Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men

Becker, James T.; Kingsley, Lawrence A.; Mullen, John C.; Cohen, Bruce A.; Martin, Eileen; Miller, Eric N.; Ragin, Ann B.; Sacktor, Ned; Selnes, Ola A.; Visscher, Barbara R.

doi:10.1212/wnl.0b013e3181bd10e7

Cited by 160 publications

(157 citation statements)

References 36 publications

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“…Our results, together with observations from other populations [29][30][31][32][33]37], suggest the hypothesis that in the recent cART era the role of CV risk factors on the pathogenesis of cognitive impairment could be greater than that of traditional HIV-or cARTrelated variables, similar to findings obtained in HIVuninfected subjects. As a consequence, CV comorbidities should be adequately investigated at the time of neuropsychological examination, in order to better explore the aetiology of cognitive disorders in the HIV-positive population and to avoid classifying as affected by HAND those patients with prevalent vascular impairment.…”

Section: Discussionsupporting

confidence: 88%

Cardiovascular risk factors and carotid intima‐media thickness are associated with lower cognitive performance in HIV‐infected patients

Fabbiani

Ciccarelli

Tana³

et al. 2012

HIV Medicine

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ObjectivesThe aim of the study was to investigate the relationship between metabolic comorbidities, cardiovascular risk factors or common carotid intima-media thickness (cIMT) and cognitive performance in HIV-infected patients. MethodsAsymptomatic HIV-infected subjects were consecutively enrolled during routine out-patient visits at two clinical centres. All patients underwent an extensive neuropsychological battery and assessment of metabolic comorbidities and cardiovascular risk factors. Moreover, cIMT was assessed by ultrasonography. Cognitive performance was evaluated by calculating a global cognitive impairment (GCI) score obtained by summing scores assigned to each test (0 if normal and 1 if pathological). ResultsA total of 245 patients (median age 46 years; 84.1% with HIV RNA < 50 copies/mL; median CD4 count 527 cells/mL) were enrolled in the study. Cardiovascular risk factors were highly prevalent in our population: the most frequent were dyslipidaemia (61.2%), cigarette smoking (54.3%) and hypertension (15.1%). cIMT was abnormal (Ն 0.9mm) in 31.8% of patients. Overall, the median GCI score was 2 [interquartile range (IQR) 1-4]; it was higher in patients with diabetes (P = 0.004), hypertension (P = 0.030) or cIMT Ն 0.9 mm (P < 0.001). In multivariate analysis, it was confirmed that diabetes (P = 0.007) and cIMT Ն 0.9 mm (P = 0.044) had an independent association with lower cognitive performance. In an analysis of patients on combination antiretroviral therapy (cART), abacavir use was independently associated with a better cognitive performance (P = 0.011), while no association was observed for other drugs or neuroeffectiveness score. ConclusionsDiabetes, cardiovascular risk factors and cIMT showed a strong association with lower cognitive performance, suggesting that metabolic comorbidities could play a relevant role in the pathogenesis of HIV-associated neurocognitive disorders in the recent cART era.Keywords: cardiovascular risk factors, carotid intima-media thickness, dementia, diabetes, HIV-associated neurocognitive disorders Accepted 27 July 2012 IntroductionAlthough combination antiretroviral therapy (cART) has markedly changed the prognosis of HIV-infected patients by reducing AIDS-related morbidity and mortality [1], HIVassociated neurocognitive disorders (HANDs) are increasingly recognized in such populations. In particular, while the incidence of HIV-associated dementia (HAD) has significantly decreased in recent years, the prevalence of milder forms of HAND has gradually increased [2][3][4]. Several factors may contribute to these epidemiological changes, such as a lower mortality leading to aging and a HIV-infected patients show a high prevalence of cardiovascular (CV) risk factors (including diabetes, hypertension, obesity, dyslipidaemia, atherosclerosis and coronary heart disease) [9,10] which can contribute to the increased mortality of a such population [11]. These factors have been linked to a lower cognitive performance in the general population [12][13][14][15]. It has been postulated ...

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Section: Discussionsupporting

confidence: 88%

Cardiovascular risk factors and carotid intima‐media thickness are associated with lower cognitive performance in HIV‐infected patients

Fabbiani

Ciccarelli

Tana³

et al. 2012

HIV Medicine

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“…These results are in accordance with those obtained in other studies with drug addict subjects during the different stages of infection [8] [28], as well as those obtained with homosexual subjects [4] [18] [29], which describe problems of attention, verbal fluency and manual dexterity.…”

Section: B Discussionsupporting

confidence: 92%

Influence of Lymphocyte T CD4 Levels on the Neuropsychological Performance of Population A ected by HIV and with a Previous History of Substance Use

Vázquéz-Justo¹,

García-Torres²,

Vergara-Moragues³

2017

IJIMAI

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“…13,14 In HIV-infected, middle-aged patients, the link of diabetes with cognitive performances remains largely unknown. 8,[15][16][17] Furthermore, robust studies that explore how impaired glycemia (prediabetes) could affect brain health are lacking, and no study has examined the impact of diabetes or prediabetes on cognitive decline over time.…”

mentioning

confidence: 99%

Diabetes and cognitive decline in a French cohort of patients infected with HIV-1

et al. 2015

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Objective: We investigated the relationship of diabetes and prediabetes with cognitive performances, assessed through raw test and z scores and according to neurocognitive impairment (NCI) classification in a cohort of individuals infected with HIV. Methods:The ANRS CO3 Aquitaine cohort is a prospective hospital-based cohort of HIV-1-infected patients under routine clinical management in 6 public hospitals in southwestern France. Between 2007 and 2009, an ancillary study consisted of a neuropsychological battery of 10 tests at baseline and 2-year follow-up. The severity of NCI (normal, asymptomatic, mild, HIV dementia) was assessed according to international guidelines.Results: At baseline (400 patients, 33 with prediabetes, 39 with diabetes), in cross-sectional multivariable analyses, patients with diabetes performed significantly worse on 9 neuropsychological tests that assessed memory, executive functions, attention, psychomotor speed, language, and manual dexterity. Participants with prediabetes had worse performances compared with those who had normal glycemia in 5 tests. The longitudinal analysis of the association between glycemia status at baseline and change in cognitive performances over 2-year follow-up (n 5 283) suggested that patients with diabetes also showed a slightly higher decline on 5 of the 10 tests, those involving executive functions and memory functioning. Glycemia status at baseline was not significantly associated with NCI severity in cross-sectional (p 5 0.44) and longitudinal (p 5 0.64) analyses. Conclusions:In this hospital-based cohort of people living with HIV, diabetes, but not the other cardiovascular risk factors, is associated with worse cognitive performances in several cognitive domains and with larger decline in fewer domains over the short term.

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Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men

Abstract: Background:The purpose of this study was to evaluate the relationship between cognitive perfor-

Cited by 160 publications

References 36 publications

Cardiovascular risk factors and carotid intima‐media thickness are associated with lower cognitive performance in HIV‐infected patients

Cardiovascular risk factors and carotid intima‐media thickness are associated with lower cognitive performance in HIV‐infected patients

Influence of Lymphocyte T CD4 Levels on the Neuropsychological Performance of Population A ected by HIV and with a Previous History of Substance Use

Diabetes and cognitive decline in a French cohort of patients infected with HIV-1

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