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Khuder SS, Chen S, Letendre S, Marcotte T, Grant I, Franklin D, Rubin LH, Margolick JB, Jacobson LP, Sacktor N, D'Souza G, Stosor V, Lake JE, Rapocciolo G, McArthur JC, Dickens AM, Haughey NJ. Impaired insulin sensitivity is associated with worsening cognition in HIV-infected patients. Neurology 2019; 92:e1344-e1353. [PMID: 30787163 DOI: 10.1212/wnl.0000000000007125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the association of insulin sensitivity and metabolic status with declining cognition in HIV-infected individuals. METHODS We conducted targeted clinical and metabolic measures in longitudinal plasma samples obtained from HIV-infected patients enrolled in the Central Nervous System HIV Anti-Retroviral Therapy Effects Research Study (CHARTER). Findings were validated with plasma samples from the Multicenter AIDS Cohort Study (MACS). Patients were grouped according to longitudinally and serially assessed cognitive performance as having stably normal or declining cognition. RESULTS Patients with declining cognition exhibited baseline hyperinsulinemia and elevated plasma c-peptide levels with normal c-peptide/insulin ratios, suggesting that insulin production was increased, but insulin clearance was normal. The association of hyperinsulinemia with worsening cognition was further supported by low high-density lipoprotein (HDL), high low-density lipoprotein/HDL ratio, and elevated cholesterol/HDL ratio compared to patients with stably normal cognition. CONCLUSIONS These findings suggest that hyperinsulinemia and impaired insulin sensitivity are associated with cognitive decline in antiretroviral therapy-treated HIV-infected patients.
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Affiliation(s)
- Saja S Khuder
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Suming Chen
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Scott Letendre
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Thomas Marcotte
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Igor Grant
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Donald Franklin
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Leah H Rubin
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Joseph B Margolick
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Lisa P Jacobson
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Ned Sacktor
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Gypsyamber D'Souza
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Valentina Stosor
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Jordan E Lake
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Giovanna Rapocciolo
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Justin C McArthur
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland
| | - Alex M Dickens
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland.
| | - Norman J Haughey
- From the Departments of Neurology (S.S.K., S.C., L.H.R., N.S., J.C.M., N.J.H.) and Psychiatry (N.J.H.), Johns Hopkins University School of Medicine, Baltimore, MD; HIV Neurobehavioral Research Program and Department of Psychiatry (S.L., T.M., I.G., D.F.), School of Medicine, University of California, San Diego, La Jolla; Department of Epidemiology (J.B.M., L.P.J., G.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (V.S.), Division of Infectious Diseases, and Department of Surgery (V.S.), Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; University of Texas Health Sciences Center (J.E.L.), Houston; Infectious Disease and Microbiology (G.R.), University of Pittsburg, PA; and Turku Centre for Biotechnology (A.M.D.), Turku University, Finland.
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