Cerebrovascular disease in children perinatally infected with HIV in Zambia

BACKGROUND: High rates of cerebrovascular disease (CVD) have previously been described in pediatric Human Immunodeficiency Virus (HIV). However, little is known about pediatric CVD in the era of antiretroviral therapy (ART), or about the contribution of CVD to HIV-associated neurocognitive disorders. METHODS: We completed a neuroimaging sub-study of the HIV-Associated Neurocognitive Disorders in Zambia study, a prospective cohort study of neurocognitive complications of pediatric HIV. Brain MRI (1.5 T) was acquired for 34 HIV+ children on ART and 17 HIV-exposed uninfected (HEU) children (8-17 years old). Demographics, medical history, neurologic exam, and neuropsychological testing results were also collected. Two neuroradiologists, blinded to HIV status and clinical course read and annotated the scans. RESULTS: CVD was identified in 7/34 children with HIV (HIV+ CVD+) and no HEU children (21% vs. 0%, p = 0.05). Three participants had white matter changes suggestive of small vessel disease, four had ischemic infarcts, and two also had evidence of intracranial artery stenosis. Age of ART initiation and exposure to protease inhibitors or efavirenz was not significantly different between children with and without CVD. HIV+ CVD+ children had significantly worse scores on a summary measure of cognition than the HIV+ CVD− group (NPZ8 score −0.57 vs. 0.33, p = 0.04). CONCLUSIONS: This study demonstrates high rates of CVD in children with HIV despite treatment with ART, and worse cognitive performance in children with CVD. Longitudinal studies are necessary to determine the mechanisms and incidence of new onset CVD in children with HIV.