Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder
Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder
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DOI：
10.1212/wnl.0b013e3182478d64
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发表时间：
2012-02-01
期刊：
影响因子：
9.9
通讯作者：
Grant, I.
中科院分区：
文献类型：
--
作者：
McCutchan, J. A.;Marquie-Beck, J. A.;Grant, I.
目的：在一项前瞻性、观察性、多中心队列研究中，评估 HIV+ 参与者亚组中 HIV 相关神经认知障碍与代谢变量之间的关系。方法：在 CNS HIV 抗逆转录病毒治疗效果研究 (CHARTER) 队列的一项横断面子研究中，130 名 HIV+ 参与者提供了空腹血样。神经认知障碍（NCI）的定义是根据年龄、教育程度、性别和种族/民族调整神经心理学测试的表现。确定了全球评级和全球赤字分数。在预测 NCI 的多变量模型中检查了人口统计学、HIV 疾病的生物标志物、代谢变量、联合抗逆转录病毒治疗 (CART) 历史、其他药物暴露和自我报告的糖尿病。单独的模型用于单独的体重指数 (BMI) (n = 90) 以及 BMI 和腰围 (WC) 一起 (n = 55)。 结果：40% 的人诊断出 NCI（总体损伤评级 >= 5）。在单变量分析中，年龄、HIV 感染持续时间较长、肥胖和 WC（而非 BMI）与 NCI 相关。在子研究中以及整个 CHARTER 队列中 55 岁以上的患者中，自我报告的糖尿病与 NCI 相关。多变量 Logistic 回归分析表明，中心性肥胖（通过 WC 测量）会增加 NCI 的风险，如果考虑到中心性肥胖的有害影响，则较大的体重可能具有保护作用。结论：与未感染 HIV 的人一样，中心性肥胖（而非更普遍的体重 (BMI) 增加）与 HIV+ 人群中 NCI 患病率较高相关。糖尿病似乎仅与老年患者的 NCI 相关。避免使用引起向心性肥胖的抗逆转录病毒药物可能可以防止或有助于逆转艾滋病毒感染者的神经认知障碍。神经病学（R）2012；78：485-492
Objective: To evaluate relationships between HIV-associated neurocognitive disorder and metabolic variables in a subgroup of HIV+ participants examined in a prospective, observational, multicenter cohort study.Methods: In a cross-sectional substudy of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort, 130 HIV+ participants provided fasting blood samples. Neurocognitive impairment (NCI) was defined by performance on neuropsychological tests adjusting for age, education, gender, and race/ethnicity. Global ratings and global deficit scores were determined. Demographics, biomarkers of HIV disease, metabolic variables, combination antiretroviral therapy (CART) history, other drug exposures, and self-reported diabetes were examined in multivariate models predicting NCI. Separate models were used for body mass index (BMI) alone (n = 90) and BMI and waist circumference (WC) together (n = 55).Results: NCI (global impairment rating >= 5) was diagnosed in 40%. In univariate analyses, age, longer duration of HIV infection, obesity, and WC, but not BMI, were associated with NCI. Self-reported diabetes was associated with NCI in the substudy and in those >55 in the entire CHARTER cohort. Multivariate logistic regression analyses demonstrated that central obesity (as measured by WC) increased the risk of NCI and that greater body mass may be protective if the deleterious effect of central obesity is accounted for.Conclusions: As in HIV-uninfected persons, central obesity, but not more generalized increases in body mass (BMI), was associated with a higher prevalence of NCI in HIV+ persons. Diabetes appeared to be associated with NCI only in older patients. Avoidance of antiretroviral drugs that induce central obesity might protect from or help to reverse neurocognitive impairment in HIV-infected persons. Neurology (R) 2012;78:485-492