Factors Associated With Incident Human Immunodeficiency Virus–Dementia

Abstract

FEW STUDIES have examined the risk factors for dementia in patients with human immunodeficiency virus (HIV) infection and these have focused primarily on demographic and medical factors. Previous studies have suggested that older age, history of HIV-related medical symptoms, lower hemoglobin levels, higher plasma viral load,¹ lower CD4⁺ cell counts,² and intravenous drug use³ are associated with a greater risk of developing dementia. There has been some suggestion that zidovudine treatment is protective.⁴ While many studies have demonstrated subtle cognitive changes in patients with HIV, and psychomotor slowing has been associated with an increased risk of dementia,⁵ it is unclear whether these are unrelated to later dementia or represent the early stages of a dementing process. Similarly, diagnostic criteria have been proposed for HIV-associated minor cognitive/motor disorder (MCMD), which applies to HIV-positive patients with subtle cognitive, neurologic, and psychiatric symptoms but minimal functional complaints.⁶ To our knowledge, the relationship between this diagnosis and a later diagnosis of dementia has been unexplored. This study prospectively followed up HIV-positive patients to evaluate which clinical features noted at the initial visit were associated with an increased risk of developing dementia. Potential correlates of incident dementia included demographic, medical, neurologic, functional, and psychiatric features as well as laboratory study results. In addition, all participants completed a battery of neuropsychological tests, allowing us to assess the predictive use of poor test performance and the presence of MCMD.