Carotid Artery Stiffness and Cognitive Performance among Men Living with and without HIV

Carotid artery stiffness has been associated with cognitive performance; however, the association among men with HIV (MWH) remains unclear. We examined the relationship between carotid artery distensibility and cognitive performance in the Multicenter AIDS Cohort Study (MACS). We analyzed data from 717 men (459 MWH and 258 men without HIV [MWoH]) who underwent carotid artery ultrasound and completed neuropsychological testing at least twice. Carotid artery distensibility was divided into tertiles. Cognitive outcomes included psychomotor speed (Trail Making Test A), executive function (Trail Making Test B), and processing speed (Symbol Digit Modalities Test). Multivariable mixed effects linear regressions were used to estimate longitudinal associations between distensibility tertiles and cognitive scores, with adjustments for socio-demographics, cardiovascular risk factors, and HIV-related characteristics. Regardless of HIV serostatus, lower vascular distensibility was associated with older age, higher systolic and diastolic blood pressure, and greater prevalence of cardiometabolic risk factors. In fully adjusted analyses, lower carotid artery distensibility was significantly associated with slower performance on Trail Making Test A and B in MWH. These associations were weaker and not statistically significant among MWoH perhaps due to low sample size. In the combined sample, the rate of decline in executive function with age was similar across distensibility tertiles, but absolute scores were lowest in the low distensibility group. Lower carotid artery distensibility is linked to worse cognitive performance among MWH, suggesting that vascular aging may compound HIV-related cognitive decline.