Measurement of retinal vessels as a biomarker of cerebrovascular ageing in older HIV positive men compared to controls

Background: To compare retinal vascular measurements, biomarkers of cerebral small vessel disease (SVD), in HIV positive men aged 50 years and above with similarly-aged HIV negative men and younger HIV positive men. Methods: We recruited white, non-diabetic men to a cross-sectional substudy of a larger cohort including three demographically-matched groups. Optic disc centred 45° colour fundus photographs were used to calculate central retinal arterial and venous calibre and the arterial- venous ratio (AVR). We used univariate and multivariable linear regression to compare retinal vessel measurements in the three groups and to identify factors associated with AVR. Results: All HIV positive men were virologically suppressed. In a multivariable model, study group was not associated with AVR (adjusted β 0.010 for HIV positive men 50 years [n=120], 95% CI -0.018 to 0.038, p=0.47; adjusted β 0.00002 for HIV negative men >50 years [n=52], 95% CI -0.022 to 0.022, p=0.99). Factors associated with lower AVR were systolic BP (adjusted β -0.009 per +10 mmHg, 95% CI - 0.015 to -0.003, p=0.002), history of stroke or transient ischemic attack (adjusted β -0.070, 95% CI -0.12 to -0.015, p=0.01), and recent recreational drug use (adjusted β -0.037, 95% CI -0.057 to -0.018, p=0.0002). Conclusion: There were no differences in retinal vascular indices between HIV positive men aged >50 years and HIV negative men aged >50 years or HIV positive men aged <50 years, suggesting that HIV is not associated with an increased burden of cerebral SVD.