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Metabolic Syndrome and Neurocognitive Deficits in HIV Infection

Yu, Beverly, BSa; Pasipanodya, Elizabeth, PhDb; Montoya, Jessica L., PhDb; Moore, Raeanne C., PhDb,c; Gianella, Sara, MDd,e; McCutchan, Allen, MDe; Ellis, Ron, MDb,f; Heaton, Robert K., PhDb; Jeste, Dilip V., MDb; Moore, David J., PhDb; Marquine, María J., PhDb

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1, 2019 - Volume 81 - Issue 1 - p 95–101
doi: 10.1097/QAI.0000000000001964
Clinical Science
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Background: The adverse consequences of HIV and related comorbidities on the central nervous system remain prevalent in the era of combination antiretroviral therapy. Metabolic syndrome (MetS) is a common comorbidity in HIV and has been linked to increased neurocognitive impairment in the general population. We investigated the association between MetS and neurocognition among persons living with HIV (PLHIV).

Methods: Participants included 109 PLHIV and 92 HIV-uninfected adults (HIV−) from the Multi-dimensional Successful Aging cohort study at the University of California San Diego (age: M = 50.8, SD = 8.0). Participants completed neuromedical, psychiatric, and neurocognitive assessments. Based on a comprehensive neurocognitive battery, we examined global neurocognitive deficits (based on the entire battery) and neurocognitive deficits in 7 domains (verbal fluency, learning, recall, executive function, working memory, speed of information processing, and fine motor skills). MetS was determined via the standard criteria by the National Cholesterol Education Program's Adult Treatment Panel-III. Covariates examined included demographics and psychiatric comorbidities (and HIV disease characteristics among PLHIV).

Results: MetS had an independent significant effect on global neurocognitive deficits among PLHIV (P = 0.03) but not among their HIV− counterparts (P = 0.93). Among PLHIV, MetS was most strongly associated with the neurocognitive domains of learning, fine motor skills, and executive function. Diabetes and elevated triglycerides were the MetS components most strongly linked with increased global neurocognitive deficits in PLHIV.

Conclusions: The present findings underscore the need for early identification of PLHIV at risk for MetS and the implementation of preventive and treatment approaches to lessen the development of MetS and neurocognitive impairment among PLHIV.

aYale School of Medicine, Yale University, New Haven, CT;

bDepartment of Psychiatry, University of California San Diego, San Diego, CA;

cVA San Diego Healthcare System, San Diego, CA;

dCenter for AIDS Research (CFAR), University of California San Diego, San Diego, CA; and

Departments of eMedicine; and

fNeuroscience, University of California San Diego, San Diego, CA.

Correspondence to: María J. Marquine, PhD, Department of Psychiatry, UCSD School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0603 (e-mail: mmarquine@ucsd.edu).

Supported by grants from the National Institutes of Health (R01MH099987, K23MH105297, K23MH107260, P30AG059299, and T32DA031098).

Presented in part at the 9th International Workshop on HIV and Aging; September 13, 2018; New York, NY.

The authors have no funding or conflicts of interest to disclose.

Received October 09, 2018

Accepted December 27, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.