Diabetes, insulin resistance, and dementia among HIV-1-infected patients.
OBJECTIVE
Metabolic complications have been associated with HIV-1 infection and with long-term use of antiretroviral (ARV) medications. In some studies, such complications have been linked to cardiovascular events, yet limited data exist concerning metabolic complications and dementia. The objective of this study was to examine the relationship between HIV-associated dementia (HAD) and diabetes among patients with HIV-1 infection.


METHODS
Cross-sectional analysis of entry data for a longitudinal cohort study.


METHODS
A total of 203 participants who were enrolled in the Hawaii Aging with HIV Cohort between October 2001 and November 2003 served as the study population. Research case definitions of HAD were determined in consensus conferences by a panel that included neurologists, neuropsychologists, and a geriatrician. Diabetes was determined by self-report or a fasting glucose level > 125 mg/dL.


RESULTS
Participants' ages ranged between 20-76 years at enrollment with approximately one-half aged >/=50 years. After adjustment for important covariates including age, education, ethnicity, CD4 lymphocyte count, duration of HIV infection, and protease inhibitor-based ARV therapy, we found a statistically significant association of diabetes with HAD (odds ratio 5.43, 1.66-17.70). A significant association remained after adjustment for other vascular risk factors. Among participants without diabetes, fasting glucose levels were higher with increasing impairment category.


CONCLUSIONS
Within the Hawaii Aging with HIV Cohort, a longitudinal study enriched with older HIV-1-infected individuals, diabetes is associated with prevalent dementia. This finding is not fully explained by age or coexisting vascular risk factors. Evaluation of underlying mechanisms is warranted.
Valcour
Victor G
VG
University of Hawaii, Neuro AIDS Specialized Neuroscience Research Program, John A. Burns School of Medicine, Honolulu, HI, USA. Vvalcour@hawaii.edu
Shikuma
Cecilia M
CM
Shiramizu
Bruce T
BT
Williams
Andrew E
AE
Watters
Michael R
MR
Poff
Pamela W
PW
Grove
John S
JS
Selnes
Ola A
OA
Sacktor
Ned C
NC
D015526:AIDS Dementia Complex / Q000209:etiology* / Q000378:metabolism; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000209:etiology* / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism*; D015497:HIV-1; D006254:Hawaii; D006801:Humans; D007333:Insulin Resistance; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
D019380:Anti-HIV Agents