Background: Neurological disturbances are frequently reported by HIV-infected patients, in particular with aging. A multitude of physical comorbidities has been shown to affect cognition in general populations in particular age and cardio-metabolic disease. However, a mild clinical picture can escape detection without formal neurological assessment and neuropsychological testing (NCT). Screening can be done inquiring about symptoms and performing brief neurocognitive tests (bNCT) that can help clinicians for further investigations. Our aim was to apply bNCT to HIV-infected-individuals evaluated for cardiovascular and metabolic diseases for primary prevention and relate cardiovascular risk with bNCT performance.

Patients and Methods: Consecutive HIV-positive patients were prospectively enrolled. Anthropometric, clinical and biochemical data were recorded; 10-year cardiovascular risk score was calculated according to the ASCVD algorithm (<7.5%, 10-20%, >20%), 5 year D:A:D and 10 yy Framingham. The measurement of common carotid IMT was performed by the same operator at 1 cm from carotid bifurcation as the average of three measurements (abnormal >0.9 mm). Data are expressed as medians (interquartile ranges). Patients received bNCT as three questions (3Qs), the International HIV Dementia Score (IHDS) and Clock Drawing Test (CDT) and Frontal Assessment Battery (age and education adjusted, aFAB), used in Geriatric Medicine for dementia screening in both HIV- and HIV+ patients. Respectively 3Qs≥1, IHDS≤10, CDT≥3 and aFAB≤13.4 were considered abnormal.

Results: 420 patients were enrolled (89% on cART, 79% male, median age 49 years). Plasma HIV-RNA was <20 copies/ml in 302 patients (72%), with a continuous duration of HIV suppression of 3.3 years. Current and nadir CD4+ cell count were 522/uL (343-690) and 200/uL (86.5-323), respectively. CV risk strata were: 5yyDAD (low 86.8%, high 13.2%), 10yFramingham (low 42.6%, intermediate 27.7%, high 29.7%) and 10yyASCVD (low 57.4%, intermediate 26.9% and high 15.7%). bNCT were abnormal in 107 (32%), 109 (42.4%), 56 (13.3%) and 38 (9%) patients, according to 3Qs, IHDS, CDT and aFAB, respectively. HAND was diagnosed in 44 patients (51.7%): 31, 10 and 3 subjects with ANI, MND or HAD. Age, education, history of hypertension, dyslipidemia, diabetes, pathological IMT affected a worse performance at ≥ 1 bNCT (p<0.05). Patients in the intermediate/high CV risk strata (using the three algorithms) had significantly lower NC performances. According to HIV infection, previous exposure to old NRTIs, as didanosine or with current NNRTIs based regimen got a low IHDS score (p=0.007), while PIs and INI based regimes seem to be over-represented in patients with normal performances.

Conclusions: Our work confirm the need for an early neuropsychological and cardiovascular assessment for HIV-positive patients to guarantee a prompt risk factors identification: a patient with intermediate/high cardiovascular risk may benefit from neurocognitive testing even if asymptomatic. Studies assessing the impact of cardiovascular risk reduction on cognition in HIV-positive subjects are urgently needed.