CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

global NP score and in 4 domains (motor function: Dominant/Non-dominant Grooved Pegboard; executive function: Trail-Making Part B, Stroop Color Word; attention: Trail-Making Part A, Stroop Word-Reading; processing speed: Symbol Digit Modalities, Stroop Color Naming). We constructed random-effects panel linear regression models to estimate the overall, HIV, and sex-stratified associations of ASCVD risk with subsequent cognitive function (NP testing performed median 2 years later, range 1-14 years) in the combined and separate cohorts. Results: In the combined cohort (mean age 46 years, 39% women), median ASCVD risk score was 3.4% (IQR 1.2-7.6%). ASCVD risk score was higher in people without HIV (3.8%, IQR 1.3-8.6%) than in PWH (3.1%, IQR 1.1-6.8%; p<0.001). Higher ASCVD risk score (per IQR for all results) predicted lower subsequent global cognition (β -0.41, SE 0.04, p<0.001). HIV did not modify the association between ASCVD risk and cognitive function (interaction p=0.465). In men, no difference in the association between ASCVD risk and subsequent cognition (global or in domains) was observed by HIV. In women, higher ASCVD risk significantly predicted lower subsequent global cognition (β -0.20, SE 0.02, p=0.016) and motor function (β -0.68, SE 0.05, p=0.009) in women with HIV but not in women without HIV (Table). Conclusion: The ASCVD risk score predicted subsequent cognitive function in PWH and people without HIV, although the magnitude of these associations was modest overall and particularly among women. These findings underscore the complex relationship between HIV and ASCVD risk on cognition. Future studies should examine the cause of these observed differences between women and men. Cumulative Exposure to CVD Risk Factors More Adversely Affects Cognition in Women With & Without HIV Abel C Obosi 1 , Yifei Ma 2 , Maria L. Alcaide 3 , Cecile D. Lahiri 4 , Monica M. Diaz 5 , Gypsyamber D'Souza 6 , Deborah Gustafson 7 , Seble Kassaye 8 , Matthew J. Mimiaga 9 , Kathleen Weber 10 , Robert Paul 11 , Leah H. Rubin 12 , Adesola Ogunniyi 1 , Babafemi Taiwo 13 , Felicia C. Chow 2 1 University of Ibadan, Ibadan, Nigeria, 2 University of California San Francisco, San Francisco, CA, USA, 3 University of Miami, Miami, FL, USA, 4 Emory University, Atlanta, GA, USA, 5 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 6 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 7 State University of New York Downstate Medical Center Downstate Medical Center, Brooklyn, NY, USA, 8 Georgetown University, Washington, DC, USA, 9 University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA, 10 Hektoen Institute of Medicine, Chicago, IL, USA, 11 University of Missouri St Louis, St Louis, MO, USA, 12 The Johns Hopkins University, Baltimore, MD, USA, 13 Northwestern University, Chicago, IL, USA Background: The adverse effect of cardiovascular disease (CVD) risk factors on cognitive health may be greater for women than men. We evaluated if sex and HIV modify the effect of CVD risk on cognition in the Women's Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS). Methods: People living with HIV (PWH) and without HIV who underwent neuropsychological testing at least once beginning in 2005 in the MACS and in 2009 in the WIHS were eligible. We examined performance on overlapping tests (TrailMaking A and B, Symbol Digit Modalities, Stroop Color Word Trials 1-3, Grooved Pegboard) in the two cohorts and averaged demographically adjusted T scores into a global summary score and within domains. We calculated cumulative years of exposure for binary CVD risk factors and the average cumulative level of continuous CVD risk factors at each follow-up visit. We constructed adjusted mixed-effects linear regression models (Figure) to estimate separate and interactive associations of each time-dependent CVD risk factor with sex and HIV on cognition. Results: Among 2,993 women from WIHS (mean follow-up 4.4 y), 2098 were living with HIV, 54% on ART at baseline. Among 2,702 men from MACS (mean follow-up 9.0 y), 1,477 were living with HIV, 44% on ART at baseline. BMI (-0.89 per 5 kg/m 2 /yr [95% CI -1.27, -0.52], p<0.001), LDL (-0.24 per 10 mg/ dL/yr [-0.36, -0.11], p<0.001), and methamphetamine (-0.74 per yr exposure [-1.36, -0.12], p=0.020) had a greater negative association with global cognition in women than men. Statins (0.39/yr exposure [0.11, 0.67], p=0.006),

despite viral suppression. Progression of WMH in relation to outcomes following onset of early antiretroviral therapy (ART) remains poorly understood. Methods: We identified participants enrolled in the SEARCH010/RV254 cohort in Thailand. Multimodal 3T MRI and cognitive testing was performed at week 0 (Fiebig I-V, at ART onset) and week 96 post-ART initiation for all participants. WMH data were extracted from T2 FLAIR sequences using an automated k-nearest neighbor approach. Total WMH volume was computed as both a raw index and as a standardized percentage of the intracranial volume (ICV) for each individual. A composite cognitive score (NPZ-4) was created by averaging Z-scores for Color Trails 1 & 2, Grooved Pegboard Non-dominant, and Trail Making A. HIV disease indices, vascular comorbidities, and cognitive scores were compared to WMH indices using nonparametric testing. Results: We identified 71 participants (70 male) with AHI and median age 27 years (IQR 24-33). Median CD4+ T-cell count was 348 (IQR 251, 481) and 674 (IQR 486, 908) at week 0 and 96. Median VL at week 0 was 6.16 logcopies/mL (IQR 5.43, 6.78). 96% of participants were virally suppressed (VL <50 copies/mL) at week 96. We observed a mean increase in standardized WMH volume of 22% from week 0 to 96, with 53 individuals (75%) showing an absolute increase and 18 individuals (25%) showing an absolute decrease. While presence of vascular comorbidities was low (9% hypertension, 1% diabetes, 7% hyperlipidemia, and 3% migraine), we found positive associations between WMH % change and history of smoking and systolic blood pressure at week 0, as well as between raw WMH change and BMI, pulse pressure, systolic blood pressure, and hypertension at week 0 (all p<0.05). We did not find an association between WMH burden and cognitive test scores. Conclusion: Individuals with AHI showed an increase in WMH volume over two years following initiation of ART. Modifiable vascular risk factors during AHI correlated with WMH progression despite successful ART. These findings implicate vulnerability of white matter following acute infection despite early and effective initiation of ART. Further studies comparing these patterns to PWOH and individuals with chronic HIV are needed.

Poster Abstracts

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Atherosclerotic Cardiovascular Disease Risk Score and Cognition by HIV Serostatus and Sex Hannah Begna 1 , Ali Mirzazadeh 1 , Maria L. Alcaide 2 , Monica M. Diaz 3 , Cecile D. Lahiri 4 , Gypsyamber D'Souza 5 , Deborah Gustafson 6 , Seble Kassaye 7 , Jeremy Martinson 8 , Matthew J. Mimiaga 9 , Kathleen Weber 10 , Pariya Wheeler 11 , Leah H. Rubin 12 , Felicia C Chow 1 1 University of California San Francisco, San Francisco, CA, USA, 2 University of Miami, Miami, FL, USA, 3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 Emory University, Atlanta, GA, USA, 5 The Johns Hopkins University, Baltimore, MD, USA, 6 State University of New York Downstate Medical Center Downstate Medical Center, Brooklyn, NY, USA, 7 Georgetown University, Washington, DC, USA, 8 University of Pittsburgh, Pittsburgh, PA, USA, 9 University of California Los Angeles, Los Angeles, CA, USA, 10 Hektoen Institute of Medicine, Chicago, IL, USA, 11 University of Alabama at Birmingham, Birmingham, AL, USA, 12 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Higher cardiovascular risk is associated with poorer cognitive health, including in people with HIV (PWH). We examined whether HIV modifies the association between the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator and subsequent cognition in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). Methods: Participants followed in the MACS (N=1773 men, 2005 to 2019) and WIHS (N=1264 women, 2009 to 2019) who had available CVD risk data and underwent neuropsychological (NP) testing at least 1 year after calculated ASCVD risk score were included. Demographically-adjusted T-scores for the cognitive tests that overlapped between the two cohorts were averaged as a

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