Moulignier A, et al. - In order to assess the cerebral small-vessel disease (CSVD) prevalence among middle-aged people living with well-controlled human immunodeficiency virus (HIV) infection (PLHIV), researchers undertook the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) EP51 Microvascular Brain Retina and Kidney Study (MicroBREAK; NCT02082574). In this cross-sectional study, 456 treated PLHIV, ≥50 years old with viral load controlled for ≥12 months, and frequency age- and sex-matched 154 HIV-uninfected controls (HUCs) were prospectively enrolled. HIV was identified as an independent risk factor for CSVD. Despite sustained immunovirological control, middle-aged PLHIV demonstrated the CSVD prevalence twice as high than that in HUCs. Among PLHIV, older age, hypertension, and lower CD4 cell count nadir were independently associated with a higher risk of CSVD.