title: Associations of cardiovascular variables and HAART with cognition in middle-aged HIV-infected and uninfected women.
abstract: Despite the use of highly active anti-retroviral treatment (HAART), cognitive impairment remains prevalent in HIV. Indeed a recent study suggested that in certain instances, stopping HAART was associated with improved cognitive function (Robertson et al. Neurology 74(16):1260-1266 2010). HAART is occasionally associated with cardiovascular pathology and such pathology may be associated with cognitive impairment. To explore these associations, we assessed the relative contributions of cardiovascular variables such as hypertension and atherosclerosis, of HIV and HAART to cognition. The participants were members of the Women's Interagency HIV Study. In the analysis of cross-sectional data using general linear models, we assessed the relationship between each cardiovascular variable and Stroop interference time and symbol digit modalities test while adjusting for age, HIV, education, depression, and race/ethnicity. We also analyzed the association of summary measures of HAART use with cognition. In multivariate models, significance was limited to carotid lesions and carotid intima-medial thickness quintile (CIMT) with Stroop interference time (for carotid lesions, coefficient = 10.5, CI 3.5 to 17.5, p = 0.003, N = 1,130; for CIMT quintile, coefficient = 8.6, CI = 1.7 to 15.4, p = 0.025, N = 1,130). The summary measures of protease inhibitor use and other HAART measures were in most cases not associated with cognitive score in multivariate models. We conclude that in the HAART era among middle-aged women with HIV, carotid disease may be significantly associated with some measures of cognitive impairment. In this cross-sectional study, we could detect neither positive nor negative effects of HAART on cognition.
authors: Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA. howard.crystal@downstate.edu
authors: Howard A
authors: HA
authors: Crystal
authors: Jeremy
authors: J
authors: Weedon
authors: Susan
authors: S
authors: Holman
authors: Jennifer
authors: J
authors: Manly
authors: Victor
authors: V
authors: Valcour
authors: Mardge
authors: M
authors: Cohen
authors: Kathryn
authors: K
authors: Anastos
authors: Chenglong
authors: C
authors: Liu
authors: Wendy J
authors: WJ
authors: Mack
authors: Elizabeth
authors: E
authors: Golub
authors: Jason
authors: J
authors: Lazar
authors: Ann
authors: A
authors: Ho
authors: Mary Jeanne
authors: MJ
authors: Kreek
authors: Robert C
authors: RC
authors: Kaplan
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002320:Cardiovascular Physiological Phenomena / Q000187:drug effects*; D002339:Carotid Arteries / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D003071:Cognition / Q000187:drug effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors