The demographics of the 189 subjects from the Hawaii Aging with HIV Cohort are similar to what is reported in the state of Hawaii. The cohort, as initially designed, enrolled older (≥50 years old) and younger (20–39 years old) subjects; thus the mean age was 44 years old, SD = 11 years (range = 21–73 years). The mean years of education was 13.93 years (SD = 2.25 years) with 51% Caucasian and 37% Asian-Pacific Islander; and 15% female and 85% male.32
The HIV RNA levels (VL) and CD4 cell counts among the three groups (normal cognition; minor cognitive motor disorder, and HIV-1-associated dementia) were not statistically significant (p = 0.78 and p = 0.36, respectively) ().
Laboratory Parameters by Diagnostic Category
The analysis comparing HIV DNA in individuals with normal cognition (NC), minor cognitive motor disorder (MCMD) and HIV-1-associated dementia (HAD) showed a significant effect among all three groups (p<0.001; NC = 83, MCMD = 85; HAD = 21; ). To examine whether the HIV DNA association was due to HIV RNA levels, we repeated the analysis among participants with undetectable VL (N = 95) and found that the significance was upheld in those with HIV-1-associated dementia (n = 11) relative to those with minor cognitive motor disorder (n = 40) and normal cognition (n = 44) (p<0.001, ); with similar CD4 cell counts (p = 0.39).
Similarly, in subjects with detectable VL (n = 94), HIV DNA was also higher in those with HIV-1-associated dementia (n = 10) relative to those with minor cognitive motor disorder (n = 45) and normal cognition (n = 39) (p<0.001, ). The results from this relatively large separate cohort from Hawaii Aging with HIV Cohort showed a positive correlation; therefore the data were reanalyzed to include the smaller subset from Hawaii Aging with HIV Cohort previously reported. The combined data, using a univarate logistic regression model with a generalized logits link function, demonstrated a strong probability of cognitive diagnosis (normal cognition, minor cognitive motor disorder, or HIV-1-associated dementia) with HIV DNA ().
Probability (CI) of Cognitive Diagnosis Predicted by HIV DNA
The decrement in baseline of each NP deficit which is associated with HIV DNA is plotted in , adjusted for age, ethnicity, CD4 cell count, and estimated premorbid IQ, where ethnicity and IQ are not confounded with cognitive diagnosis. For each unit increase in log of HIV DNA, there is a decrease in neuropsychiatric deficit. Neuropsychological deficits were significantly associated with entry HIV DNA in all deficits () (regression coefficients range from −0.24 to −0.07, p<0.05). The effect of HIV DNA on NP deficits remained significant after adjusting for age, ethnicity, and estimated premorbid IQ.
Neuropsychological Deficits Associated with Unit Increase in Log10 of HIV DNA
Association between Entry HIV DNA & Neurocognitive Function (n = 189)