Plasma Cystatin C Associates with HIV-Associated Neurocognitive Disorder but Is a Poor Diagnostic Marker in Antiretroviral Therapy-Treated Individuals

Robert C. Kalayjian, Kevin R. Robertson, Jeffrey M. Albert, Carl J. Fichtenbaum, Todd T. Brown, Babafemi O. Taiwo

Research output: Contribution to journalArticle

Abstract

Objective:To examine associations between plasma cystatin C and neurocognitive impairment (NCI) and its performance as a diagnostic marker before and during initial antiretroviral therapy (ART).Methods:Multivariable logistic regression and generalized estimating equations examined associations with NCI, determined by neuropsychological measurements, in participants of a 48-week randomized clinical trial of initial ART. Receiver operator characteristic curves examined diagnostic models of NCI.Results:Cystatin C was associated with NCI before ART [odds ratio (OR) 3.4 (95% CI: 1.2 to 9.4) for each 2-fold increase in baseline levels] and during 48 weeks of ART, in models that excluded baseline measurements [OR 3.0 (1.2 to 7.8) for each 2-fold increase in time-updated levels]. The strength of association increased with more severe impairment using HIV-associated neurocognitive disorder criteria [OR 2.2 (0.8 to 6.0) with asymptomatic NCI and OR 4.0 (1.5 to 11.0) with mild neurocognitive disorder or HIV-associated dementia vs. no impairment, for each 2-fold increase in time-updated levels] or by global development score [OR 2.6 (1.1 to 6.3) with mild impairment and OR 4.6 (1.1 to 18.9) with moderate or severe impairment vs. no impairment]. Cystatin C performed poorly as a diagnostic marker for NCI, however, with an area under the receiver operator characteristic curve of 0.58 at baseline and 0.54 at week 48.Conclusions:Higher plasma cystatin C levels were significantly associated with NCI, but these levels did not seem to be useful as a diagnostic marker for this condition.

Original languageEnglish (US)
Pages (from-to)e49-e54
JournalJournal of acquired immune deficiency syndromes
Volume81
Issue number2
DOIs
StatePublished - Jun 1 2019

Keywords

  • HAND
  • cystatin C
  • endovascular dysfunction
  • neurocognitive impairment
  • neuroinflammation

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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