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Factors Associated With Incident Human Immunodeficiency Virus–Dementia
Yaakov Stern, PhD;
Michael P. McDermott, PhD;
Steven Albert, PhD;
Donna Palumbo, PhD;
Ola A. Selnes, PhD;
Justin McArthur, MD;
Ned Sacktor, MD;
Giovanni Schifitto, MD;
Karl Kieburtz, MD, MPH;
Leon Epstein, MD;
Karen S. Marder, MD, MPH;
for the Dana Consortium on the Therapy of HIV–Dementia and Related
Cognitive Disorders
Arch Neurol. 2001;58:473-479.
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 ß2-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.
From the Departments of Neurology (Drs Stern, Albert, and Marder) and
Psychiatry (Dr Stern), Sergievsky Center and the Taub Institute, Columbia
University College of Physicians and Surgeons, New York, NY; New York Presbyterian
Hospital, New York (Drs Stern and Marder); Departments of Neurology and Biostatistics,
University of Rochester Medical Center, Rochester, NY (Dr McDermott); Department
of Neurology (Drs Palumbo, Schifitto, and Kieburtz) and Biostatistics (Drs
Palumbo and Schifitto), University of Rochester School of Medicine and Dentistry,
Rochester; Department of Neurology (Drs Selnes and McArthur) and Epidemiology
(Dr McArthur), The Johns Hopkins University School of Medicine, Baltimore,
Md; Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore
(Dr Sacktor); and the Department of Pediatrics, Children's Memorial Hospital,
Northwestern University Medical School, Chicago, Ill (Dr Epstein).
Corresponding author and reprints: Yaakov Stern, PhD, Sergievsky
Center, 630 W 168th St, New York, NY 10032 (e-mail: ys11{at}columbia.edu).
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