THE BOTTOM LINE:
A study of 109 persons living with HIV and 92 in an uninfected comparison group with an average age of 51 showed a relationship of the metabolic syndrome (high blood pressure, elevated triglycerides, low HDL cholesterol, increased waste circumference, and high blood sugar) with a deficit on a comprehensive neurocognitive measure. This was seen in the HIV group but not in the comparison group. Diabetes and elevated triglycerides were the major predictive metabolic factors. Learning, executive function, and fine motor skills were the most negatively affected. The results indicate the need to diagnose and treat the metabolic syndrome with the hope of a possible reduction of its impact on cognition.
Background: The adverse consequences of HIV and related comorbidities on the central nervous system remain prevalent in the era of combination antiretroviral therapy. Metabolic syndrome (MetS) is a common comorbidity in HIV and has been linked to increased neurocognitive impairment in the general population. We investigated the association between MetS and neurocognition among persons living with HIV (PLHIV).
Methods: Participants included 109 PLHIV and 92 HIV-uninfected adults (HIV−) from the Multi-dimensional Successful Aging cohort study at the University of California San Diego (age: M = 50.8, SD = 8.0). Participants completed neuromedical, psychiatric, and neurocognitive assessments. Based on a comprehensive neurocognitive battery, we examined global neurocognitive deficits (based on the entire battery) and neurocognitive deficits in 7 domains (verbal fluency, learning, recall, executive function, working memory, speed of information processing, and fine motor skills). MetS was determined via the standard criteria by the National Cholesterol Education Program's Adult Treatment Panel-III. Covariates examined included demographics and psychiatric comorbidities (and HIV disease characteristics among PLHIV).
Results: MetS had an independent significant effect on global neurocognitive deficits among PLHIV (P = 0.03) but not among their HIV− counterparts (P = 0.93). Among PLHIV, MetS was most strongly associated with the neurocognitive domains of learning, fine motor skills, and executive function. Diabetes and elevated triglycerides were the MetS components most strongly linked with increased global neurocognitive deficits in PLHIV.Conclusions: The present findings underscore the need for early identification of PLHIV at risk for MetS and the implementation of preventive and treatment approaches to lessen the development of MetS and neurocognitive impairment among PLHIV.