title: Coagulation imbalance and neurocognitive functioning in older HIV-positive adults on suppressive antiretroviral therapy.
abstract: The aim of this study was to compare plasma biomarkers of coagulation between HIV-infected individuals and HIV-uninfected controls and to assess the impact of disturbances in coagulation on neurocognitive functioning in HIV.
  
  
  
  A cross-sectional study of 66 antiretroviral therapy treated, virally suppressed, HIV-infected and 34 HIV-uninfected older (≥50 years of age) adults.
  
  
  
  Participants completed standardized neurobehavioral and neuromedical assessments. Neurocognitive functioning was evaluated using a well validated comprehensive neuropsychological battery. Plasma biomarkers associated with procoagulation (fibrinogen, p-selectin, tissue factor and von Willebrand factor), anticoagulation (antithrombin, protein C and thrombomodulin), fibrinolysis (d-dimer, plasminogen activator inhibitor-1 and plasminogen) were collected. Multivariable linear regression was used to test the interaction of HIV and coagulation on neurocognitive functioning.
  
  
  
  Most participants were male (78.0%) and non-Hispanic white (73.0%) with a mean age of 57.8 years. Among HIV-infected participants, mean estimated duration of HIV infection was 19.4 years and median current CD4 cell count was 654 cells/μl. Levels of soluble biomarkers of procoagulation, anticoagulation and fibrinolysis were comparable between the HIV serostatus groups. Coagulation and HIV had an interacting effect on neurocognitive functioning, such that greater coagulation imbalance was associated with poorer neurocognitive functioning among the HIV-infected participants. The moderating effect of coagulation on neurocognition was driven by procoagulant but not anticoagulant or fibrinolytic biomarkers.
  
  
  
  Elevated levels of procoagulants may exert a particularly detrimental effect on neurocognitive functioning among older HIV-infected persons. A better understanding of the specific role of coagulation in the cause of HIV-associated neurocognitive disorders may lead to treatments aimed at reducing coagulopathy, thereby improving neurocognitive outcomes.
authors.affiliation: aSDSU/UCSD Joint Doctoral Program in Clinical Psychology bDepartment of Psychiatry cDepartment of Family Medicine and Public Health dDepartment of Neurosciences eDepartment of Medicine, University of California, San Diego, La Jolla, California fDepartment of Pharmacy Practice, University of Buffalo, Buffalo, New York, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Montoya
authors.forename: Jennifer
authors.initials: J
authors.lastname: Iudicello
authors.forename: Hannah A
authors.initials: HA
authors.lastname: Oppenheim
authors.forename: Pariya L
authors.initials: PL
authors.lastname: Fazeli
authors.forename: Michael
authors.initials: M
authors.lastname: Potter
authors.forename: Qing
authors.initials: Q
authors.lastname: Ma
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.forename: Scott L
authors.initials: SL
authors.lastname: Letendre
authors.forename: David J
authors.initials: DJ
authors.lastname: Moore
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D019965:Neurocognitive Disorders / Q000453:epidemiology*; D000072230:Sustained Virologic Response
chemical_list: D044966:Anti-Retroviral Agents