2001 Articles

Factors Associated With Incident Human Immunodeficiency Virus–Dementia

Stern, Yaakov; McDermott, Michael P.; Albert, Steve M.; Palumbo, Donna; Selnes, Ola A.; Sacktor, Ned; McArthur, Justin C.; Schifitto, Giovanni; Kieburtz, Karl; Epstein, Leon G.; Marder, Karen

Background: Antecedents to human immunodeficiency virus–dementia (HIV-D) are poorly understood. Objective: To identify risk factors for HIV-D. Methods: Subjects who are positive for HIV who have CD4+ counts either below 200/µL or below 300/µL with evidence of cognitive impairment were enrolled in this study. Neurologic, cognitive, functional, and laboratory assessments were done semiannually for up to 30 months. Human immunodeficiency virus–dementia was diagnosed using American Academy of Neurology criteria for probable HIV-1–associated dementia complex. Results: One hundred forty-six nondemented patients were enrolled, 45 of whom subsequently met criteria for incident HIV-D. In univariate analyses using the Cox proportional hazards regression model, the following variables were significantly associated with time to develop dementia: cognitive: abnormal scores on Timed Gait, Verbal Fluency, Grooved Pegboard, and Digit Symbol tests; attention-memory, psychomotor, and executive function domain scores; and the diagnosis of minor cognitive/motor disorder; neurologic and medical: increased abnormalities on the neurologic examination, extrapyramidal signs, history of HIV-related medical symptoms; functional: higher reported role or physical function difficulties. Depression was also a strong risk factor, along with sex, hematocrit, hemoglobin, and β2-microglobulin levels. In a multivariate model that used cognitive domain scores, covariates with significant hazard ratios included depression, executive dysfunction, and the presence of minor cognitive/motor disorder. Conclusion: Cognitive deficits, minor cognitive/motor disorder, and depression may be early manifestations of HIV-D.