Abstract
Cognitive impairment remains prevalent in the era of combination antiretroviral therapy (cART) and may be partially due to comorbidities. We postulated that insulin resistance (IR) is negatively associated with cognitive performance. We completed a cross-sectional analysis among 1547 (1201 HIV(+)) women enrolled in the Women's Interagency HIV Study (WIHS). We evaluated the association of IR with cognitive measures among all WIHS women with concurrent fasting bloods and cognitive testing [Trails A, Trails B, and Symbol Digit Modalities Test (SDMT)] using multiple linear regression models. A smaller subgroup also completed the Stroop test (n=1036). IR was estimated using the Homeostasis Model Assessment (HOMA). Higher HOMA was associated with poorer performance on the SDMT, Stroop Color-Naming (SCN) trial, and Stroop interference trial, but remained statistically significant only for the SCN in models adjusting for important factors [β=3.78 s (95% CI: 0.48-7.08), p=0.025, for highest vs. lowest quartile of HOMA]. HIV status did not appear to substantially impact the relationship of HOMA with SCN. There was a small but statistically significant association of HOMA and reduced neuropsychological performance on the SCN test in this cohort of women.
Highlights
Insulin resistance (IR) represents the syndrome whereby body tissue becomes increasingly unresponsive to insulin in a setting of increased glucose loads, a process that is generally considered to be a precursor to diabetes mellitus (DM)
As expected, increasing severity of IR correlated with higher frequency of other metabolic abnormalities (Table 1). combination antiretroviral therapy (cART) use was more highly prevalent and mean CD4 lymphocyte counts were higher with increasing IR severity
Examining unadjusted raw neuropsychological data, we noted a pattern suggestive of poorer performance on most tests with increasing quartile of Homeostasis Model Assessment (HOMA) among HIV-uninfected women but only on the Symbol Digit Modalities Test (SDMT), Stroop color-naming, and interference trial for HIV-infected women (Fig. 1). This cross-sectional analysis of a large group of women at risk for IR identified an association between IR and neuropsychological testing performance; the effects are diminished substantially when controlling for other factors
Summary
Insulin resistance (IR) represents the syndrome whereby body tissue becomes increasingly unresponsive to insulin in a setting of increased glucose loads, a process that is generally considered to be a precursor to diabetes mellitus (DM) Both IR and DM are linked to obesity, which has become a major health issue, affecting 36% of women in the United States.[1] HIV-specific factors such as immune activation and specific antiretroviral drugs have been associated with IR.[2,3,4,5]. Examining associations between IR and cognitive function in HIV-infected women could be substantially informative
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