title: Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder.
abstract: OBJECTIVE
  To evaluate relationships between HIV-associated neurocognitive disorder and metabolic variables in a subgroup of HIV+ participants examined in a prospective, observational, multicenter cohort study.
  
  
  METHODS
  In a cross-sectional substudy of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort, 130 HIV+ participants provided fasting blood samples. Neurocognitive impairment (NCI) was defined by performance on neuropsychological tests adjusting for age, education, gender, and race/ethnicity. Global ratings and global deficit scores were determined. Demographics, biomarkers of HIV disease, metabolic variables, combination antiretroviral therapy (CART) history, other drug exposures, and self-reported diabetes were examined in multivariate models predicting NCI. Separate models were used for body mass index (BMI) alone (n = 90) and BMI and waist circumference (WC) together (n = 55).
  
  
  RESULTS
  NCI (global impairment rating ≥5) was diagnosed in 40%. In univariate analyses, age, longer duration of HIV infection, obesity, and WC, but not BMI, were associated with NCI. Self-reported diabetes was associated with NCI in the substudy and in those >55 in the entire CHARTER cohort. Multivariate logistic regression analyses demonstrated that central obesity (as measured by WC) increased the risk of NCI and that greater body mass may be protective if the deleterious effect of central obesity is accounted for.
  
  
  CONCLUSIONS
  As in HIV-uninfected persons, central obesity, but not more generalized increases in body mass (BMI), was associated with a higher prevalence of NCI in HIV+ persons. Diabetes appeared to be associated with NCI only in older patients. Avoidance of antiretroviral drugs that induce central obesity might protect from or help to reverse neurocognitive impairment in HIV-infected persons.
authors.affiliation: University of California, San Diago, USA. amccutchan@ucsd.edu
authors.forename: J A
authors.initials: JA
authors.lastname: McCutchan
authors.forename: J A
authors.initials: JA
authors.lastname: Marquie-Beck
authors.forename: C A
authors.initials: CA
authors.lastname: Fitzsimons
authors.forename: S L
authors.initials: SL
authors.lastname: Letendre
authors.forename: R J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: R K
authors.initials: RK
authors.lastname: Heaton
authors.forename: T
authors.initials: T
authors.lastname: Wolfson
authors.forename: D
authors.initials: D
authors.lastname: Rosario
authors.forename: T J
authors.initials: TJ
authors.lastname: Alexander
authors.forename: C
authors.initials: C
authors.lastname: Marra
authors.forename: B M
authors.initials: BM
authors.lastname: Ances
authors.forename: I
authors.initials: I
authors.lastname: Grant
mesh_terms: D015526:AIDS Dementia Complex / Q000150:complications* / Q000378:metabolism* / Q000523:psychology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D048909:Diabetes Complications / Q000523:psychology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000523:psychology; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009765:Obesity / Q000150:complications* / Q000378:metabolism; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D000998:Antiviral Agents; D014280:Triglycerides