title: Baseline CD4(+) T-cell count and cardiovascular risk factors predict the evolution of cognitive performance during 2-year follow-up in HIV-infected patients.
abstract: BACKGROUND
  The aim of our study was to better understand the dynamics between cardiovascular risk factors and immunological parameters in the evolution of cognitive performance in HIV+ patients.
  
  
  METHODS
  We conducted a prospective longitudinal study, consecutively enrolling asymptomatic HIV+ subjects during routine outpatient visits at two clinical centres. At baseline and after 2 years, all patients underwent a comprehensive neuropsychological battery. Common carotid intima-media thickness (cIMT) was also measured.
  
  
  RESULTS
  A total of 150 patients completed the study (77% males, median age 46 years, 20% with past AIDS-defining events, 95% on cART, 88% with HIV-RNA<50 copies/ml). After a 2-year follow-up, there was no difference in the proportion of patients with cognitive impairment (32% versus 33% at baseline; P=1.00). However, a significantly worse memory performance was observed (z score mean change -0.51, sd 1.05; P=0.001). At multivariate analysis, baseline dyslipidaemia (OR 2.7, 95% CI 1.1, 7.1; P=0.037) showed a significant association with a higher risk of memory impairment at 2-year follow-up, while higher baseline CD4(+) T-cell count (OR 0.80 per 100 cells/μl higher; 95% CI 0.66, 0.97; P=0.026) was found to be a protective factor, adjusting for the presence of a memory impairment at baseline. When the analysis was restricted to patients who did not change antiretroviral therapy during the study period (n=109), baseline cIMT (OR 14.6 per 0.1 mm higher; 95% CI 1.1, 189.9; P=0.041) also emerged as an independent risk factor for memory impairment at 2-year follow-up.
  
  
  CONCLUSIONS
  Immunological parameters and cardiovascular risk factors are independently associated with the evolution of cognitive status in HIV+ patients.
authors.affiliation: Department of Public Health, Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy. nicoletta.ciccarelli@rm.unicatt.it.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ciccarelli
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Grima
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fabbiani
authors.forename: Eleonora
authors.initials: E
authors.lastname: Baldonero
authors.forename: Alberto
authors.initials: A
authors.lastname: Borghetti
authors.forename: Benedetta
authors.initials: B
authors.lastname: Milanini
authors.forename: Silio
authors.initials: S
authors.lastname: Limiti
authors.forename: Manuela
authors.initials: M
authors.lastname: Colafigli
authors.forename: Enrica
authors.initials: E
authors.lastname: Tamburrini
authors.forename: Roberto
authors.initials: R
authors.lastname: Cauda
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
authors.forename: Simona
authors.initials: S
authors.lastname: Di Giambenedetto
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D059168:Carotid Intima-Media Thickness; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D018450:Disease Progression; D050171:Dyslipidemias / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood*; D012307:Risk Factors
chemical_list: D012367:RNA, Viral