Cardiovascular Disease Risk in PLWHIV Alters Brain Glucose Metabolism

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PLWHIV who have received treatment had lower whole-brain standardized uptake values compared to healthy controls with risk for CVD as the best predictor.
PLWHIV who have received treatment had lower whole-brain standardized uptake values compared to healthy controls with risk for CVD as the best predictor.

People living with HIV (PLWHIV) who have received antiretroviral therapy (ART) had lower whole-brain and regional standardized uptake values compared to healthy controls and risk scores for atherosclerotic cardiovascular disease were the best predictor for this reduction in brain glucose metabolism, according to a study published in Neurology.

Researchers in this cross-sectional comparison of fluorodeoxyglucose uptake measured brain glucose metabolism in 47 cohort participants with HIV who have received ART, 10 age-matched and socioeconomically and geographically similar participants who did not have HIV with comorbid conditions (cardiovascular disease, substance abuse, coinfections) in common with cohort group and 19 age-matched healthy controls.

Whole-brain and regional standardized uptake values were compared among the 3 groups and the values were correlated to neuropsychological and clinical assessments.

Investigators found lower whole brain standardized uptake values in PLWHIV compared to the healthy control participants (difference −2.668; 95% CI, −4.724 to −0.6119; P =.009), but not with the participants without HIV. In the relative regional standardized uptake values measurements, only the relative values of thalamic uptake were lower in cohort group compared with the group of participants without HIV.

When participants were grouped together, regardless of HIV status, the best predictors of standardized uptake values (both maximum and mean) were risk scores for atherosclerotic cardiovascular disease (P =.0019; r=−0.413; R2=.17 for standardized uptake maximum values; P =.004, r=−0.38, R2=.146 for standardized uptake values mean).

When evaluated separately, the brain glucose metabolism of PLWHIV also showed significant correlations with atherosclerotic cardiovascular disease risk scores (P =.002, r=−0.446, R2=.206 for standardized uptake values max; P=.0024, r=−0.454, R2=.199 for standardized uptake values mean).

Study investigators concluded that cardiovascular disease plays an important role in neuronal dysfunction/loss in PLWHIV who have received ART. They note that "[t]his underscores the need for shifting the focus of clinical intervention in this vulnerable population from HIV effects alone to a wider set of comorbid conditions, mainly cardiovascular disease."

Reference

Hammoud DA, Sinharay S, Steinbach S, et al. Global and regional brain hypometabolism on FDG-PET in treated HIV-infected individuals [published online September 26, 2018]. Neurology. doi:10.1212/WNL.0000000000006398

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