Factors associated with incident human immunodeficiency virus-dementia.
BACKGROUND
Antecedents to human immunodeficiency virus-dementia (HIV-D) are poorly understood.


OBJECTIVE
To identify risk factors for HIV-D.


METHODS
Subjects who are positive for HIV who have CD4+ counts either below 200/microL or below 300/microL with evidence of cognitive impairment were enrolled in this study. Neurologic, cognitive, functional, and laboratory assessments were done semiannually for up to 30 months. Human immunodeficiency virus-dementia was diagnosed using American Academy of Neurology criteria for probable HIV-1-associated dementia complex.


RESULTS
One hundred forty-six nondemented patients were enrolled, 45 of whom subsequently met criteria for incident HIV-D. In univariate analyses using the Cox proportional hazards regression model, the following variables were significantly associated with time to develop dementia: cognitive: abnormal scores on Timed Gait, Verbal Fluency, Grooved Pegboard, and Digit Symbol tests; attention-memory, psychomotor, and executive function domain scores; and the diagnosis of minor cognitive/motor disorder; neurologic and medical: increased abnormalities on the neurologic examination, extrapyramidal signs, history of HIV-related medical symptoms; functional: higher reported role or physical function difficulties. Depression was also a strong risk factor, along with sex, hematocrit, hemoglobin, and beta2-microglobulin levels. In a multivariate model that used cognitive domain scores, covariates with significant hazard ratios included depression, executive dysfunction, and the presence of minor cognitive/motor disorder.


CONCLUSIONS
Cognitive deficits, minor cognitive/motor disorder, and depression may be early manifestations of HIV-D.
Department of Neurology and Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, 630 W 168th St., New York, NY 10032, USA. ys11@columbia.edu
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McDermott
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Albert
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Palumbo
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Selnes
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McArthur
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Sacktor
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Schifitto
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Kieburtz
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Epstein
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Marder
D015526:AIDS Dementia Complex / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors