Cardiovascular Contributors to Cognitive Impairment Among People Living With HIV Age 40 Years and Older in Kazakhstan

Abstract

Introduction

The Kazakh population has been increasing in age over the last two decades. Life expectancy in Kazakhstan in 2022 was 73.8 years (y). Noncommunicable diseases (NCDs) accounted for ∼84% of deaths, particularly among men, and included cardiovascular disease, diabetes, chronic respiratory disease and cancer. It is anticipated that life expectancy trends will be similar among People Living With HIV (PLWH) who are virally suppressed in Kazakhstan. However, the prevalence and types of aging-related NCDs among Kazakh PLWH are unknown, despite ∼40% of Kazakh PLWH being age >40 years (y). In addition, and limited knowledge exists about the NCD-HIV care continuum.

Methods

An ongoing cross-sectional study is being conducted among PLWH, >40y at the Almaty AIDS center. Cardiovascular, clinical, sociodemographic, mental health, medical history, health behavior, and HIV measures are collected. The Montreal Cognitive Assessment was included (range: 0-30).

Results

113 PLWH were interviewed over ∼6 months (43.4% females; 54.9% age 40-49y, 30.1%, 11.5% and 3.5% age 50-59, 60-69, >70 years, respectively; gender: 58.3% cis men, 41.7% cis women; 20.4% self-reported Asian (Kazakh) race, 56.6% White (Russian), 23.0% unknown; 55.4% were employed; 25.7% reported education beyond college; 65.5% consumed alcohol; 76.1% were current smokers and 26.5% drug users. 54% had healthy BMI (18.5- <25 kg/m2). Systolic blood pressure range was 90-140mmHg (median 120); diastolic blood pressure range, 60-100mmHg (median 80). Median oxygen saturation was 98%. 76.7% participants had undetectable HIV viral load (<50 copies/ml), and 16.7% exhibited CD4 cell count <200 cells/mm3. However, 36.3% had high NT-pro-BNP (≥125 pg/ml), which was accompanied by a higher mean HIV viral load (p=0.026). Mean plasma glucose (mmol/l) and triglycerides were higher (p<0.10) among those with NT- proBNP ≥125 pg/ml. Among those taking antiretroviral therapies over a longer time period, there was higher NT-proBNP, however p>0.05. The MoCA indicated that 61.9% scored <26 (raw score); average 23.1. Comparing those with MoCA <26 versus ≥26, there were no differences in pro-BNP or lipid levels, HIV viral load or CD4+ count. However, diastolic blood pressure was higher among those with MoCA<26 (p=0.043).

Discussion

Further investigation to understand cardiovascular contributors to cognitive impairment among PLWH is necessary.