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Weight, Diabetes Linked to Impaired Cognition in HIV


 

MONTREAL — Weight control and treatment with antiretroviral drugs that are less likely to induce type 2 diabetes could reduce the risk of neurocognitive impairment associated with HIV infection, suggest study findings presented at the Conference of Retroviruses and Opportunistic Infections.

The cross-sectional observational study indicated that both waist circumference and clinical history of diabetes were strongly correlated with HIV-related neurocognitive deficits, while other components of the metabolic syndrome were not, reported Dr. Allen McCutchan, of the University of California, San Diego.

“People with HIV are living longer thanks to advances in antiretroviral therapy, but the prolonged survival is accompanied by complications of chronic HIV infection and its treatment,” including the development of the metabolic syndrome and associated cardiovascular problems, Dr. McCutchan said. While the prevalence of HIV-associated dementia has diminished substantially with combination highly active antiretroviral therapy, rates of less severe asymptomatic neurocognitive impairment and mild neurocognitive disorder have risen with the aging HIV population, he said.

Dr. McCutchan and colleagues selected 145 HIV-infected individuals from a pool of 1,534 HIV-positive patients enrolled in the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study. All patients in the analysis gave a fasting blood sample. Neurocognitive impairment was determined based on a battery of neurologic assessments adjusted for age, education, and race-specific norms, and validated to detect HIV-related impairment.

Univariate and multivariate models were used to test the effects of demographics, biomarkers of HIV disease (CD4 counts, plasma HIV levels, and AIDS diagnosis), antiretroviral drug history, and metabolic syndrome-related variables on neurocognitive impairment, Dr. McCutchan explained.

The metabolic syndrome-related variables included history of type 2 diabetes, body mass index, waist circumference, blood pressure, glucose, insulin, insulin resistance, triglycerides, HDL and LDL cholesterol, and serum leptin, he noted.

Of the 145 patients included in the analysis, 53 had neurocognitive impairment, which is consistent with estimates in the literature, he said.

In univariate models, the metabolic syndrome-related variables that correlated with neurocognitive impairment included a greater waist circumference, lower LDL cholesterol levels, and an increased prevalence of type 2 diabetes.

However, “in multivariate logistic regression analysis, waist circumference, type 2 diabetes, and AIDS, but not low-density lipoprotein cholesterol or other metabolic factors, were significantly increased in individuals with neurocognitive impairment,” he noted. In fact, type 2 diabetes increased the risk of neurocognitive impairment more than sevenfold, while other factors associated with metabolic syndrome, such as abnormal cholesterol or triglycerides, were not associated with increased risk.

Dr. McCutchan reported no financial disclosures related to this presentation.

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