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Variable cognitive benefits in HAART-treated patients: are aging and low cholesterol linked?
María Jose Míguez-Burbano1, John E Lewis2, Ximena Burbano3, Rhonda Rosenberg1, Joel Fishman4, Deshratn Asthana2, Karl Goodkin5, Robert M Malow1
1Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work and College of Medicine, Florida International University, Miami, FL, USA; 2Departments of Psychiatry and Behavioral Sciences, 3Epidemiology and Public Health, and 4Radiology, University of Miami Miller School of Medicine, Miami, FL, USA; 5Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
Objective: Since a sizeable portion of the brain is composed of cholesterol, which serves various vital functions, we investigated interrelationships among hypocholesterolemia (HypoCHL < 150 mg/dL) and neurocognitive impairment for people living with HIV (PLWH).
Methods: Fasting blood samples were obtained in 125 PLWH younger than 45 years of age (Group 1) and 40 PLWH older than 46 years old (Group 2) at baseline and after 24 weeks on highly active antiretroviral therapy (HAART). Participants with HypoCHL were compared with non-HypoCHL on learning/memory (California Verbal Learning Test = CVLT) and global neurocognitive status (HIV Dementia Scale = HDS).
Results: HypoCHL was prevalent in Group 1 (35%) and Group 2 (30%) and associated with lower CVLT (P = 0.03) and HDS (P = 0.02) scores. After HAART in Group 1, non-HypoCHL subjects improved in every neurocognitive parameter, but progress was limited and non-significant in the HypoCHL subjects. Despite better adherence and lower viral loads (P = 0.05) exhibited by Group 2, the HypoCHL participants showed declines in HDS scores (-2.5) and total CVLT (-0.86 words). After adjusting for relevant variables, HypoCHL subjects from Group 1 showed a three-fold increased risk for scoring in the dementia range (P < 0.01), and the risk was even higher for HypoCHL participants in Group 2 (OR = 5.0, 95% CI: 1.25–21.3, P = 0.008).
Conclusions: The association of HypoCHL with limited HAART neurocognitive recovery and even a continuous decline indicates the importance of restoring lipid balance.
Keywords: lipids, metabolism, cognition, HIV-associated neurocognitive disorders, HAART, HIV/AIDS