Association of Body Mass Index and Viral Burden with Neurocognitive Performance among HIV-1 Infected Patients

Abstract

Introduction: The pathogenesis of HIV associated neurocognitive disorders (HAND) involves interaction of viral, host, treatment, and comorbid factors, though the specific mechanisms remain unclear. We examined the association of body mass index (BMI) and viral burden with cognitive function among HIV-1 infected individuals in high burden and resource limited settings. Methods: This was a secondary analysis of data obtained from 3 prospective cohort studies conducted in China, India and Nigeria. A total of 761 HIV-1 infected participants from these 3 cohorts were included for the analyses of BMI and cognitive function; 179 participants from the Nigeria cohort for the analyses of plasma HIV RNA and cognition; while 36 individuals at baseline from the Nigeria study were included in the analysis of HIV DNA levels and cognitive performance. Data on demographic and clinical information were obtained using standardized questionnaires and thorough general medical assessments at each study visit during the conduct of the primary studies. Utilizing demographic and practice effect adjusted T scores obtained from a 7-domain neuropsychological test battery, cognitive status was determined by the global deficit score (GDS) approach, with a GDS of ≥ 0.5 indicating cognitive impairment. Results: In a multivariable logistic regression of pooled longitudinal data, adjusting for clinical and demographic variables, the odds of global neurocognitive impairment were higher among the overweight/obese and the underweight as compared to normal weight participants (OR: 1.38 [95% CI: 1.1, 1.72]; P=0.0049; and OR: 1.39 [95% CI: 1.03, 1.87]; P=0.0292 respectively). The odds of neurocognitive impairment were 30% higher per log10 increase in plasma HIV RNA (OR: 1.3 [95% CI: 1.1, 1.5]; P=0.0048) among the Nigeria cohort. Also among this group, the odds of cognitive impairment were 6.2 times greater per log10 increase in HIV DNA within T&B lymphocytes (OR: 6.2 [95% CI, 1.01-37.4]; p= 0.048). (p= 0.048). Conclusion: In this study, we found significant associations between weight categories, plasma HIV RNA levels as well as HIV DNA levels within peripheral blood lymphocytes, and neurocognitive performance among HIV-1 infected patients in resource limited and HIV high burden settings. Further studies are required to characterize the mechanistic basis for these findings.