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Increased vascular stiffness has been found in adults with HIV. A key question is if the vascular stiffness is related to cognitive decline. This issue was investigated in the Women’s Interagency HIV Study, which includes 1662 women with 72% HIV positive and the remainder, similar in demographics, but who are HIV negative. Carotid ultrasound at a single baseline visit was used as a measure of stiffness and longitudinal neuropsychological test results as a measure of cognitive status were determined from 2004-2016. Results indicated that more carotid stiffness was associated with greater decline in neuropsychological scores over the 10-year follow-up. However, changes in cognitive function did not differ between the HIV positive and negative groups. The results of this study suggest the need to introduce early modification of cardiovascular risk factors to lessen chronic cognitive decline in older adults.