title: Determinants of reduced cognitive performance in HIV-1-infected middle-aged men on combination antiretroviral therapy.
abstract: OBJECTIVE
  The spectrum of risk factors for HIV-associated cognitive impairment is likely very broad and includes not only HIV/antiretroviral therapy-specific factors but also other comorbid conditions. The purpose of this current study was to explore possible determinants for decreased cognitive performance.
  
  
  METHODS
  Neuropsychological assessment was performed on 103 HIV-1-infected men with suppressed viraemia on combination antiretroviral therapy for at least 12 months and 74 HIV-uninfected highly similar male controls, all aged at least 45 years. Cognitive impairment and cognitive performance were determined by multivariate normative comparison (MNC). Determinants of decreased cognitive performance and cognitive impairment were investigated by linear and logistic regression analysis, respectively.
  
  
  RESULTS
  Cognitive impairment as diagnosed by MNC was found in 17% of HIV-1-infected men. Determinants for decreased cognitive performance by MNC as a continuous variable included cannabis use, history of prior cardiovascular disease, impaired renal function, diabetes mellitus type 2, having an above normal waist-to-hip ratio, presence of depressive symptoms, and lower nadir CD4⁺ cell count. Determinants for cognitive impairment, as dichotomized by MNC, included cannabis use, prior cardiovascular disease, impaired renal function, and diabetes mellitus type 2.
  
  
  CONCLUSIONS
  Decreased cognitive performance probably results from a multifactorial process, including not only HIV-associated factors, such as having experienced more severe immune deficiency, but also cardiovascular/metabolic factors, cannabis use, and depressive symptoms.
authors.affiliation: aDepartment of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development bDepartment of Neurology cDepartment of Radiology dDivision of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA) eDepartment of Experimental Immunology fDepartment of Medical Psychology, Academic Medical Center gDepartment of Psychology, University of Amsterdam hPublic Health Service Amsterdam, Infectious Diseases Research iDepartment of Neurology, Onze Lieve Vrouwe Gasthuis jDutch HIV Monitoring Foundation, Amsterdam, The Netherlands. *See "Acknowledgements" section for details concerning the AGEhIV Study Group.
authors.forename: Judith
authors.initials: J
authors.lastname: Schouten
authors.forename: Tanja
authors.initials: T
authors.lastname: Su
authors.forename: Ferdinand W
authors.initials: FW
authors.lastname: Wit
authors.forename: Neeltje A
authors.initials: NA
authors.lastname: Kootstra
authors.forename: Matthan W A
authors.initials: MW
authors.lastname: Caan
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Geurtsen
authors.forename: Ben A
authors.initials: BA
authors.lastname: Schmand
authors.forename: Ineke G
authors.initials: IG
authors.lastname: Stolte
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.forename: Charles B
authors.initials: CB
authors.lastname: Majoie
authors.forename: Peter
authors.initials: P
authors.lastname: Portegies
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002318:Cardiovascular Diseases; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000209:etiology*; D003863:Depression; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D002189:Marijuana Abuse; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents