TY - JOUR
T1 - Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder
AU - McCutchan, J. A.
AU - Marquie-Beck, J. A.
AU - FitzSimons, C. A.
AU - Letendre, S. L.
AU - Ellis, R. J.
AU - Heaton, R. K.
AU - Wolfson, T.
AU - Rosario, D.
AU - Alexander, T. J.
AU - Marra, C.
AU - Ances, B. M.
AU - Grant, I.
N1 - Funding Information:
Dr. McCutchan serves on the editorial board of the Swiss Medical Journal , authors chapters on HIV for the Merck Manual , and receives research support from the NIH and the CDC. J. Marquie-Beck receives support from the HNRC grant P30 MH06512 . C.A. FitzSimons receives support from the HNRC grant P30 MH06512 . Dr. Letendre serves on scientific advisory boards for Tibotec Therapeutics, Gilead Sciences, Inc. and GlaxoSmithKline; has received speaker honoraria from Lucid Group UK, Stratagen, ApotheCom, GlaxoSmithKline, Tibotec Therapeutics, and Abbott; and receives research support from Abbott, Merck Serono, Tibotec Therapeutics, Schering-Plough Corp., GlaxoSmithKline, and the NIH. Dr. Ellis served on the editorial advisory board of the Journal of Neuroimmune Pharmacology ; has received speaker honoraria from GlaxoSmithKline and Abbott; has received research support from the NIH; and his spouse holds stock in Abbott. Dr. Heaton served on a scientific advisory board for the NINCDS; serves on the editorial boards of the Journal of the International Neuropsychological Society , the Journal of Clinical and Experimental Neuropsychology , and The Clinical Neuropsychologist ; has received publishing royalties for Revised Comprehensive Norms for and Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African American and Caucasian Adults (Psychological Assessment Resources, Inc., 1991–present), Revised Comprehensive Norms for and Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African American and Caucasian Adults Scoring Program (Psychological Assessment Resources, Inc., 1994–present), and Wisconsin Card Sorting Test Manual–Revised and Expanded (Psychological Assessment Resources, Inc., 1991–present); and receives research support from the NIH. T. Wolfson reports no disclosures. D. Rosario receives support from the HNRC grant P30 MH06512. T.J. Alexander receives support from the HNRC grant P30 MH06512. Dr. Marra receives research support from the NIH (NINDS and NIMH) and receives publishing royalties for Infections of the Central Nervous System, 3rd ed. (Lippincott Williams & Wilkins, 2004) and from UpToDate, Inc. Dr. Ances serves on a scientific advisory board for Eli Lilly & Company and receives research support from Pfizer Inc, the NIH, and the Dana Foundation. Dr. Grant has received speaker honoraria from Abbott; serves as an Associate Editor for Journal of Neurovirology ; and receives research support from the NIH (NIMH, NIDA, and NIA).
PY - 2012/2/14
Y1 - 2012/2/14
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84858127194&partnerID=8YFLogxK
U2 - 10.1212/WNL.0b013e3182478d64
DO - 10.1212/WNL.0b013e3182478d64
M3 - Article
C2 - 22330412
AN - SCOPUS:84858127194
VL - 78
SP - 485
EP - 492
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 7
ER -