Impaired Glucoregulation May Fuel Cognitive Dysfunction in HIV-Infected Patients

Diabetes is an independent risk factor for HIV-associated dementia.

Dr. Victor Valcour from the Hawaii AIDS Clinical Research Program at the University of Hawaii in Honolulu and colleagues report these findings. The data also hint that subtle, pre-diabetic abnormalities in glucose regulation may also pose a risk for cognitive impairment.

"Insulin resistance and diabetes are emerging complications of HAART therapy and they are likely to have important clinical consequences as patients are required to take antiretroviral medications for the long-term," Dr. Valcour pointed out.

Moreover, studies among HIV-negative populations indicate a correlation between diabetes and cognitive function, but there are limited data on metabolic abnormalities and cognitive function in HIV-1-infected patients.

Dr. Valcour’s team looked for associations between HIV-associated dementia and diabetes among 203 adults aged 20 to 76 years who joined the Hawaii Aging with HIV Cohort between October 2001 and November 2003. Roughly half of these individuals were older than 50 years of age at entry.

"In this preliminary analysis," Dr. Valcour stated that, "older HIV patients with diabetes were more likely to meet our research classification of HIV dementia" — which was determined in consensus conferences with a panel of neurologists, neuropsychologists, and a geriatrician.

In analyses adjusting for age, education, ethnicity, CD4 count, duration of HIV infection, and protease inhibitor-based antiretroviral regimen, diabetes was statistically significantly associated with HIV-associated dementia with an odds ratio of 5.43. This association remained after adjusting for coexisting vascular risk factors for dementia.

"We also looked at both young and old HIV patients and began to see a relationship whereby abnormalities in glucose regulation, shy of diabetes, may relate to cognitive function," Dr. Valcour said. That is, in subjects without overt diabetes, increasing cognitive impairment was associated with higher fasting glucose levels.

"If confirmed, this would be an important observation," Dr. Valcour said, "because it would suggest our findings regarding diabetes may be important for patients with subclinical glucose abnormalities." More work is needed to clarify this point, he added.
J Acquir Immune Defic Syndr 2005;38:31-36.