Risk factors for cognitive impairment in HIV-1-infected persons with different risk behaviors.
BACKGROUND
Although it is well established that acquired immunodeficiency syndrome dementia complex mainly develops in patients with advanced human immunodeficiency virus 1 (HIV-1) infection and severe immunosuppression, other factors that might increase the risk of early neuropsychological abnormalities are controversial.


OBJECTIVE
To identify risk factors for HIV-1-related cognitive impairment.


METHODS
Case-control study.


METHODS
Division of Infectious Diseases, University of Bologna.


METHODS
We studied 272 consecutive individuals: 90 HIV-1-seronegative, 88 asymptomatic HIV-1-seropositive, and 94 symptomatic HIV-1-seropositive persons.


METHODS
Cognitive impairment was defined as poor performance on at least 2 of the 7 neuropsychological tests included in the battery. Cutoff scores for poor performance on a test were established as 2 or more SDs lower than the mean of the seronegative group in the corresponding risk behavior strata: injecting drug users, hemophiliacs, and other risk behaviors. The following risk factors were studied: age, sex, education, risk behaviors, HIV-1 stage, lymphocyte count, and antiretroviral therapy.


RESULTS
Compared with individuals with higher levels of education, those with less than 6 years of schooling had an odds ratio (OR) of 17.2 (95% confidence interval [CI], 3.6-83.3) for cognitive impairment, independent of age, sex, disease stage, antiretroviral therapy, and risk behavior. Compared with injecting drug users, homosexual/bisexual and heterosexual participants had ORs of 9.6 (95% CI, 2.2-42.7) and 6.3 (95% CI, 2.2-18.3), respectively, for cognitive impairment. Use of antiretroviral treatment (any vs none) was associated with lower prevalence of cognitive impairment (OR, 0.1; 95% CI, 0.0-0.3). Compared with persons with high CD4+ cell counts (> or =500/microL), those with low (<200/microL) and moderate (200-499/microL) CD4+ cell counts had adjusted ORs of 8.6 (95% CI, 1.0-71.0) and 6.9 (95% CI, 1.0-48.4), respectively. The presence of prominent depressive symptoms did not change the results.


CONCLUSIONS
Low educational level, low CD4+ cell count, and homosexual/bisexual and heterosexual risk behaviors are risk factors for cognitive impairment in HIV-1-seropositive persons. Antiretroviral therapy exerts a beneficial effect against cognitive impairment in symptomatic individuals. Homosexual/bisexual and heterosexual persons who survive longer are expected to be the group at highest risk for cognitive impairment. However, the protective effect of antiretroviral therapy may balance this increased risk.
De Ronchi
Diana
D
Institute of Psychiatry, University of Bologna, Italy. Diana.de.Ronchi@cnsf.ki.se
Faranca
Irma
I
Berardi
Domenico
D
Scudellari
Paolo
P
Borderi
Marco
M
Manfredi
Roberto
R
Fratiglioni
Laura
L
D015526:AIDS Dementia Complex / Q000453:epidemiology* / Q000523:psychology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology; D004522:Educational Status; D005260:Female; D015497:HIV-1; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking