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Published on: January 12, 2016
Cardiovascular risk factors and carotid intima-media thickness are associated with lower cognitive performance in
M Fabbiani1, N Ciccarelli, M Tana
1Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy. massifab@alice.it
Insights
Metabolic issues like diabetes and hypertension, along with common carotid intima-media thickness (cIMT), are linked to lower cognitive performance in HIV patients. These factors may contribute to HIV-associated neurocognitive disorders.
Area of Science:
- Neuroscience
- Cardiology
- Infectious Diseases
Background:
- HIV infection can impact cognitive function.
- Metabolic comorbidities and cardiovascular risk factors are common in HIV patients.
- The role of common carotid intima-media thickness (cIMT) in HIV-associated neurocognitive disorders is under investigation.
Purpose of the Study:
- To investigate the relationship between metabolic comorbidities, cardiovascular risk factors, and cIMT with cognitive performance in HIV-infected patients.
- To assess the prevalence of these factors in an asymptomatic HIV-infected population.
- To identify potential contributors to HIV-associated neurocognitive disorders.
Main Methods:
- Enrolled 245 asymptomatic HIV-infected subjects.
- Assessed metabolic comorbidities and cardiovascular risk factors.
- Measured cIMT using ultrasonography and evaluated cognitive performance via a global cognitive impairment (GCI) score.
Main Results:
- High prevalence of dyslipidemia (61.2%), smoking (54.3%), and hypertension (15.1%).
- Abnormal cIMT (≥ 0.9mm) found in 31.8% of patients.
- Diabetes, hypertension, and cIMT ≥ 0.9 mm were associated with lower cognitive performance (higher GCI scores).
- Diabetes and cIMT ≥ 0.9 mm independently predicted lower cognitive performance.
- Abacavir use was linked to better cognitive performance in patients on combination antiretroviral therapy (cART).
Conclusions:
- Metabolic comorbidities and cIMT are strongly associated with reduced cognitive performance in HIV patients.
- These findings suggest metabolic factors play a significant role in HIV-associated neurocognitive disorders.
- Further research into managing these comorbidities may improve cognitive outcomes in HIV care.
Objectives:
The aim of the study was to investigate the relationship between metabolic comorbidities, cardiovascular risk factors or common carotid intima-media thickness (cIMT) and cognitive performance in HIV-infected patients.
Methods:
Asymptomatic HIV-infected subjects were consecutively enrolled during routine out-patient visits at two clinical centres. All patients underwent an extensive neuropsychological battery and assessment of metabolic comorbidities and cardiovascular risk factors. Moreover, cIMT was assessed by ultrasonography. Cognitive performance was evaluated by calculating a global cognitive impairment (GCI) score obtained by summing scores assigned to each test (0 if normal and 1 if pathological).
Results:
A total of 245 patients (median age 46 years; 84.1% with HIV RNA < 50 copies/mL; median CD4 count 527 cells/μL) were enrolled in the study. Cardiovascular risk factors were highly prevalent in our population: the most frequent were dyslipidaemia (61.2%), cigarette smoking (54.3%) and hypertension (15.1%). cIMT was abnormal (≥ 0.9mm) in 31.8% of patients. Overall, the median GCI score was 2 [interquartile range (IQR) 1-4]; it was higher in patients with diabetes (P = 0.004), hypertension (P = 0.030) or cIMT ≥ 0.9 mm (P < 0.001). In multivariate analysis, it was confirmed that diabetes (P = 0.007) and cIMT ≥ 0.9 mm (P = 0.044) had an independent association with lower cognitive performance. In an analysis of patients on combination antiretroviral therapy (cART), abacavir use was independently associated with a better cognitive performance (P = 0.011), while no association was observed for other drugs or neuroeffectiveness score.
Conclusions:
Diabetes, cardiovascular risk factors and cIMT showed a strong association with lower cognitive performance, suggesting that metabolic comorbidities could play a relevant role in the pathogenesis of HIV-associated neurocognitive disorders in the recent cART era.
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