Impaired insulin sensitivity is associated with worsening cognition in HIV-infected patients
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Objective To determine the association of insulin sensitivity and metabolic status with declining cognition in HIV-infected individuals.
Methods We conducted targeted clinical and metabolic measures in longitudinal plasma samples obtained from HIV-infected patients enrolled in the Central Nervous System HIV Anti-Retroviral Therapy Effects Research Study (CHARTER). Findings were validated with plasma samples from the Multicenter AIDS Cohort Study (MACS). Patients were grouped according to longitudinally and serially assessed cognitive performance as having stably normal or declining cognition.
Results Patients with declining cognition exhibited baseline hyperinsulinemia and elevated plasma c-peptide levels with normal c-peptide/insulin ratios, suggesting that insulin production was increased, but insulin clearance was normal. The association of hyperinsulinemia with worsening cognition was further supported by low high-density lipoprotein (HDL), high low-density lipoprotein/HDL ratio, and elevated cholesterol/HDL ratio compared to patients with stably normal cognition.
Conclusions These findings suggest that hyperinsulinemia and impaired insulin sensitivity are associated with cognitive decline in antiretroviral therapy–treated HIV-infected patients.
Glossary
- ART=
- antiretroviral therapy;
- BMI=
- body mass index;
- CHARTER=
- Central Nervous System HIV Anti-Retroviral Therapy Effects Research;
- CI=
- confidence interval;
- GLUT=
- glucose transporter;
- HAND=
- HIV-Associated Neurocognitive Disorders;
- HCV=
- hepatitis C virus;
- HDL=
- high-density lipoprotein;
- HOMA-IR=
- homeostatic model assessment of insulin resistance;
- LDL=
- low-density lipoprotein;
- MACS=
- Multicenter AIDS Cohort Study;
- PI=
- protease inhibitor;
- TC=
- total cholesterol
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received October 10, 2017.
- Accepted in final form November 8, 2018.
- © 2019 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Jeffrey Allen and Dr. Nicholas Purcell
► Watch
Related Articles
- No related articles found.
Topics Discussed
Alert Me
Recommended articles
-
Articles
Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorderJ.A. McCutchan, J.A. Marquie-Beck, C.A. FitzSimons et al.Neurology, February 13, 2012 -
Article
Systemic metabolism in frontotemporal dementiaRebekah M. Ahmed, Mia MacMillan, Lauren Bartley et al.Neurology, October 10, 2014 -
Articles
Insulin metabolism and the risk of Alzheimer diseaseThe Rotterdam StudyE.M.C. Schrijvers, J.C.M. Witteman, E.J.G. Sijbrands et al.Neurology, November 29, 2010 -
Articles
Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive personsE.J. Wright, B. Grund, K. Robertson et al.Neurology, August 11, 2010