title: Neurocognitive impairment is an independent risk factor for death in HIV infection. San Diego HIV Neurobehavioral Research Center Group.
abstract: OBJECTIVE
  To determine if mortality is increased in individuals with human immunodeficiency virus type 1 (HIV-1)-associated neurocognitive disorders less severe than frank dementia.
  
  
  METHODS
  A prospective cohort study; median duration of follow-up was 2.4 years. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival times according to neurocognitive classification.
  
  
  METHODS
  University-based research unit.
  
  
  METHODS
  A volunteer sample of 414 individuals seropositive for HIV-1. Subjects were classified at their baseline evaluation as neuropsychologically (NP) normal or abnormal (impaired in > or = 2 NP test domains). A subgroup of NP abnormal subjects met operational criteria for HIV-associated minor cognitive motor disorder; the remaining subjects were designated NP impaired. Subjects with frank dementia were excluded.
  
  
  METHODS
  Mortality.
  
  
  RESULTS
  At the baseline evaluation, 256 (62%) of 414 subjects were designated normal; 109 (26%). NP impaired; and 49 (12%), minor cognitive motor disorder. One hundred six participants (26%) died during follow-up. Compared with the NP normal group, the unadjusted relative risk (RR) of death for all NP abnormal subjects (minor cognitive motor disorder and NP impaired) was significantly increased (RR, 1.7; 95% confidence interval [CI], 1.2-2.6; P < .005). After adjusting for concurrently measured predictors of survival (CD4 lymphocyte counts, Centers for Disease Control and Prevention HIV disease classification, hemoglobin concentration, and serum beta 2-microglobulin) in proportional hazards models, mortality for all NP abnormal subjects remained elevated (RR, 1.8; 95% CI, 1.2-2.8; P < .01). The elevation in mortality risk for subjects with minor cognitive motor disorder was statistically significant (RR, 2.2; 95% CI, 1.2-3.8; P < .01); for NP impaired subjects it was marginally significant (RR, 1.6; 95% CI, 1.0-2.8; P = .06).
  
  
  CONCLUSIONS
  The HIV-infected individuals with NP impairment had a higher risk of dying than those without impairment. This was particularly true for those meeting syndromic diagnostic criteria.
authors.affiliation: Department of Neurosciences, University of California, Department of Medicine, San Diego, USA. roellis@ucsd.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: R
authors.initials: R
authors.lastname: Deutsch
authors.forename: R K
authors.initials: RK
authors.lastname: Heaton
authors.forename: T D
authors.initials: TD
authors.lastname: Marcotte
authors.forename: J A
authors.initials: JA
authors.lastname: McCutchan
authors.forename: J A
authors.initials: JA
authors.lastname: Nelson
authors.forename: I
authors.initials: I
authors.lastname: Abramson
authors.forename: L J
authors.initials: LJ
authors.lastname: Thal
authors.forename: J H
authors.initials: JH
authors.lastname: Atkinson
authors.forename: M R
authors.initials: MR
authors.lastname: Wallace
authors.forename: I
authors.initials: I
authors.lastname: Grant
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012307:Risk Factors