Lack of association of Vascular Risk Factors with HIV-associated neurocognitive disorders in cART-treated adults aged ≥50 years in Tanzania

Abstract

Objectives: HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with treated HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity. This hypothesis is yet to be examined in the population ageing with HIV in sub-Saharan Africa. Our aim was to evaluate relationships of VRFs, vascular end organ damage and HAND in individuals aged ≥50 receiving HIV treatment in TanzaniaDesign: Cross sectional observational study, with systematic sampling.Methods: c-ART-treated individuals were assessed for HAND by consensus criteria. Prevalence of VRFs (hypertension, hypercholesterolemia, obesity, diabetes, and smoking) and end organ damage markers (prior myocardial infarction, stroke, left ventricular hypertrophy, estimated-glomerular filtration rate, ankle-brachial pressure index, retinal arteriovenous ratio) were measured. Independent associations of VRFs, end organ damage and HAND were examined by multivariable logistic regression.Results: Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior MI) to 12.5% (LVH). Measured VRFs and end organ damage were not independently associated with HAND, although there was a significant association with lower diastolic BP (p 0.030, OR 0.969 (0.943-0.997).Conclusion: The overall lack of association between vascular risk factors, vascular end organ damage and HAND suggests vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.