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Associations Between Regional Fat Deposition and Neurocognitive Function in the Multicenter AIDS Cohort Study
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Reported by Jules Levin
CROI 2013
Jordan E. Lake*1, Quynh Vo2, Lisa P. Jacobson3, Ned Sacktor3, Wendy S. Post3, James Becker4, Frank J. Palella, Jr.5, Ann Ragin5, and Todd Brown3
1University of California-Los Angeles, Los Angeles, CA, U.S.A.; 2Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, U.S.A.;
3Johns Hopkins University, Baltimore, MD, U.S.A; 4Univerisity of Pittsburgh, Pittsburgh, PA, U.S.A.; 5Northwestern University, Chicago, IL, U.S.A.
ABSTRACT
Background: Obesity has been associated with cognitive decline in the general population. The effects of regional adipose tissue (AT) and fat wasting on cognition are not well understood, but adipocytokines have been implicated as mediators. This cross-sectional analysis explores relationships between regional
AT, adipocytokines and neuropsychiatric (NP) testing among HIV+ and HIV- men in the MACS.
Methods: Participants underwent CT-quantified AT volumes [visceral (VAT), subcutaneous abdominal (aSAT) and thigh (tSAT)] as well as NP testing ±1 year from CT scan. Trails A (TA) and B (TB) and Symbol Digit (SymD) tests were selected as screens for psychomotor speed and executive function. Higher TA/TB and lower SymD scores indicate worse performance. Serum biomarkers were measured from fasting samples using standardized assays. Medians were compared using nonparametric tests, correlations were determined with Spearman coefficients and multivariable regression was used to determine predictors of NP function.
Results: We studied 780 men (509 HIV+, 271 HIV-). HIV+ men were younger, more likely to be Black, current smokers, less educated, and have depressive symptoms, metabolic syndrome and hepatitis C infection. Median aSAT and tSAT volumes were lower in HIV+. VAT volume, BMI, and NP scores did not vary by HIV status. Median time since HIV diagnosis: 10 years, time on ART: 9.5 years, CD4+ T cell count: 583 cells/mm3; 14% had a history of AIDS, 81% had HIV-1 RNA <50 copies/mL, and 51% were on PI-based ART.
In HIV+, lower VAT and higher tSAT, adiponectin and IL-6 levels correlated with worse NP performance. In HIV-, worse NP performance correlated with higher IL-6 and CRP only.
In multivariable analysis, older age, !high school education and Black race, but not AT volume or site, predicted worse TA, TB, and SymD scores regardless of HIV status. In HIV+ only, higher adiponectin and IL-6 were independently associated with lower SymD score (but not higher TA or TB). No HIV-specific factors predicted NP score.
Conclusions: Relationships between regional AT, adipocytokines and NP function differed by HIV serostatus is this subset of MACS participants. Demographic factors but not adiposity predicted NP performance in all subjects. In HIV+ only, higher adiponectin and IL-6 levels were associated with poorer executive function scores. Longitudinal analysis of this cohort will better inform the relationship between regional AT, adipocytokines and cognitive function.
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