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  Conference on Retroviruses
and Opportunistic Infections
Seattle, Washington
March 4-7, 2019
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Higher cardiovascular risk in older HIV
group tied to worse cognitive function
  Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2019, Seattle
Mark Mascolini
Higher initial 10-year cardiovascular risk predicted worse cognitive function 4 years later in older people with HIV, according to results of a 988-person longitudinal study [1]. The impact of cardiovascular risk on cognitive function proved greater in women than men, and in women the association remained statistically significant after adjustment for other cognitive risk factors.
AIDS Clinical Trials Group (ACTG) researchers who conducted this study noted that individual cardiovascular risk factors tied to cognitive impairment have varied from study to study and include history of cardiovascular disease, diabetes, abnormal cholesterol, high waist circumference, and physical inactivity. Combined cardiovascular risk factors carry a higher cognitive risk than a single factor [2].
The ACTG team conducted this study to see if two 10-year risk scores, the Atherosclerotic CVD (ASCVD) and Framingham risk score (FRS), which combine several risk factors, predict cognitive function in adults with HIV. The researchers focused on members of ACTG A5322 (HAILO), who started antiretroviral therapy (ART) in an ACTG trial at age 40 or older. Participants undergo annual neurocognitive testing.
People were eligible for this analysis if they had neurocognitive testing at study entry and 4 years later. The primary neurocognitive outcome was the NPZ-4 score, which combines results of 4 tests. The primary predictor was 10-year ASCVD or FRS. The investigators explored potential associations between risk scores and 4-year NPZ-4 in unadjusted linear regression models and in a model adjusted for demographics, clinical variables, HIV-related factors, and education.
The 988 study participants averaged 52 years in age, 20% were women, 30% black, and 21% Hispanic. Half had an undergraduate degree, and 14% attended graduate school. Nine in 10 people had a viral load below 40 copies, CD4 count averaged 661, and median ART duration stood at 8 years.
At the baseline study visit, women had significantly lower average cardiovascular risk scores than men (ASCVD 4.1% versus 7.5%, FRS 8.1% versus 14.3%, P < 0.001 for both). In an unadjusted analysis, initial ASCVD risk significantly predicted cognitive function 4 years later: For every 1% higher initial ASCVD, NPZ-4 at year 4 was 1.4 standard deviation (SD) lower (P = 0.003). This association was stronger in women (NPZ-4 3.6 SD lower, P = 0.007) than in men (NPZ-4 1.6 SD lower, P = 0.002). For women and men combined, there was a trend toward an association between higher FRS and subsequent cognitive impairment: For every 1% higher initial FRS, NPZ-4 at year 4 was 0.6 SD lower (P = 0.058).
In a statistical model adjusted for age, sex, race/ethnicity, education, physical activity, HCV infection, and duration of ART, there was a trend toward a 1.1 SD lower NPZ-4 score at year 4 for every 1% higher ASCVD risk (P = 0.085). The trend was significant for women (3.1 SD lower NPZ-4, P = 0.010) but not for men (0.4 SD lower NPZ-4, P = 0.55). In adjusted analysis, the association between FRS and NPZ-4 score also remained significant for women (2.1 SD lower NPZ-4, P = 0.015) but not for men (0.2 SD lower, P = 0.72). For women both the ASCVD and FRS associations remained significant after further adjustment for initial NPZ-4 score.
The researchers concluded that "a higher cardiovascular risk score may help identify people with HIV who are at risk for worse cognitive function over time." Future work might address potential mechanisms underlying this association, such as cerebrovascular injury, impaired cerebral perfusion, inflammation, and oxidative stress. Another critical unanswered question is whether strategies to lower cardiovascular risk can preserve cognitive health in people with HIV.
1. Chow FC, Lyass A, Massaro J, et al. Cardiovascular risk scores predict longitudinal cognitive function in older people with HIV. Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2019. Seattle. Abstract 128.
2. Kivipelto M, Helkala EL, Hanninen T, et al. Midlife vascular risk factors and late-life mild cognitive impairment: a population-based study. Neurology. 2001;56:1683-1689.
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