Role of central obesity, diabetes, and metabolic variables in HIV-associated neurocognitive disorder.

Type: Poster
Title: Role of central obesity, diabetes, and metabolic variables in HIV-associated neurocognitive disorder.
Authors: McCutchan JA, Marquie-Beck J, FitzSimons C, Letendre S, Ellis RJ, Heaton R, Wolfson T, Marra C, Ances B, Grant I, for the CHARTER Group
Date: 03-05-2012
Abstract:Objective: Both central obesity and diabetes are associated with cognitive impairment in HIV-uninfected persons. We evaluated the relationships of HIVAssociated Neurocognitive Disorder (HAND) to central obesity (waist circumference = WC), body mass index (BMI), diabetes (DM), and multiple other metabolic variables in a cross-sectional substudy of HIV+ patients who were examined in CHARTER, a prospective study of 1574 patients at 6 US academic HIV clinics. Methods: HIV+ volunteers (n = 130) provided fasting blood samples and underwent extensive neuropsychological evaluation that adjusts for age, education, gender and race/ethnicity. Neurocognitive impairment (NCI) was defined by both clinical ratings of global cognitive functioning (global impairment rating ≥ 5) and global deficit scores (GDS > 0.5). Demographics, biomarkers of HIV disease, metabolic variables including leptin levels and HOMA (a measure of Insulin resistance), anthropomorphic measures (WC and BMI), CART history, other drug exposures, and self reported diabetes (DM) were examined in univariate analyses and multivariate models predicting NCI. Based on the availability of data for these models, we examined BMI alone (n=90) and BMI plus WC (n=55) as correlates of NCI. Results: NCI was diagnosed in 40% of 130 participants. In univariate analyses, age, longer duration of HIV infection, and WC were associated with NCI, but other variable including BMI, leptin levels, and HOMA were not. Self-reported diabetes was associated with NCI in the substudy and in those of age > 55, but not those < 55, in the entire CHARTER cohort. Multivariate logistic regression analyses demonstrated that diagnosis of AIDS (OR = 50, p = .02); diagnosis of DM (OR = 18, p = .07); and WC (OR = 1.34 per cm, p = .001) increased the risk of NCI, but that greater body mass (OR = .69. p = .04) was protective. Conclusions: As in HIV-uninfected persons, diabetes and central obesity were associated with a higher prevalence of NCI in HIV+ persons, but increased body mass (BMI) was protective when the deleterious effects of central obesity are accounted for in the model. Diabetes appeared to be associated with NCI only in older patients. The mechanisms by which diabetes and central obesity, both of which are associated with insulin resistance, contribute to NCI are unclear. Avoidance of antiretroviral drugs that induce central obesity might help to protect from or reverse neurocognitive impairment in HIV-infected persons.