Objective: To evaluate relationships between HIV-associated neurocognitive disorder and metabolic variables in a subgroup of HIVϩ 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 HIVϩ 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 ϭ 90) and BMI and waist circumference (WC) together (n ϭ 55).Results: NCI (global impairment rating Ն5) 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 Ͼ55 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 HIVϩ 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 HIVinfected persons. Neurology ® 2012;78:485-492 GLOSSARY AIC ϭ Akaike Information Criterion; ARV ϭ antiretroviral; BMI ϭ body mass index; CART ϭ combination antiretroviral therapy; Ch ϭ choline; CHARTER ϭ CNS HIV Anti-Retroviral Therapy Effects Research; DM ϭ diabetes mellitus; GDS ϭ global deficit scores; HAND ϭ HIV-associated neurocognitive disorder; HDL ϭ high-density lipoprotein; HOMA-IR ϭ homeostasis model assessment of insulin resistance; LDL ϭ low-density lipoprotein; MetS ϭ metabolic syndrome; NAA ϭ N-acetylaspartate; NCI ϭ neurocognitive impairment; OR ϭ odds ratio; WC ϭ waist circumference; WHR ϭ waist to hip ratio; WMH ϭ white matter hyperintensity.