TOPLINE

Among people with HIV (PWH), vascular disease was independently associated with more frequent and severe apathy — a neuropsychiatric syndrome primarily characterized by diminished motivation; more than half of those carrying both conditions showed clinically elevated apathy.

METHODOLOGY

• Researchers conducted a retrospective, cross-sectional analysis involving PWH to examine whether vascular disease contributed to the frequency and severity of apathy.
• They analyzed 319 PWH (mean age, 50.4 years; 16% women) and 133 people without HIV (mean age, 51.1 years; 32.3% women) recruited from urban Southern California between 2006 and 2018.
• Vascular disease was identified through semi-structured interviews and medical records, based on current or historical diagnoses including hyperlipidemia, hypertension, chronic cardiopulmonary disease, type 2 diabetes, and myocardial infarction; 149 participants (33%) were classified as having vascular disease.
• Participants were grouped according to HIV and vascular disease status: PWH with vascular disease (n = 121), PWH without vascular disease (n = 198), people without HIV but with vascular disease (n = 28), and those with neither condition (n = 105).
• Apathy was measured using two validated self-report questionnaires, whose scores were combined into a composite score; clinically elevated apathy was defined as a score of ≥ 65.

TAKEAWAY

• The frequency of clinically elevated apathy rose in a stepwise fashion, from 21.0% in participants with neither HIV nor vascular disease to 52.1% in those with both conditions (P < .0001 for trend). HIV and vascular disease were associated with 2.4-fold (95% CI, 1.5-3.7) and 1.7-fold (95% CI, 1.1-2.5) higher odds of clinically elevated apathy, respectively.
• In the adjusted analysis, HIV disease and vascular disease were both independent predictors of apathy symptom severity (P < .05 for both).
• Among vascular conditions, chronic cardiopulmonary disease and other vascular diseases (including congestive heart failure, transient ischemic attack, myocardial infarction, or peripheral vascular disease) were significantly associated with higher apathy.
• In an analysis predicting general psychiatric distress, vascular disease was not a significant predictor, suggesting that the vascular association was more specific to apathy than to generalized psychiatric distress.

IN PRACTICE

"Clinicians working with PWH who present with comorbid vascular disease (eg, hypertension) might consider formally screening for apathy or referring directly to behavioral health," the authors wrote.

SOURCE

The study was led by Steven P. Woods, University of Houston, Houston. It was published online on August 24, 2026, in AIDS Care.

LIMITATIONS

The retrospective, cross-sectional design of the study could not determine whether vascular disease directly causes apathy. Apathy was measured using self-report questionnaires, which are susceptible to bias. The sample consisted mostly of well-educated White men from Southern California, limiting generalizability. Vascular disease was determined by interview and medical record review rather than biological markers or neuroimaging.

DISCLOSURES

The study was supported by the National Institutes of Health. The authors did not report any relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.