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Metabolic Syndrome, Diabetes, and Cognitive Impairment in the Era of Combination Antiretroviral Therapy
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Reported by Jules Levin
CROI 2009
Feb 8-12 Montreal
Allen McCutchan1, Jennifer Marquie-Beck1, Scott Letendre1, Robert K. Heaton1, Tanya Wolfson1, Debra Rosario1, Terry Alexander1, Christina Marra2, Beau Ances3, Igor Grant1 and the CHARTER Group
1University of California, San Diego, 2University of Washington, Seattle, 3Washington University
AUTHOR SUMMARY & CONCLUSION
In HIV patients, Type 2 diabetes (DM II) and multiple components of metabolic syndrome were associated with prevalent cognitive impairment in IV-infected persons, but the mechanism is unclear (from Jules: in HIV-unifected I recall mechanisms discussed in published literature)
In contrast to findings in an older Hawaian cohort, increased insulin resistance, a causal mechanism for DMII, did not correlate with cognitive impairment
Thus, CART drugs that are less likely to induce the metabolic syndrome might reduce the risk of cognitive impairment in HIV-infected persons.
OBJECTIVE
To evaluate the relationship of cognitive impairment in HIV-infection to components of the metabolic syndrome (MS).
BACKGROUND & SIGNIFICANCE
Metabolic syndrome, a common complication of combination antiretroviral therapy (CART), includes components such as:
--insulin resistance (glucose intolerance and type II diabetes),
--dyslipidemias (high total cholesterol, triglycerides and LDL and low HDL),
--lipodystrophy (truncal obesity), and
--hypertension.
In HIV-uninfected populations, both diabetes and high body mass index (BMI) have been correlated with prevalent cognitive impairment.
In two studies of the Hawaii Aging with HIV Cohort, diabetes, insulin resistance and elevated glucose levels were linked to dementia in older HIV+ patients.
We examined the relationship of cognitive impairment to components of the metabolic syndrome in a substudy of the CHARTER Cohort.
METHODS
This was a prospectively designed substudy of CHARTER. an observational cohort study at 6 North American academic HIV clinics, that examines the effects of combination antiretroviral therapy (CART) on the nervous system.
RESULTS
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