Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons

E. J. Wright, Birgit Grund, K. Robertson, B. J. Brew, Mollie J Roediger, M. P. Bain, F. Drummond, M. J. Vjecha, J. Hoy, C. Miller, A. C. Penalva De Oliveira, W. Pumpradit, J. C. Shlay, W. El-Sadr, R. W. Price

Research output: Contribution to journalArticle

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Abstract

Objective: To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. Methods: Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. Results: The 292 participants had a median CD4 cell count of 536 cells/mm, 88% had an HIV viral load ≤400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was-0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. Conclusions: In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.

Original languageEnglish (US)
Pages (from-to)864-873
Number of pages10
JournalNeurology
Volume75
Issue number10
DOIs
StatePublished - Sep 7 2010

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Cardiovascular Diseases
HIV
AIDS Dementia Complex
CD4 Lymphocyte Count
Hypercholesterolemia
Demography
Hypertension
Sex Education
Thailand
Neurology
North America
Viral Load
Population
Brazil
Outcome Assessment (Health Care)
Therapeutics

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Wright, E. J., Grund, B., Robertson, K., Brew, B. J., Roediger, M. J., Bain, M. P., ... Price, R. W. (2010). Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. Neurology, 75(10), 864-873. https://doi.org/10.1212/WNL.0b013e3181f11bd8

Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. / Wright, E. J.; Grund, Birgit; Robertson, K.; Brew, B. J.; Roediger, Mollie J; Bain, M. P.; Drummond, F.; Vjecha, M. J.; Hoy, J.; Miller, C.; Penalva De Oliveira, A. C.; Pumpradit, W.; Shlay, J. C.; El-Sadr, W.; Price, R. W.

In: Neurology, Vol. 75, No. 10, 07.09.2010, p. 864-873.

Research output: Contribution to journalArticle

Wright, EJ, Grund, B, Robertson, K, Brew, BJ, Roediger, MJ, Bain, MP, Drummond, F, Vjecha, MJ, Hoy, J, Miller, C, Penalva De Oliveira, AC, Pumpradit, W, Shlay, JC, El-Sadr, W & Price, RW 2010, 'Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons', Neurology, vol. 75, no. 10, pp. 864-873. https://doi.org/10.1212/WNL.0b013e3181f11bd8
Wright, E. J. ; Grund, Birgit ; Robertson, K. ; Brew, B. J. ; Roediger, Mollie J ; Bain, M. P. ; Drummond, F. ; Vjecha, M. J. ; Hoy, J. ; Miller, C. ; Penalva De Oliveira, A. C. ; Pumpradit, W. ; Shlay, J. C. ; El-Sadr, W. ; Price, R. W. / Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. In: Neurology. 2010 ; Vol. 75, No. 10. pp. 864-873.
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abstract = "Objective: To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. Methods: Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. Results: The 292 participants had a median CD4 cell count of 536 cells/mm, 88{\%} had an HIV viral load ≤400 copies/mL, and 92{\%} were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was-0.72; 14{\%} of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. Conclusions: In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.",
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AU - Wright, E. J.

AU - Grund, Birgit

AU - Robertson, K.

AU - Brew, B. J.

AU - Roediger, Mollie J

AU - Bain, M. P.

AU - Drummond, F.

AU - Vjecha, M. J.

AU - Hoy, J.

AU - Miller, C.

AU - Penalva De Oliveira, A. C.

AU - Pumpradit, W.

AU - Shlay, J. C.

AU - El-Sadr, W.

AU - Price, R. W.

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N2 - Objective: To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. Methods: Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. Results: The 292 participants had a median CD4 cell count of 536 cells/mm, 88% had an HIV viral load ≤400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was-0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. Conclusions: In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.

AB - Objective: To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. Methods: Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. Results: The 292 participants had a median CD4 cell count of 536 cells/mm, 88% had an HIV viral load ≤400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was-0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. Conclusions: In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.

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