Metabolic syndrome and vascular risk factors impact neurocognitive decline in HIV.

Type: Poster
Title: Metabolic syndrome and vascular risk factors impact neurocognitive decline in HIV.
Authors: Ghias A, Marquine M, Kao Y, Deutsch R, Fazeli P, Iudicello J, Riggs K, Franklin D, Heaton RK, Hong S, McCutchan JA, Grant I, Ellis RJ
Date: 10-14-2013
Abstract:Background and Objectives: We evaluated the impact of metabolic syndrome and vascular risk factors (MSVRF) on neurocognitive (NC) change in HIV+ and HIV- subjects.¬ Methods: MSVRF (hypertension [HTN], diabetes mellitus [DM], tobacco smoking [TOB], history of heart disease [CHD], body mass index [BMI] and hyperlipidemia [HL]) were ascertained at baseline in HIV+ and HIV- individuals enrolled in prospective cohort studies. Neuropsychological (NP) performance was evaluated at baseline and at least one follow-up visit. The primary outcome was subject-specific slopes of mean change of scaled scores on the NP test battery. The following terms were entered into separate models for each MSVRF: MSVRF, time, HIV serostatus, and interaction terms for MSVRF X time and HIV X MSVRF. The models were reduced by backward elimination, retaining terms with p<0 .10. Results: Subjects were 634 HIV+ and 107HIV-, men (80%) and women (20%) with mean (±SD) age 42.1 (±9.3) years, and mean education12.7 (±2.6) years. Among HIV+, median (range) nadir and current CD4 were 180 (50-312) and 442 (276-630); 62% took HAART, and 59% of these had undetectable plasma viral load. Significant main effects of HIV on global NC change were seen in each model. In the combined study sample, HTN, DM, TOB and CHD, but not BMI and HL, were associated with worse NC change (all ps<0.05). Results were similar in the HIV+ group analyzed separately, except that TOB did not reach significance. Conclusions: MSVRFs and HIV serostatus both contributed to worsening NC performance over time. Our results support future studies in which these risk factors are aggressively managed to determine if NC decline can be ameliorated.