| |
Vascular risk drives cognitive decline over 10
years in people aging with well-controlled HIV
|
| |
| |
AIDS Publish Ahead of Print, July 07, 2026
Download the PDF here
-------------------------------------------
Nearly all US ischemic heart disease deaths tied to modifiable risk factors
Download the PDF here
------------------------------------------
Older age remained a significant risk factor even after accounting for Framingham and VACS scores, with each decade increasing the risk by approximately 35%.
Objective:
To characterize long-term cognitive trajectories in adults aging with well-controlled HIV and identify baseline predictors of cognitive decline.
Design:
Prospective, multicenter longitudinal cohort study with repeated cognitive assessments for up to 10 years.
Methods:
Positive Brain Health Now enrolled HIV+ adults aged ≥35 years without dementia and followed at 9-12-month intervals across two study phases (2013-2018; 2019-2024). Cognitive performance was assessedusing the Brief Cognitive Ability Measure (B-CAM). Group-based trajectory modeling identified patterns of cognitive change among participants with at least one visit in each phase. Baseline predictors of declining trajectory membership were examined using generalized estimating equations.
Results:
Two cognitive trajectories were identified: one stable and one declining. Although no decline was detected during the initial 3-year follow-up, 47% of participants exhibited decline over up to 10 years, with an estimated 0.35-0.5 SD difference in B-CAM scores between trajectories.
The strongest baseline predictors of decline were higher cognitive performance (floor effect), higher Framingham Risk Score and peripheral artery disease(OR [95% CI]: 2.84 [1.35-5.98] and 3.07 [2.06-4.57]), and older age, lower education, needing academic support, cannabis use, anxiety, low motivation, detectable plasma HIV RNA, and higher VACS Index 1.0 scores. Nadir CD4 count and HIV duration were not independently associated with decline.
Those who completed an intial assessment were mostly men, on average 53 years of age, had been living with HIV for 17 years and were aviremic, with a few exceptions. While they were not immunosuppressed, the average nadir CD4 count was low (median <200 cells/μL).
Decline was associated with vascular risk factors, cannabis use, older age, lower educational attainment at study entry and needing special academic support, while detectable plasma HIV RNA, low motivation, anxiety, and higher VACS Index contributed more modestly to risk
Conclusions:
Among adults aging with well-controlled HIV, cognitive decline, when present, progressed slowly and was driven primarily by vascular risk factors, suggesting that, in the current treatment era, vascular comorbidities may play a greater role in cognitive decline than traditional HIV-related factors.
Cognitive decline emerging over this longer time frame was most strongly predicted by poor vascular health.
|
|
| |
| |
|
|
|
