Abstract 30: Carotid Artery Stiffness and Decline in Cognitive Function Among Women With, or at Risk for, HIV Infection

Abstract

Background: Vascular stiffness is associated with aging and cognitive impairment in populations without HIV infection. HIV is also associated with increased vascular stiffness. The objective of this study was to examine the association of baseline carotid artery stiffness with progression of cognitive decline among women with, or at risk for, HIV infection, and to determine whether HIV modified this association. Methods: We used available baseline carotid stiffness and serial cognitive assessments from 2004 to 2015 in the Women’s Interagency HIV Study, a longitudinal cohort study of women with, or at risk for, HIV. Baseline measurements of carotid stiffness (distensibility) were determined from B-mode carotid artery ultrasound. Serial neurocognitive testing including Trail Making Tests A and B (TRLA, TRLB) and the Symbol Digit Modalities Test (SDMT) was conducted over a median 8.5 years of follow-up. Linear mixed effects models were used to determine associations of baseline measures of carotid stiffness with progression of cognitive decline, with time operationalized as participant age. Models were adjusted by HIV serostatus and demographic, behavioral, and cardiometabolic factors. Results: Among 1732 women (1244 HIV+; 488 HIV-) median age at baseline was 41 (IQR 34-47), and the majority were non-Hispanic black (60%) or Hispanic (28%). Greater baseline distensibility, indicating less carotid stiffness, was associated with lower cognitive decline over time in SDMT (β = 0.006 per 10 –6 х Newton –1 х meter 2 , p <0.001), TRLA (β = -0.01; p = 0.04), and TRLB (β = -0.05; p = 0.002), depicted in the figure. Longitudinal associations did not differ by HIV status (p interaction ≥ 0.13). Conclusions: Less baseline carotid stiffness was associated with slower progression of cognitive decline in women with, or at risk for, HIV infection, independent of potential confounders. Targeting of cardiovascular risk factors could prevent cognitive decline regardless of HIV serostatus.