The Prevalence of Cerebral Microbleeds in HIV-Infected Hemophilia Patients

Objective: Several studies have shown that rates of cerebrovascular events in HIV-infected patients are increased in comparison to uninfected individuals. In addition, cerebral bleeding represents a serious complication in hemophilia patients. Recently, asymptomatic cerebral microbleeds (CMBs), which can be detected by highly sensitive techniques such as T2*-weighted magnetic resonance imaging (MRI), have emerged as an important marker for predicting symptomatic cerebral bleeding. The aim of the present study was to investigate the prevalence of CMBs in HIVinfected hemophilia patients and to evaluate the association between HIV infection and cerebral bleeding. Methods: All HIV-infected hemophilia patients (HIV+ HemPts) who visited our hospital from January 2015 to December 2016 were enrolled in this study. In addition, all HIV-uninfected hemophilia patients (HIV- HemPts) who visited our hospital in the same period were enrolled as controls. CMBs were assessed using T2*-weighted MRI. The relationship between cerebral bleeding and the patients’ clinical factors was examined. Results: Two HIV+ HemPts had symptomatic cerebral bleedings during the study period. Twenty-one asymptomatic HIV+ HemPts and 13 HIV- HemPts underwent T2*-weighted MRI. CMBs were observed in 7 HIV+ HemPts (30.4%) and 1 HIV- HemPts (7.7%). In the multivariate logistic regression analysis, HIV infection was the factor most closely related to cerebral bleeding (odds ratio: 9.78, p-value: 0.08). Conclusion: This is the first report to investigate the prevalence of CMBs in HIV-infected patients. The prevalence of CMBs or symptomatic cerebral bleeding in HIV+ HemPts was high in comparison to that in HIV- HemPts. The brain screening test by T2*-weighted MRI seems to be meaningful for HIV+ HemPts.