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

TitleRole of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder.
Publication TypeJournal Article
Year of Publication2012
AuthorsMcCutchan, JA, Marquie-Beck, JA, Fitzsimons, CA, Letendre, SL, Ellis, RJ, Heaton, RK, Wolfson, T, Rosario, D, Alexander, TJ, Marra, C, Ances, BM, Grant, I
Corporate AuthorsCHARTER Group
Date Published2012 Feb 14
KeywordsAdult, AIDS Dementia Complex, Antiretroviral Therapy, Highly Active, Antiviral Agents, Body Mass Index, CD4 Lymphocyte Count, CHARTER, Cohort Studies, Diabetes Complications, Female, Humans, Hyperglycemia, Insulin Resistance, Internal, Logistic Models, Male, Middle Aged, Neuropsychological Tests, Obesity, Prospective Studies, Triglycerides, Waist Circumference

OBJECTIVE: To evaluate relationships between HIV-associated neurocognitive disorder and metabolic variables in a subgroup of HIV+ participants examined in a prospective, observational, multicenter cohort study.METHODS: In a cross-sectional substudy of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort, 130 HIV+ participants provided fasting blood samples. Neurocognitive impairment (NCI) was defined by performance on neuropsychological tests adjusting for age, education, gender, and race/ethnicity. Global ratings and global deficit scores were determined. Demographics, biomarkers of HIV disease, metabolic variables, combination antiretroviral therapy (CART) history, other drug exposures, and self-reported diabetes were examined in multivariate models predicting NCI. Separate models were used for body mass index (BMI) alone (n = 90) and BMI and waist circumference (WC) together (n = 55).RESULTS: NCI (global impairment rating ≥5) was diagnosed in 40%. In univariate analyses, age, longer duration of HIV infection, obesity, and WC, but not BMI, were associated with NCI. Self-reported diabetes was associated with NCI in the substudy and in those >55 in the entire CHARTER cohort. Multivariate logistic regression analyses demonstrated that central obesity (as measured by WC) increased the risk of NCI and that greater body mass may be protective if the deleterious effect of central obesity is accounted for.CONCLUSIONS: As in HIV-uninfected persons, central obesity, but not more generalized increases in body mass (BMI), was associated with a higher prevalence of NCI in HIV+ persons. Diabetes appeared to be associated with NCI only in older patients. Avoidance of antiretroviral drugs that induce central obesity might protect from or help to reverse neurocognitive impairment in HIV-infected persons.

Alternate JournalNeurology
PubMed ID22330412
PubMed Central IDPMC3280051
Grant ListHHSN271201000027C / / PHS HHS / United States
HHSN271201000030C / / PHS HHS / United States
N01 MH22005 / MH / NIMH NIH HHS / United States