Insulin resistance is associated with cognition among HIV-1-infected patients: the Hawaii Aging With HIV cohort

VG Valcour, NC Sacktor, RH Paul… - JAIDS Journal of …, 2006 - journals.lww.com
VG Valcour, NC Sacktor, RH Paul, MR Watters, OA Selnes, BT Shiramizu, AE Williams
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006journals.lww.com
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 (BMI), and …
Abstract
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 (BMI), 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% CI: 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.
Lippincott Williams & Wilkins
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