RT Journal Article
SR Electronic
T1 Impaired insulin sensitivity is associated with worsening cognition in HIV-infected patients
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1344
OP e1353
DO 10.1212/WNL.0000000000007125
VO 92
IS 12
A1 Khuder, Saja S.
A1 Chen, Suming
A1 Letendre, Scott
A1 Marcotte, Thomas
A1 Grant, Igor
A1 Franklin, Donald
A1 Rubin, Leah H.
A1 Margolick, Joseph B.
A1 Jacobson, Lisa P.
A1 Sacktor, Ned
A1 D'Souza, Gypsyamber
A1 Stosor, Valentina
A1 Lake, Jordan E.
A1 Rapocciolo, Giovanna
A1 McArthur, Justin C.
A1 Dickens, Alex M.
A1 Haughey, Norman J.
YR 2019
UL http://n.neurology.org/content/92/12/e1344.abstract
AB 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.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