Objectives:Mounting evidence indicates that vascular risk factors (VRFs) are elevated in HIV and play a significant role in the development and persistence of HIV-associated neurocognitive disorder. Given the increased longevity of people living with HIV (PLWH), there is a great need to better elucidate vascular contributions to neurocognitive impairment in HIV. This systematic review and meta-analysis examine relationships between traditional VRFs, cardiovascular disease (CVD), and cognition in PLWH in the combination antiretroviral therapy era.Methods:For the systematic review, 44 studies met inclusion criteria and included data from 14,376 PLWH and 6,043 HIV-seronegative controls. To better quantify the contribution of VRFs to cognitive impairment in HIV, a robust variance estimation meta-analysis (N = 11 studies) was performed and included data from 2139 PLWH.Results:In the systematic review, cross-sectional and longitudinal studies supported relationships between VRFs, cognitive dysfunction, and decline, particularly in the domains of attention/processing speed, executive functioning, and fine motor skills. The meta-analysis demonstrated VRFs were associated with increased odds of global neurocognitive impairment (odds ratio [OR ]= 2.059, p = .010), which remained significant after adjustment for clinical HIV variables (p = .017). Analyses of individual VRFs demonstrated type 2 diabetes (p = .004), hyperlipidemia (p = .043), current smoking (p = .037), and previous CVD (p = .0005) were significantly associated with global neurocognitive impairment.Conclusions:VRFs and CVD are associated with worse cognitive performance and decline, and neurocognitive impairment in PLWH. Future studies are needed to examine these relationships in older adults with HIV, and investigate how race/ethnicity, gender, medical comorbidities, and psychosocial factors contribute to VRF-associated cognitive dysfunction in HIV.

中文翻译：

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联合抗逆转录病毒治疗时代的艾滋病毒、血管危险因素和认知：系统回顾和荟萃分析


目的：越来越多的证据表明，艾滋病毒中血管危险因素（VRF）升高，并在艾滋病毒相关神经认知障碍的发展和持续中发挥重要作用。鉴于艾滋病毒感染者（PLWH）寿命的延长，非常需要更好地阐明血管对艾滋病毒神经认知障碍的影响。这项系统回顾和荟萃分析探讨了联合抗逆转录病毒治疗时代传统 VRF、心血管疾病 (CVD) 和 PLWH 认知之间的关系。方法：在系统回顾中，44 项研究符合纳入标准，纳入了来自 14,376 名 PLWH 和 6,043 名 PLWH 的数据HIV 血清阴性对照。为了更好地量化 VRF 对 HIV 认知障碍的影响，进行了一项稳健的方差估计荟萃分析（N = 11 项研究），其中包括 2139 名 PLWH 的数据。 结果：在系统评价中，横断面和纵向研究支持了相关关系VRF、认知功能障碍和衰退之间的关系，特别是在注意力/处理速度、执行功能和精细运动技能领域。荟萃分析表明，VRF 与整体神经认知障碍的几率增加相关（优势比 [OR ]= 2.059，p = .010），在调整临床 HIV 变量后仍然显着（p = .017）。对个体 VRF 的分析表明，2 型糖尿病 (p = .004)、高脂血症 (p = .043)、当前吸烟 (p = .037) 和既往 CVD (p = .0005) 与整体神经认知障碍显着相关。 结论：VRF 和 CVD 与 PLWH 的认知能力较差、认知能力下降以及神经认知障碍有关。 未来的研究需要检查老年 HIV 感染者的这些关系，并调查种族/民族、性别、医疗​​合并症和心理社会因素如何导致 HIV 中与 VRF 相关的认知功能障碍。