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

Abstract

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 ...

HIV-associated neurocognitive disorder — pathogenesis and prospects for treatment

“…In a study of 245 HIV+ individuals in Italy, diabetes, carotid intima-media thickness and cardiovascular risk factors — including hyperlipidaemia and tobacco use — were strongly associated with lower cognitive performance 30 .…”

Increased ophthalmic artery resistance index is associated with cognitive impairment in HIV-infected patients

“…the inadequacy of other collateral vessels such as the anterior communicating artery. 13 Recent data show that increased carotid intima-media thickness (cIMT), a subclinical marker of atherosclerosis, predicts cognitive decline in memory and executive function 14,15 in agreement with the hypothesis that subjects with cognitive impairment can exhibit pathological arterial wall changes. 16 It is also known that OARI provides additional hemodynamic information for the assessment of cardiovascular disease severity in HIV-1-infected patients 8,17 with potential advantages over cIMT measurement.…”

HIV Associated Neurocognitive Disorders (HAND) in Malawian Adults and Effect on Adherence to Combination Anti-Retroviral Therapy: A Cross Sectional Study

“…In addition to challenges with neurocognitive classification, the aetiology of ANI also remains unclear. For instance, evidence is emerging to suggest that neurocognitive impairment in HIV positive patients may be mediated by effects on endothelial damage rather than direct CNS effects of the virus [44], [45]. Although we took full medical histories from all patients, it is possible that other co-morbidities may have been involved in neurocognitive impairment in HIV.…”