Factors associated with incident human immunodeficiency virus-dementia

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.