Factors associated with incident human immunodeficiency virus-dementia

Y. Stern, M. P. McDermott, S. Albert, D. Palumbo, O. A. Selnes, J. McArthur, N. Sacktor, G. Schifitto, K. Kieburtz, L. Epstein, K. S. Marder

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Antecedents to human immunodeficiency virus-dementia (HIV-D) are poorly understood. Objective: To identify risk factors for HIV-D. Methods: Subjects who are positive for HIV who have CD4+ counts either below 200/μL or below 300/μL with evidence of cognitive impairment were enrolled in this study. Neurologic, cognitive, functional, and laboratory assessments were done semiannually for up to 30 months. Human immunodeficiency virus - dementia was diagnosed using American Academy of Neurology criteria for probable HIV-1-associated dementia complex. Results: One hundred forty-six nondemented patients were enrolled, 45 of whom subsequently met criteria for incident HIV-D. In univariate analyses using the Cox proportional hazards regression model, the following variables were significantly associated with time to develop dementia: cognitive: abnormal scores on Timed Gait, Verbal Fluency, Grooved Pegboard, and Digit Symbol tests; attention-memory, psychomotor, and executive function domain scores; and the diagnosis of minor cognitive/motor disorder; neurologic and medical; increased abnormalities on the neurologic examination, extrapyramidal signs, history of HIV-related medical symptoms; functional: higher reported role or physical function difficulties. Depression was also a strong risk factor, along with sex, hematocrit, hemoglobin, and β2-microglobulin levels. In a multivariate model that used cognitive domain scores, covariates with significant hazard ratios included depression, executive dysfunction, and the presence of minor cognitive/motor disorder. Conclusion: Cognitive deficits, minor cognitive/motor disorder, and depression may be early manifestations of HIV-D.

Original languageEnglish (US)
Pages (from-to)473-479
Number of pages7
JournalArchives of neurology
Volume58
Issue number3
DOIs
StatePublished - 2001

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

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