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PREDICTORS OF NEUROCOGNITIVE DECLINE AMONG AVIREMIC INDIVIDUALS IN THE CHARTER COHORT
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....the authors conclude "The strongest predictor of decline was eGFR, a known independent predictor of atherosclerotic vascular disease.....this work suggests that controlling additional cardio-vascular risk factors could be a useful strategy for minimizing cognitive decline. Modifiable risk factors were very common in the entire cohort, with as many as 80% reporting either smoking or a BMI ≥ 25. Smoking cessation and avoidance of obesity would be obvious starting points to maintain brain health." from Jules: and suggests trying to maintain kidney health is crucial.
from Jules: the whole subject of neurologic & cognitive decline is difficult to frame, understand very well the causes & to quantify. In this poster I did not see mention of a history of substance abuse, which may be a predictor. Although diabetes, hypertension, nadir CD4, CPE score, HCV and hypertension were not found to predict decline other studies have found them to be predictors. There was another poster at CROI finding kidney function as represented as eGFR with CVD [http://www.natap.org/2015/CROI/croi_131.htm], there is the poster from the NIH [Impaired Cardiac Strain and Biomarkers of Immune Activation in HIV http://www.natap.org/2015/CROI/croi_129.htm]finding an association between subclinical impairment in systolic function, subclinical impairment in cardiac strain with markers of chronic immune activation, inflammation and tissue remodeling and concluding: Our findings indicate that subclinical impairment in cardiac strain tracks with markers of chronic inflammation and immune activation, which may serve as targets for future therapeutic strategies to optimize long-term cardiovascular health in persons living with HIV. HOWEVER, a high CD4 & undetectable viral load, achieving & maintaining this is key to giving a patient the best chance in preventing the onset of all these comorbidities, and of course exercise & diet. There were 3 studies at CROI on exercise with a bit of mixed results but mostly finding exercise improves the brain & cognition: The impact of physical activity on cognition in men with and without HIV - of course the general literature in full of data supporting exercise & diet as key to managing, improving & sustaining health & preventing comorbidities.
Bone disease appears as well to be associated with impaired immunity & inflammation/activation. All together highlighting the interconnectedness of all the metabolic issues (the vascular system), immunity, inflammation & activation, HIV appears to cause the entire system to go awry, its the virus! HIV even in small amounts in individuals with undetectable viral load in the blood (<50 c/ml) still have HIV present in low levels, this is enough to throw things into disorder, and in patients with detectable viral load of course the system is in worse shape.
Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Marie-Josee Brouillette1, Tracy Yuen1, Susan C. Scott1, Lesley K Fellows2, Robert K Heaton3, Scott Letendre3, Ronald J. Ellis3, the CHARTER Group, Nancy E Mayo1
1 McGill University Health Centre and 2 Montreal Neurological Hospital and Institute, Montreal, Canada; 3 University of California -San Diego, San Diego, CA, United States
"The objective of the study was to identify baseline factors predicting NC decline over the subsequent 3 years in aviremic individuals......As part of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study, HIV+ individuals were administered 15 neuropsychological tests every 6 months....
Conclusions: It is encouraging that cognitive decline over 3 years was uncommon in this sample of aviremic HIV+ individuals. The strongest predictor of decline was eGFR, a known independent predictor of atherosclerotic vascular disease. While an extension of this work in a larger sample will be needed to further clarify the contribution of vascular factors to cognitive decline in aviremic individuals, this work suggests that controlling additional cardio-vascular risk factors could be a useful strategy for minimizing cognitive decline. Modifiable risk factors were very common in the entire cohort, with as many as 80% reporting either smoking or a BMI ≥ 25. Smoking cessation and avoidance of obesity would be obvious starting points to maintain brain health.""
program abstract
Background: Limited information is available on the predictors of neurocognitive (NC) decline in individuals with good virological control. Identification of modifiable risk factors that predict decline would support the development of targeted interventions aimed at minimizing NC decline in higher-risk individuals. The objective of the study was to identify baseline factors predicting NC decline over the subsequent 3 years in aviremic individuals.
Methods: As part of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study, HIV+ individuals were administered 15 neuropsychological tests every 6 months. Group-based trajectory analysis was used to detect patterns of NC change on each test over the course of follow-up. Individuals who deteriorated ≥ 0.5 SD on at least 1 test within the first 36 months of follow-up were considered decliners. Multiple logistic regression was used to identify baseline socio-demographic, clinical, biological and lifestyle factors associated with decline.
Results: 191 patients evaluated semi-annually were aviremic at all time points in the first 3 years; 166 had undergone CSF analysis. Viral presence in CSF was rare (10 /649 person-visits). Among the 191 patients, 23 (12%) declined cognitively over 3 years. In the multivariate analysis, the factors at baseline that met our threshold for predicting NC decline are listed in Table 1. Some risk factors identified in prior cross-sectional studies did not predict decline in this sample: older age, non-white ethnicity, low nadir CD4, CPE score, hepatitis C co-infection, diabetes, hypertension, low hemoglobin, low platelets, or a diagnosis of AIDS.
Conclusions: It is encouraging that cognitive decline over 3 years was uncommon in this sample of aviremic HIV+ individuals. The strongest predictor of decline was eGFR, a known independent predictor of atherosclerotic vascular disease. While an extension of this work in a larger sample will be needed to further clarify the contribution of vascular factors to cognitive decline in aviremic individuals, this work suggests that controlling additional cardio-vascular risk factors could be a useful strategy for minimizing cognitive decline. Modifiable risk factors were very common in the entire cohort, with as many as 80% reporting either smoking or a BMI ≥ 25. Smoking cessation and avoidance of obesity would be obvious starting points to maintain brain health.
What is Tail Making Test B- http://en.wikipedia.org/wiki/Trail_Making_Test
The Trail Making Test is a neuropsychological test of visual attention and task switching. It consists of two parts in which the subject is instructed to connect a set of 25 dots as fast as possible while still maintaining accuracy.[1] It can provide information about visual search speed, scanning, speed of processing, mental flexibility, as well as executive functioning.[1] It is also sensitive to detecting several cognitive impairments such as Alzheimer's disease and dementia.[2]
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