Vascular contributions to cognitive impairments and dementia (VCID) among people living with HIV in the country of Georgia

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Limited knowledge exists about vascular contributions to cognitive impairments and dementia (VCID) among PLWH or older adults without infection in the Eastern European and Central Asia (EECA) region including Georgia. The intersection of VCID with the HIV care continuum has never been estimated in Georgia and the EECA, and not evaluated among PLWH who are living to older ‘at risk’ ages. To mitigate adverse effects of VCID among PLWH, the prevalence of VCID and other aging-related risk factors must be estimated and characterized across the HIV care continuum. This application is a supplement to Fogarty HIV Research Training Grant (1D43TW011532; Strategic Training Partnership to End AIDS in Georgia). We propose to address the surging ‘HIV + noncommunicable disease (NCD)’ care continuum in Georgia. Early Stage Investigator (ESI) training will be operationalized via: Aim 1. Advanced didactic training in HIV-aging, VCID measures, and brain health outcomes; and Aim 2. Hands- on training in research project development, implementation and analysis via conducting a cross-sectional pilot study of 150 PLWH age >40 years. Among these participants, the goals of the pilot study are to: Aim 2.a. Characterize sociodemographic and HIV (e.g., HIV viral load, CD4+ count) factors; Aim 2.b. Estimate the prevalence of VCID and brain health using pilot study measures. VCID include obesity, hypertension, Type 2 diabetes, and hyperlipidemias; history of cardio- and peripheral vascular events; cigarette smoking; alcohol use; and substance abuse. Brain health outcomes include cognitive performance and impairment, severity and clinically-relevant depression and anxiety symptoms, and history of cerebrovascular disease and stroke. Aim 2.c. Evaluate VCID risk and history with stratification by HIV severity (viral load and CD4+ count), HCV coinfection (yes/no), injection drug use (yes/no), 10-year age group, and sex and gender. This innovative pilot study is the first in Georgia and the EECA region among aging PLWH that uses standardized and validated clinical and blood-based biomarker approaches. Our results will inform development of interventions to reduce VCID and adverse brain health outcomes related to the HIV+NCD care continuum among PLWH; and prospective observational studies to compare aging processes between PLWH and people without HIV infection. These future deliverables will be achieved through HIV research capacity building of one Georgian ESI, a recent doctoral graduate, who will receive advanced didactic and hands-on training in the development of a strategic skillset.