In:
Journal of the International AIDS Society, Wiley, Vol. 17, No. 4S3 ( 2014-11)
Abstract:
The aim of our study was to investigate the potential relationship between liver fibrosis (LF) and cognitive performance in HIV+ patients. Materials and Methods We performed a cross‐sectional cohort study by consecutively enrolling HIV+ patients during routine outpatient visits at two clinical centres in Italy. Subjects with decompensated liver disease were excluded. All subjects underwent a comprehensive neuropsychological battery exploring memory, attention, psychomotor speed and language; cognitive impairment was defined as at least two abnormal [1.5 SD below the mean for appropriate norms] cognitive domains. LF was explored by calculating FIB4 index; in a subgroup of patients, LF was also assessed by transient elastography. Factors associated with cognitive impairment were investigated by logistic regression models. Results A total of 413 patients [77% males, median age 46 (IQR 39–52), 17% with past AIDS‐defining events, 19% past IDU, 3% with diabetes, 94% on cART, 90% with HIV RNA 〈 50 copies/mL, 18% co‐infected with HCV] were enrolled. Seventeen patients (4%) had FIB4 〉 3.25 and 14/129 (3%) had liver stiffness 〉 14KPa. Forty‐seven patients (11%) were diagnosed with cognitive impairment. At multivariate analyses patients with FIB4 〉 1.45 showed a higher risk of cognitive impairment in comparison with those with lower values (OR 2.19, 95% CI 1.02–4.72; p=0.044) after adjusting for education (OR 0.79, 95% CI 0.71–0.88; p 〈 0.001), past IDU (OR 1.69, 95% CI 0.67–4.23; p=0.264), diabetes (OR 2.35, 95% CI 0.62–8.86; p=0.207), HIV RNA 〈 50 copies/mL (OR 0.47, 95% CI 0.19–1.14; p=0.095) and HCV co‐infection (OR 0.88, 95% CI 0.33–2.39; p=0.807). Analyzing any single cognitive domain, a higher risk of abnormal psychomotor speed was associated with fibroscan score 〉 14KPa in comparison with fibroscan score 〈 7KPa (OR 285.07; 95% CI 2.42–33574.06; p=0.020) after adjusting for education (OR 0.54, 95% CI 0.31–0.92; p=0.024), age (for 10 years increase) (OR 2.03, 95% CI 0.55–7.53; p=0.288), past IDU (OR 4.43, 95% CI 0.35–7.57; p=0.526), HIV RNA 〈 50 copies/mL (OR 0.01, 95% CI 0.00–0.18; p=0.003), HIV history (for 1 year increase) (OR 0.96, 95% CI 0.83–1.12; p=0.641), CD4 cells count at nadir (OR 1.10, 95% CI 0.56–2.16; p=0.779), and HCV co‐infection (OR 0.06; 95% CI 0.00–1.93; p=0.113). Conclusions In HIV‐infected patients higher LF, estimated through non‐invasive methods, is associated to a higher risk of cognitive impairment.
Type of Medium:
Online Resource
ISSN:
1758-2652
,
1758-2652
DOI:
10.7448/IAS.17.4.19722
Language:
English
Publisher:
Wiley
Publication Date:
2014
detail.hit.zdb_id:
2467110-1
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