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Brief Report

Body Mass Index and Cognitive Function Among HIV-1–Infected Individuals in China, India, and Nigeria

Jumare, Jibreel, MBBS, PhD*; El-Kamary, Samer S., MD, MPH*; Magder, Laurence, PhD*; Hungerford, Laura, DVM, PhD*; Umlauf, Anya, MS; Franklin, Donald, PhD; Ghate, Manisha, MBBS, PhD; Abimiku, Alash'le, PhD*; Charurat, Man, PhD*; Letendre, Scott, MD; Ellis, Ronald J., MD, PhD; Mehendale, Sanjay, MD, MPH; Blattner, William A., MD*; Royal, Walter III, MD*; Marcotte, Thomas D., PhD; Heaton, Robert K., PhD; Grant, Igor, MD; McCutchan, John A., MD, MSc

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1, 2019 - Volume 80 - Issue 2 - p e30–e35
doi: 10.1097/QAI.0000000000001906
Clinical Science

Background: Risk of cognitive impairment is increased among persons with high or low body mass index in HIV− and HIV+ populations in resource-rich settings. We examined this association among HIV+ patients in 3 resource-limited settings.

Methods: This secondary analysis included data of 761 HIV+ volunteers pooled from 3 prospective cohort studies conducted in China (n = 404; 53%), India (n = 200; 26%), and Nigeria (n = 157; 21%). World Health Organization (WHO) weight classifications were based on body mass index. T scores, adjusted for demographics and practice effects, were derived from a 7-domain neuropsychological battery. Neurocognitive impairment (NCI) was defined as global deficit score of ≥0.5.

Results: Overall, prevalence of NCI at baseline was 27.7% (similar across all cohorts). The overweight/obese and underweight constituted 37.3% and 15.5% of the total participants, respectively. In a multivariable logistic regression of pooled longitudinal data, adjusting for clinical and demographic variables, the odds of global NCI were 38% higher among the overweight/obese as compared to normal weight participants [odds ratio: 1.38 (95% confidence interval: 1.1 to 1.72); P = 0.005]. Similarly, the odds of global NCI were 39% higher among the underweight as compared to normal weight participants [odds ratio: 1.39 (95% confidence interval: 1.03 to 1.87); P = 0.029].

Conclusions: NCI among HIV-1–infected patients was more prevalent in both overweight/obese and underweight than normal weight individuals in 3 resource-limited settings, confirming observations in resource-rich settings. Mechanisms underlying these associations are unclear but likely differ for underweight and overweight persons.

*University of Maryland School of Medicine, Baltimore, MD;

University of California San Diego, School of Medicine, San Diego, CA; and

National AIDS Research Institute, Pune, India.

Correspondence to: Jibreel Jumare, MBBS, PhD, Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201 (e-mail:

Supported by National Institutes of Health grant #R01 P30 MH62512-14 (to I.G.), National Institute of Mental Health (NIMH) grant #R01 MH78748 (to T.D.M.), National Institutes of Health grant #R01 MH086356 (to W.A.B. and W.R.), and by National Institutes of Health Fogarty/AIDS International Training and Research Program grant #2D43TW001041-14 (training support to J.J.).

W.A.B. is an editor for JAIDS. The remaining authors have no funding or conflicts of interest to disclose.

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Received July 08, 2018

Accepted October 15, 2018

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