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Determinants of reduced cognitive performance in HIV-1-infected middle-aged men on combination antiretroviral therapy

Schouten, Judith; Su, Tanja; Wit, Ferdinand W.; Kootstra, Neeltje A.; Caan, Matthan W.A.; Geurtsen, Gert J.; Schmand, Ben A.; Stolte, Ineke G.; Prins, Maria; Majoie, Charles B.; Portegies, Peter; Reiss, Peter

doi: 10.1097/QAD.0000000000001017
Clinical Science

Objective: The spectrum of risk factors for HIV-associated cognitive impairment is likely very broad and includes not only HIV/antiretroviral therapy-specific factors but also other comorbid conditions. The purpose of this current study was to explore possible determinants for decreased cognitive performance.

Design and methods: Neuropsychological assessment was performed on 103 HIV-1-infected men with suppressed viraemia on combination antiretroviral therapy for at least 12 months and 74 HIV-uninfected highly similar male controls, all aged at least 45 years. Cognitive impairment and cognitive performance were determined by multivariate normative comparison (MNC). Determinants of decreased cognitive performance and cognitive impairment were investigated by linear and logistic regression analysis, respectively.

Results: Cognitive impairment as diagnosed by MNC was found in 17% of HIV-1-infected men. Determinants for decreased cognitive performance by MNC as a continuous variable included cannabis use, history of prior cardiovascular disease, impaired renal function, diabetes mellitus type 2, having an above normal waist-to-hip ratio, presence of depressive symptoms, and lower nadir CD4+ cell count. Determinants for cognitive impairment, as dichotomized by MNC, included cannabis use, prior cardiovascular disease, impaired renal function, and diabetes mellitus type 2.

Conclusion: Decreased cognitive performance probably results from a multifactorial process, including not only HIV-associated factors, such as having experienced more severe immune deficiency, but also cardiovascular/metabolic factors, cannabis use, and depressive symptoms.

aDepartment of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development

bDepartment of Neurology

cDepartment of Radiology

dDivision of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA)

eDepartment of Experimental Immunology

fDepartment of Medical Psychology, Academic Medical Center

gDepartment of Psychology, University of Amsterdam

hPublic Health Service Amsterdam, Infectious Diseases Research

iDepartment of Neurology, Onze Lieve Vrouwe Gasthuis

jDutch HIV Monitoring Foundation, Amsterdam, The Netherlands.

*See “Acknowledgements” section for details concerning the AGEhIV Study Group.

Correspondence to Judith Schouten, MD, Department of Global Health and Department of Neurology, Academic Medical Center; Amsterdam Institute for Global Health and Development, Trinity Building C, 3rd floor, Pietersbergweg 17, 1105 BM Amsterdam Zuidoost, The Netherlands. Tel: +31 20 5669111/5663349; fax: +31 20 5669557; e-mail:

Received 25 November, 2015

Revised 24 December, 2015

Accepted 4 January, 2016

Copyright © 2016 Wolters Kluwer Health, Inc.