Aging amplifies HIV neurocognitive impairment: The effects may be related to vascular and metabolic factors.

Type: Published Abstract
Title: Aging amplifies HIV neurocognitive impairment: The effects may be related to vascular and metabolic factors.
Authors: Heaton R, Franklin D, Letendre S, Ellis R, Fennema-Notestine C, Vaida F, Smith D, Collier A, Marra C, Clifford D, Gelman B, McArthur J, Morgello S, Simpson D, McCutchan A, Grant I, for the CHARTER Group
Year: 2012
Publication: Journal of NeuroVirology
Volume: 18 Issue: Suppl 1 Pages: S46
Abstract:Background: Modern antiretroviral therapy (ART) has substantially extended the survival of HIV infected persons into their later years, raising the possibility that age-related organ changes, including neurodegenerative and cerebrovascular changes, might amplify HIV effects on the brain. This study investigated the effects of age, HIV, and vascular and metabolic markers on neurocognitive (NC) function. Methods: 1521 HIV + participants from the CHARTER study and 273 HIV- participants from the HNRP were selected for analysis. Subjects received comprehensive neuromedical, neurocognitive, and laboratory assessments. Logistic regression was used to examine the effects of age, HIV, and vascular metabolic markers on global and domain specific cognitive function. Interactions between age and HIV disease and vascular markers were also modeled in analyses of HIV + participants. Results: HIV + cases performed worse than HIV- in all domains and globally (all p < .01). There were significant age x HIV interactions with older HIV + performing incrementally worse on working memory, learning and on global NC function captured by a global deficit score (GDS; all p < .05). Exploratory analyses of HIV disease and vascular and metabolic markers showed age interactions with AIDS diagnosis, systolic blood pressure (SBP), BMI, and cholesterol in predicting worse GDS. Multivariate modeling (predictors = age, AIDS, SBP, BMI, and cholesterol; individually and an age interaction term to predict GDS) showed that AIDS (p = 0.005); the interaction of age and AIDS (p = 0.18); and the interaction of age and cholesterol (p = .05) related to worse GDS. Current and nadir CD4, ART status, and plasma viral load were not related to GDS. Conclusions: Our results show disproportionate reduction in neurocognitive performance in HIV + persons as they age, and that both severity of HIV disease and indicators of vascular metabolic changes that have been linked to vascular diseases of aging may play a role in amplifying these effects.