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Metabolic syndrome tied to neurocognitive deficit with (but not without) HIV
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9th International Workshop on HIV and Aging, September 13-14, 2018, New York
Mark Mascolini
Metabolic syndrome affected twice as many people with than without HIV in a 200-person US study [1]. Statistical analysis linked metabolic syndrome to neurocognitive deficits in people with HIV but not in the HIV-negative group.
Previous work showed that people with HIV run a higher risk of metabolic syndrome, defined as having 3 or more of the following 5 conditions: increased waist circumference, high triglycerides, low "good" high-density lipoprotein (HDL) cholesterol, high blood pressure, and high fasting glucose. Prior research also linked metabolic syndrome to neurocognitive impairment, but that association had not been verified in people with HIV. University of California, San Diego (UCSD) researchers conducted this study to explore potential associations between metabolic syndrome and neurocognitive deficits in adults with versus without HIV.
The analysis involved HIV-positive and negative adults in the Multi-Dimensional Successful Aging cohort study. Participants had to be between 35 and 65 years old and could not have a history of a non-HIV neurologic disorder, a history of learning disability, or current psychotic disorder. They completed comprehensive neuromedical and neurobehavioral assessments. The main outcome was a global deficit score (GDS) encompassing 15 neurocognitive tests across 7 domains.
The researchers used multivariable linear regression to see whether HIV status modified the association between metabolic syndrome and neurocognitive deficits, using the predictors HIV status, metabolic syndrome x HIV status, and covariates that univariable analysis tied to GDS. They also used multivariable linear regression to further explore associations between metabolic syndrome and GDS in people with HIV.
The study included 109 people with HIV and 92 without HIV, both groups averaging about 51 years in age. The HIV group had a higher proportion of men (83.5% versus 69.9%, P = 0.02), fewer average years of education (13.9 versus 15.1, P < 0.001), and a lower WRAT-4 Reading Scaled Score (102.5 versus 106.9, P = 0.02). People with HIV had been infected for a median of 18.4 years and only 7.4% had a detectable viral load in plasma. Median nadir and current CD4 counts stood at 176 and 629.
Almost a twice higher proportion of people with than without HIV had metabolic syndrome (39.5% versus 20.7%, P = 0.004). Metabolic syndrome was significantly associated with worse GDS (greater neurocognitive deficit) in people with HIV (estimate 0.22, P = 0.03) but not in the HIV-negative group (estimate -0.01, P = 0.93). Further analysis verified that the association between HIV and worse GDS persisted (P < 0.05) after adjustment for significant covariates (estimated premorbid functioning and nadir CD4 count).
Compared with HIV-positive people without metabolic syndrome, those with metabolic syndrome had significantly lower scores in 2 of 7 cognitive domains: complex motor skills (P = 0.04) and learning (P = 0.04). Two of the 5 metabolic syndrome components, diabetes and high triglycerides, were significantly associated with worse GDS in people with HIV.
The UCSD team proposed that "HIV may worsen the impact of metabolic syndrome on neurocognitive function, potentially by systemic inflammation and decreased blood brain barrier integrity." The researchers called for early identification of HIV-positive people at risk for metabolic syndrome and adoption of preventive measures.
Reference
1. Yu B, Pasipanodya E, Montoya J, et al. Metabolic syndrome is associated with neurocognitive deficits in persons living with HIV. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 6.
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