Immune dysregulation persists in PWH on antiretroviral therapy (ART) and may lead to accelerated vascular aging, cardiovascular (CV) diseases like stroke, and cognitive impairment. 

RV254 participants were enrolled during AHI, initiated ART within days and underwent regular follow-up. FRS CV risk at week 288 was calculated. FRS-based vascular age was defined as age with the same predicted CV risk but optimally-controlled risk factors. Vascular age deviation (VAD) was vascular age minus actual age. Cognitive performance (NPZ-4) was determined by averaging z-scores of: Color Trails 1 & 2, non-dominant Grooved Pegboard (GPB), and Trails Making A. Linear regression model was used to assess factors associated with VAD.

356 participants (98% male; 100% viral suppression)  completed week 288 visit. At week 288,  actual and vascular ages were 32 (IQR 28,37) and 34 (IQR 30,40) years (p<0.001). Vascular age was higher than actual age in 232 (65%) participants (VAD = 3(IQR -1,7) years). 10-year CV risk was 2.3% (IQR 1.6,3.9, “low risk” ≤10%). Only one clinically-relevant CV adverse event occurred (embolic stroke) within the study period.

In univariable analysis, higher week 288 CD4+ T-cell count was associated with increased VAD (B[95%CI]: 0.5 years [0.3-0.7] per 100 cell increase in CD4+ T-cell count, p<0.001). In stratification analysis, CD4+ T-cell count remained independently associated with VAD regardless of smoking status (p<0.05). Vascular age and VAD at week 288 were not associated with NPZ-4.

In young PWH after 6 years of ART initiated during AHI, 10-year CV risk was low and CV events rare. Higher CD4 count was associated with higher VAD even after controlling for smoking. Vascular risk after 6 years on ART did not predict cognitive test performance.