Fig. 1.

Conceptual diagram of vascular contributions to neurocognitive dysfunction in HIV. Diagram illustrates hypothesized relationships between HIV infection, cardiovascular damage, and cognitive dysfunction. Increased prevalence of subclinical CVD (e.g. arterial stiffness, atherosclerosis) and CVD in HIV has multiple etiologies including cART side effects and traditional risk factors (e.g. smoking, type 2 diabetes mellitus, hypertension, dyslipidemia, obesity), immune activation and associated inflammation, comorbidities (e.g. Hepatitis C, cytomegalovirus) and substance use (e.g. cocaine, methamphetamine). Cardiovascular damage leads to brain injury through vascular mechanisms including ischemia (e.g. cerebral small vessel disease, white matter hyperintensities), and reduced blood flow to the brain, which in turn leads to neurocognitive dysfunction. Circles represent additional factors that may influence these relationships.