Anemia and Red Blood Cell Indices Predict HIV-Associated Neurocognitive Impairment in the Highly Active Antiretroviral Therapy Era.

TitleAnemia and Red Blood Cell Indices Predict HIV-Associated Neurocognitive Impairment in the Highly Active Antiretroviral Therapy Era.
Publication TypeJournal Article
Year of Publication2016
AuthorsKallianpur, AR, Wang, Q, Jia, P, Hulgan, T, Zhao, Z, Letendre, S, Ellis, RJ, Heaton, RK, Franklin, D, Barnholtz-Sloan, JS, Collier, AC, Marra, CM, Clifford, DB, Gelman, B, McArthur, JC, Morgello, S, Simpson, DM, McCutchan, JA, Grant, I
Corporate AuthorsCHARTER Group
JournalJ Infect Dis
Volume213
Issue7
Pagination1065-73
Date Published2016 Apr 01
ISSN1537-6613
KeywordsAdult, AIDS Dementia Complex, Anemia, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CHARTER, Cohort Studies, Cross-Sectional Studies, Erythrocyte Count, Erythrocyte Indices, Female, HIV Infections, Humans, Internal, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Risk Factors
Abstract

BACKGROUND: Anemia has been linked to adverse human immunodeficiency virus (HIV) outcomes, including dementia, in the era before highly active antiretroviral therapy (HAART). Milder forms of HIV-associated neurocognitive disorder (HAND) remain common in HIV-infected persons, despite HAART, but whether anemia predicts HAND in the HAART era is unknown.METHODS: We evaluated time-dependent associations of anemia and cross-sectional associations of red blood cell indices with neurocognitive impairment in a multicenter, HAART-era HIV cohort study (N = 1261), adjusting for potential confounders, including age, nadir CD4(+) T-cell count, zidovudine use, and comorbid conditions. Subjects underwent comprehensive neuropsychiatric and neuromedical assessments.RESULTS: HAND, defined according to standardized criteria, occurred in 595 subjects (47%) at entry. Mean corpuscular volume and mean corpuscular hemoglobin were positively associated with the global deficit score, a continuous measure of neurocognitive impairment (both P < .01), as well as with all HAND, milder forms of HAND, and HIV-associated dementia in multivariable analyses (all P < .05). Anemia independently predicted development of HAND during a median follow-up of 72 months (adjusted hazard ratio, 1.55; P < .01).CONCLUSIONS: Anemia and red blood cell indices predict HAND in the HAART era and may contribute to risk assessment. Future studies should address whether treating anemia may help to prevent HAND or improve cognitive function in HIV-infected persons.

DOI10.1093/infdis/jiv754
Alternate JournalJ. Infect. Dis.
PubMed ID26690344
PubMed Central IDPMC4779306
Grant ListHHSN271201000036C / / PHS HHS / United States
K24 MH097673 / MH / NIMH NIH HHS / United States
HHSN271201000036C / MH / NIMH NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
N01 MH022005 / MH / NIMH NIH HHS / United States
R01 MH107345 / MH / NIMH NIH HHS / United States
R01 MH095621 / MH / NIMH NIH HHS / United States
U24 MH100930 / MH / NIMH NIH HHS / United States