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Abstract
Objective: To evaluate relationships between HIV-associated neurocognitive disorder and metabolic variables in a subgroup of HIV+ participants examined in a prospective, observational, multicenter cohort study.
Methods: In a cross-sectional substudy of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort, 130 HIV+ participants provided fasting blood samples. Neurocognitive impairment (NCI) was defined by performance on neuropsychological tests adjusting for age, education, gender, and race/ethnicity. Global ratings and global deficit scores were determined. Demographics, biomarkers of HIV disease, metabolic variables, combination antiretroviral therapy (CART) history, other drug exposures, and self-reported diabetes were examined in multivariate models predicting NCI. Separate models were used for body mass index (BMI) alone (n = 90) and BMI and waist circumference (WC) together (n = 55).
Results: NCI (global impairment rating ≥5) was diagnosed in 40%. In univariate analyses, age, longer duration of HIV infection, obesity, and WC, but not BMI, were associated with NCI. Self-reported diabetes was associated with NCI in the substudy and in those >55 in the entire CHARTER cohort. Multivariate logistic regression analyses demonstrated that central obesity (as measured by WC) increased the risk of NCI and that greater body mass may be protective if the deleterious effect of central obesity is accounted for.
Conclusions: As in HIV-uninfected persons, central obesity, but not more generalized increases in body mass (BMI), was associated with a higher prevalence of NCI in HIV+ persons. Diabetes appeared to be associated with NCI only in older patients. Avoidance of antiretroviral drugs that induce central obesity might protect from or help to reverse neurocognitive impairment in HIV-infected persons.
GLOSSARY
- AIC=
- Akaike Information Criterion;
- ARV=
- antiretroviral;
- BMI=
- body mass index;
- CART=
- combination antiretroviral therapy;
- Ch=
- choline;
- CHARTER=
- CNS HIV Anti-Retroviral Therapy Effects Research;
- DM=
- diabetes mellitus;
- GDS=
- global deficit scores;
- HAND=
- HIV-associated neurocognitive disorder;
- HDL=
- high-density lipoprotein;
- HOMA-IR=
- homeostasis model assessment of insulin resistance;
- LDL=
- low-density lipoprotein;
- MetS=
- metabolic syndrome;
- NAA=
- N-acetylaspartate;
- NCI=
- neurocognitive impairment;
- OR=
- odds ratio;
- WC=
- waist circumference;
- WHR=
- waist to hip ratio;
- WMH=
- white matter hyperintensity
Footnotes
Coinvestigators of the CHARTER Group are listed on the Neurology® Web site at www.neurology.org.
Study funding: The CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) is supported by awards N01 MH22005, HHSN271201000027C, and HHSN271201000030C from the NIH.
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Supplemental data at www.neurology.org
- Received March 23, 2011.
- Accepted October 7, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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