The veterans aging cohort study index is associated with concurrent risk for neurocognitive impairment.

TitleThe veterans aging cohort study index is associated with concurrent risk for neurocognitive impairment.
Publication TypeJournal Article
Year of Publication2014
AuthorsMarquine, MJ, Umlauf, A, Rooney, AS, Fazeli, PL, Gouaux, BD, Woods, SPaul, Letendre, SL, Ellis, RJ, Grant, I, Moore, DJ
Corporate AuthorsHIV Neurobehavioral Research Program (HNRP) Group
JournalJ Acquir Immune Defic Syndr
Volume65
Issue2
Pagination190-7
Date Published2014 Feb 1
ISSN1944-7884
KeywordsAdolescent, Adult, Aged, Aging, AIDS Dementia Complex, California, Cohort Studies, Female, Humans, Male, Middle Aged, Risk Assessment, Veterans, Young Adult
Abstract

OBJECTIVE: The Veterans Aging Cohort Study (VACS) Index is predictive of mortality and combines age, traditional HIV biomarkers (HIV-1 plasma RNA and current CD4 count), and non-HIV biomarkers (indicators of renal and liver function, anemia, and hepatitis C coinfection). We examined the association between the VACS Index and HIV-associated neurocognitive impairment (NCI).

DESIGN AND METHODS: Participants included 601 HIV-infected adults enrolled in cohort studies at the University of California, San Diego, HIV Neurobehavioral Research Program (ages: 18-76 years; 88% male; 63% white; median current CD4 = 364 cells/mm; 63% on antiretroviral therapy; AIDS = 64%). Biomarkers used in calculating the VACS Index were measured in prospectively collected blood samples using conventional laboratory methods. NCI was defined using global and seven domain deficit scores.

RESULTS: Higher VACS Index scores were associated with concurrent risk for global NCI [P < 0.001; odds ratio = 1.21, confidence interval (CI): 1.12 to 1.32], even when adjusting for psychiatric comorbidities. This relation was statistically significant for most cognitive domains in adjusted models. Furthermore, the VACS Index predicted concurrent NCI beyond nadir CD4 and estimated duration of infection. Older age, lower hemoglobin, and lower CD4 counts were the VACS components most strongly linked to NCI.

CONCLUSIONS: The findings extend previous research on the potential usefulness of the VACS Index in predicting HIV-associated outcomes to include NCI. Although the effect size was relatively small, our findings suggest that demographic information, HIV-disease factors, and common comorbidities might each play important roles in the clinical manifestation of cognitive impairment among HIV-infected individuals. Additional research is needed to determine if a more sensitive and specific index can be developed.

DOI10.1097/QAI.0000000000000008
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID24442225
PubMed Central IDPMC3907119
Grant ListP01 DA012065 / DA / NIDA NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
P30MH062512 / MH / NIMH NIH HHS / United States
R24MH59745 / MH / NIMH NIH HHS / United States
R25 MH080663 / MH / NIMH NIH HHS / United States
R25 MH081482 / MH / NIMH NIH HHS / United States
T32 DA031098 / DA / NIDA NIH HHS / United States
T32 MH019934 / MH / NIMH NIH HHS / United States
T32DA031098 / DA / NIDA NIH HHS / United States
U01 MH083506 / MH / NIMH NIH HHS / United States
U01MH083506 / MH / NIMH NIH HHS / United States
U24 MH100928 / MH / NIMH NIH HHS / United States
U24 MH100928 / MH / NIMH NIH HHS / United States