Atherosclerosis, vascular events and dementia risk in HIV-infected patients. Preliminary data from the Italian multicentre cohort of the Cardiovascular and late-life dementia risk in HIV (CARDH) Study

Background: With the increased survival of HIV-infected patients in the HAART era, comorbidities, as vascular disease, emerged as major health issues. Cognitive impairment, in addidion, ranging from mild deficits to severe dementia, proved prevalent in about half of HIV patients, more closely associated with cardiometabolic than with viro-immunological factors. We aimed to evaluate the determinants of accelerated atherosclerosis and vascular events and to assess their potential inference on late-life cognitive decline risk, in a midlife HIV population aged 40 to 65 years. Methods: HIV patients from the Infectious Disease Units of Pescara and Sassari were consecutively enrolled as part of CISAI CARDH cohort study. Patients were characterized for clinical and viroimmunological parameters, traditional cardiovascular (CV) risk factors, and psychological factors (Distress personality, Alexithymia and depression). Carotid plaques (CP), defined as a focal thickening≥1.0 mm, and vascular events follow-up were also searched. The risk for 20-year cognitive decline was estimated using the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score, based on cognitive reserve, physical activity, anthropometric and cardiometabolic variables. The CAIDE risk score was also dichotomized for low and high risk, using the 75° percentile cut-off (≥7.4% risk). Results: A cohort of consecutive 201 subjects (75.2% male, age 47.6±6.0 yr, 43.7% with AIDS) was recruited. Of them, 85% was on HAART, with mean treatment duration 67.2±52.0 months. The mean CAIDE score was 7.24±25 (mean risk 3.7±3.2%), with 20.6% presenting a CAIDE≥7.4%. At multivariate analyses, CPs were associated with increasing age (OR=1.10[95%CI=1.0-1.2]; p=0.02) and CAIDE score (OR=1.16[95%CI=1.0-1.3]; p=0.04). Vascular events at a median of 2.5 years were predicted by a higher CAIDE (OR=3.56[95%CI=1.1-10.7]; p=0.02), whereas all other variables including age, CP, HeartScore, Framingham and Alexithymia were uniformative. On the other hand, a CAIDE≥7.4% risk was independently associated with: age (OR=1.14[95%IC=1.0 -1.2]; p=0.003), smoke (OR=3.58[95%IC=1.2-10.2]; p=0.02), Alexithymia (OR=5.81[95%CI=1.9 -17.3]; p=0.002) and Distress (OR=3.49 [95%CI=1.2-9.8]; p=0.02). Conclusions: In mid-life HIV patients, the CAIDE risk score may predict atherosclerosis and future vascular events better than a traditional CV risk algorithm. Interestingly, cognitive decline risk in HIV may be more related to CV risk than to viroimmunological factors.