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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
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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: jibreel.jumare@som.umaryland.edu).

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received July 08, 2018

Accepted October 15, 2018

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