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Carotid Inflammation on FDG-PET Is Associated With
Lower Cognitive Function in Treated HIV Infection
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Meg Wilson, Shady Abohashem, Ahmed A. Tawakol, Priscilla Y. Hsue, Felicia C. Chow
CROI 2024 March 3-6 Denver
program abstract
Background: Studies investigating the relationship between cardiovascular disease (CVD) and cognition in people with HIV (PWH) have largely focused on CVD risk factors and cerebral small vessel disease. We examined the relationship between subclinical carotid arterial inflammation on 18F-fluorodeoxyglucose (FDG)- PET and cognitive function in PWH.
Methods: ART-treated PWH at moderate to high CVD risk underwent PET/CT of the neck and chest, from which we calculated FDG uptake in the carotid arteries and ascending aorta. Participants completed a battery of neuropsychological tests (Hopkins Verbal Learning Test-Revised, Digit Symbol, Grooved Pegboard, Trail Making Test Parts A & B, Stroop, Letter Fluency) and stress measures within 2 weeks of the PET scan. Z scores were created by comparing raw scores to age, sex, ethnicity, and education-matched norms and then averaged into a global cognitive summary score. In addition to individual CVD risk factors, we devised a CVD risk score reflecting the total number of CVD risk factors (history of heart disease or stroke, hypertension, diabetes, dyslipidemia, or current smoking) per participant. We used partial correlations to examine the relationship between arterial inflammation and global cognition adjusted for age, race, and education.
Results: Forty-seven PWH (mean age 60, 98% men) with undetectable viral load were included. Carotid inflammation was negatively correlated with global cognition (r=-0.32, p=0.037), even after adjusting for CVD risk (r=-0.34, p=0.029). In contrast, aorta inflammation was not associated with global cognition (r=-0.05, p=0.75). Current smoking was the only individual CVD risk factor that correlated significantly with global cognition (r=-0.35, p=0.018). The correlation between carotid inflammation and global cognition was slightly attenuated after adjusting for current smoking (r=-0.30, p=0.055). Of stress measures that correlated significantly with global cognition (post-traumatic stress, r=-0.47, p=<0.001; early childhood stress, r=-0.43, p=0.003), the negative correlation between carotid inflammation and global cognition remained significant after accounting for post-traumatic (r=-0.33, p=0.033) but not early childhood stress (r=-0.25, p=0.10).
Conclusion: Carotid but not aorta inflammation was negatively correlated with global cognition independent of CVD risk. Future studies should focus on identifying upstream factors that may be targeted to reduce carotid inflammation and potentially preserve cognitive health in PWH.
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