controls (odds ratio, 3.0; 95% CI, 1.6-5.6; P =.0006). In the multiple logistic regression analysis with age and tobacco use as covariates, the risk for increased WMH load was almost 4-fold higher for patients living with HIV, compared with controls (adjusted odds ratio, 3.7; 95% CI, 1.8-7.5; P =.0004).

Among patients living with HIV, older age, male sex, history of tobacco use, hypertension and hepatitis C virus coinfection were all associated with a higher rate of WMH. Additionally, in a subset of 75 participants from whom sufficient cerebrospinal fluid was available, the presence of measurable tumor necrosis factor-alpha in cerebrospinal fluid was associated with a higher mean total Fazekas score.

The study had several limitations including the lack of matching for sex and comorbidities, the exploratory nature of the analysis, and the use of a single manual rating scale.

“[O]ur results suggest that HIV serostatus affects the extent of brain WMH even in the setting of well-controlled infection. This contribution is possibly mediated by accelerated aging and modifiable cardiovascular [comorbidities], as few significant correlations were found with specific HIV disease parameters,” concluded the study researchers.


Mina Y, Wu T, Hsieh HC, et al. Association of white matter hyperintensities with HIV status and vascular risk factors. Neurology. Published online February 26, 2021. doi:10.1212/WNL.0000000000011702