Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 43, Issue 4, Pages 405-410Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.qai.0000243119.67529.f5
Keywords
HIV; AIDS dementia complex; insulin resistance; aging; acquired immunodeficiency syndrome
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Funding
- NCRR NIH HHS [P20 RR 11091] Funding Source: Medline
- NIAID NIH HHS [G12 RR/AI 03061] Funding Source: Medline
- NIMH NIH HHS [K23 MH 065857] Funding Source: Medline
- NINDS NIH HHS [1U54 NS 43049] Funding Source: Medline
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Objective: To determine if insulin resistance (IR) is associated with lower cognitive performance among HIV-1-infected adults and to determine if advanced age magnifies risk. Design: Cross-sectional analysis within the Hawaii Aging With HIV Cohort. Methods: We calculated the homeostasis model assessment of insulin resistance (HOMA-IR) among 145 cohort participants. Values were compared to concurrent neuropsychological test performance and cognitive diagnoses. Results: Hypertension, body mass index (BMT), and non-Caucasian self-identity were directly related to insulin resistance (IR); however, age, CD4 lymphocyte count, and rates of treatment with HAART were not. In logistic regression analyses and stratifying cognition status on a 3-tiered scale (normal, minor cognitive motor disorder (MCMD), and HIV-associated dementia (HAD)), we identified an increased risk of meeting a higher diagnostic category as HOMA-IR increased (OR, 1.12; 95% Cl: 1.003 to 1.242 per unit of HOMA-IR, P = 0.044). In linear regression models and among nondiabetic participants, an increasing degree of IR was associated with lower performance on neuropsychological summary scores. Conclusions: IR is associated with cognitive dysfunction in this contemporary HIV-1 cohort enriched with older individuals. Metabolic dysfunction may contribute to the multifactorial pathogenesis of cognitive impairment in the era of HAART.
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