Introduction
Dementia disproportionately affects people living with HIV (PLWH) with a significantly earlier onset age than HIV-negative counterparts. This age-associated illness is associated with morbidity, mortality and higher healthcare costs. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia (BC), Canada.

Methods
This retrospective cohort study utilized data from the STOP HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002-2016. Our outcome of interest was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event. Clinical covariates included the diagnosis of chronic comorbidities associated with dementia within the general population.

Results
Among 5,121 eligible PLWH, 108 (2%) developed dementia. The crude 15-year prevalence of dementia was 2.1%, and the age-sex standardized incidence rate of dementia was 4.3 (95% CI: 4.2-4.4) per 1000 PYs. Among the adjusted covariates, CD4 cell count <50 cells/mm³ (aCSH 8.61, 95% CI: 4.75-15.60), uncontrolled viremia (aCSH 1.95, 95% CI 1.20-3.17), 10-year increase in age (aCSH 2.41, 95% CI 1.89-3.07), schizophrenia (aCSH 2.85, 95% CI:1.69-4.80), traumatic brain injury (aCSH 2.43, 95% CI 1.59-3.71), delirium (aCSH 2.27, 95% CI 1.45-3.55), substance use disorders (aCSH 1.94, 95% CI:1.18-3.21), and mood/anxiety disorders (aCSH 1.80, 95% CI:1.13-2.86) were associated with an increased hazard for dementia.

Conclusion
Our findings demonstrate the adverse impacts of mental health and substance use disorders on the risk of dementia and call for enhanced integration of HIV care with health care services provided for mental health, substance use disorder, and other risk-inducing comorbidities to lower the risk of dementia among PLWH.

Background
Advancements in treatment have resulted in improved survival among people living with HIV, who now have a life expectancy approaching that of the general population. However, due to multiple factors, including comorbidities, frailty tends to develop at a younger age among people living with HIV. We set out to examine the prevalence of frailty and its correlates among older adults living with HIV in Canada, with a primary interest in nadir CD4 cell count.

Methods
We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV age >65. Participants meeting at least 3/5 Fried Frailty Phenotype criteria (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, low physical activity) at cohort entry were characterized as frail. We used logistic regression to estimate the association between nadir CD4 count and frailty, as well as the following a priori selected variables: age, gender, time since HIV diagnosis, number of comorbidities, marital status, and loneliness (measured using UCLA loneliness scale, higher scores indicate more loneliness).

Results
Among 439 cohort participants (median age 69 years, 90% men, all on antiretrovirals, 99.5% viral load <200 copies/mL), 73 were frail (prevalence 16.6%). Frailty was not associated with nadir CD4 count (median CD4 count 222 in frail vs. 198 cells/mm3 in non-frail participants). Not being in a relationship (adjusted odds ratio [aOR] 2.22, 95% confidence interval [CI] 1.00-5.00) and greater degree of loneliness (aOR 1.33 per 10-point increase, 95% CI 1.07-1.66) were associated with frailty.

Conclusions
Frailty occurred in approximately 1 in 6 older, mainly male, adults living with HIV in this cohort. While nadir CD4 count did not correlate with frailty, being single and lonely did, highlighting the importance of recognizing and addressing these social vulnerabilities among people aging with HIV.

Objectives: To describe engagement in physical activity and experiences of disability among adults living with HIV in Canada.

Methods: We conducted a cross-sectional web-based survey with adults living with HIV in Canada. Community-based organizations and clinics recruited participants online (email) and in-person (on site). Participants completed a 40-minute online questionnaire about physical activity (Canadian Physical Activity Guidelines (CPAG)), disability (Episodic Disability Questionnaire (EDQ)), and HIV and personal characteristics. We calculated descriptive statistics. The CPAG recommend completing ≥150mins of moderate-intensity aerobic physical activity (or equivalent) weekly. We calculated EDQ presence, severity and episodic scores (range 0-100; higher scores indicate more disability). We examined differences between mean EDQ domain severity scores among participants who did versus did not meet the CPAG for aerobic physical activity using the Mann-Whitney U test.

Results: Of 238 respondents, most were from Ontario (64%), men (71%), median age 53 years (25th,75th percentile:39,61), and had a median of 5 (2,9) concurrent health conditions. Highest EDQ scores for presence (78(54,100)) and severity (45(30,55)) of disability were in the uncertainty domain. Highest EDQ scores for episodic nature of disability (10(0,40)) were in the physical domain. In the past week, 99 (42%) respondents reported meeting the CPAG for aerobic physical activity. Among participants who met the CPAG for aerobic physical activity versus those who did not, mean EDQ severity scores were lower for physical (z=-2.247; 95% Confidence Interval(CI):0,10), cognitive (z=-2.680; 95%CI:0,13)), mental-emotional (z=-3.424; 95%CI:5,16), uncertainty (z=-3.802; 95%CI:5,15), difficulty with day-to-day activities (z=-3.861; 95% CI:5,17), and social inclusion (z=-3.644: 95%CI:3,12) domains (p<0.05).

Conclusions: Fewer than half of respondents reported meeting the CPAG in the past week. Meeting the CPAG for aerobic physical activity was associated with lower disability scores across all domains. Future research should explore strategies to enhance physical activity engagement to reduce severity of disability among adults living with HIV.

Background: People with HIV (PWH) are at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) and its severe forms, including metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis. While recent studies have implicated gut microbial dysbiosis in the MASLD pathogenesis, but its specific role in PWH remains unclear.

Methods: We included PWH with a diagnosis of MASLD, defined as controlled attenuation parameter >238 dB/m by Fibroscan without viral hepatitis coinfection or alcohol abuse. Severe MASLD was defined as presence of MASH (serum cytokeratin-18 >130.5 U/L) and/or significant liver fibrosis (liver stiffness measurement >7.1 kPa). Taxonomic composition of gut microbiota was determined using 16S ribosomal RNA gene sequencing of stool samples. PICRUSt-based functional prediction was employed. Bacterial and functional differences were assessed using an adjusted generalized linear model using a negative binomial distribution.

Results: 34 PWH with MASLD were enrolled (mean age 52 years, 15% females). Among them, 32% had severe MASLD. After adjusting for age and sex, severe MASLD explained seven percentage of the overall variation (r2 = 0.07, p = 0.09) in bacterial composition. Among others, participants with severe MASLD had increases of genera Eubacterium, Bacteroides, Ruminococcsu, Roseburia and decreases of Prevotella, Olsenella, Oribacterium, Dialister (Figure). In severe MASLD, functional analysis revealed increases in fatty acid degradation and flavonoid biosynthesis, and decreases in steroid biosynthesis, folate biosynthesis, and alanine, aspartate metabolism.

Conclusion: In PWH, gut dysbiosis and altered gut microbiota metabolism correlate with MASLD severity. This analysis complements traditional predictors and identifies potential novel metabolic targets for pre-/probiotics therapies.

Background: People living with HIV (PLWH) have higher prevalence of Adverse Childhood Experiences (ACEs). ACEs, in turn, have been linked with adverse physical and mental health outcomes. We examined whether resilience coping and social support moderate the negative effect of ACEs on depressive symptoms among PLWH.

Methods: Data for the current study come from participants of the OHTN Cohort Study (OCS) who completed the annual questionnaire (2021-2022). OCS is a longitudinal cohort of PLWH receiving care in 15 clinics across Ontario. Exposure to ACEs, depressive symptoms, social support, and resilient coping were assessed using the ACE-10 scale, PHQ-9 survey, the MOS-SS scale, and the BRCS scale, respectively. Linear regression methods were used to assess the moderating effect of resilience coping and social support on the relationship between ACEs and depressive symptoms.

Results: Participants (N=2,556) were predominantly gay/bisexual men (64.8%), 50 years or older (64.3%), single (61.4%), White (59.2%) and had an income of <$40K/year (54.4%). Nearly two-thirds (71.4%) reported exposure to ≥1 ACEs and higher number of ACEs was associated with greater depression symptomatology (B= 0.71, p<0.001). In multivariable regression analyses, we found that both social support (B= 0.43, p=0.011) and resilient coping (B= 0.46, p=0.011) buffered against the impact of ACEs on depressive symptomatology. Further, we found an interaction effect between social support and resilient coping (B= 0.70, p<0.001) as well as a three-way interaction effect between ACEs, social support, and resilient coping (B= -0.14, p=0.003). This suggests that while social support provided protective effect against depressive symptomatology, this effect is further magnified with higher levels of resilient coping.

Conclusions: Social support and resilient coping moderated the impact of ACEs on burden of depressive symptomatology. Interventions that boost social support and resilience coping skills may contribute to improved mental health among PLWH.

Background: Socioeconomic status drives health disparities. People with HIV (PWH) are at risk for chronic liver diseases. The association between material deprivation and hepatic outcomes in PWH has not been evaluated.

Purpose: To evaluate the association between material deprivation and liver fibrosis, metabolic dysfunction-associated steatotic liver disease (MASLD) and clinical outcomes in PWH.

Method: We included PWH from the LIVEr disease in HIV cohort. MASLD was defined as hepatic steatosis (controlled attenuation parameter >248 dB/m) plus BMI>25 Kg/m2, type 2 diabetes, hypertension, or dyslipidemia. Liver fibrosis was defined as liver stiffness measurement >8. Socioeconomic status was assessed using the Pamplon Material Deprivation Index by linking patient postal code to the 2016 Canadian census. PWH were classified as materially “deprived” or “privileged”. Multivariable linear regression and Kaplan Meier analyses were completed.

Results: Among 768 PWH included, 305 (40%) were materially privileged and 359 (47%) were materially deprived. Materially deprived PWH were more frequently female, of Black ethnicity, and had metabolic comorbidities. After adjustments, material deprivation was associated with increased liver fibrosis (β=1.858, 95% CI 0.53-3.17; p=0.006) but not with steatosis (β=6.469, 95% CI -5.55-18.49; p=0.291). During a median follow-up of 3.8 years, incidence of liver-related events was 14.6 (10.3–20.7) per 1000 person years. Incidence of liver-related events was higher in materially deprived compared to privileged PWH while there was no difference in extrahepatic events or mortality.

Conclusions: Material deprivation is associated with liver fibrosis and liver-related events in PWH. Future strategies should assess whether improved material security improves liver outcomes.