| Abstract |
Background: As a result of widespread use of Highly Active Antiretroviral Therapy (HAART), the mortality associated with HIV has been reduced, and HIV infection is now a chronic condition. However, HAART treatment has been associated with complex medical issues. The metabolic syndrome (MetS) is prevalent in HIV-infected individuals, and is a risk factor for cardiovascular disease, atherosclerosis, and stroke. The metabolic syndrome is characterized by at least three of the following components: abdominal obesity, atherogenic dyslipidemia, hypertension, and insulin resistance (NCEP, 2001). It is not known whether HIV+ individuals with metabolic syndrome are at risk for subtle cognitive changes that can result from vascular disease.
Purpose: The purpose of this proposed project is to study the relationship between MetS and cognitive function in HIV-infected adults. We hypothesize that individuals who fulfill the criteria for MetS will have poorer cognitive function compared to those without MetS.
Significance: To date there are no published studies on MetS and cognitive function in HIV+ individuals, and a search of the CRISP database indicates that there have been no NIH grants awarded to study this important topic. Cognitive function is closely associated with quality of life and employment status. Now that HIV is a chronic, manageable disease, efforts to maximize quality of life -- including preservation of cognitive function -- are crucial. If results from the proposed study show that cognitive impairment is associated with metabolic syndrome, it would demonstrate the necessity of including cognitive function as an outcome in intervention trials. The results from this proposed case-control study would serve as preliminary data for an R01 submission, and would be used to assess whether there is cognitive impairment associated with metabolic syndrome in HIV+ adults. The results would also serve as baseline cognitive data for a longitudinal study assessing the impact of metabolic syndrome on cognitive function and cerebrovascular disease in HIV+ adults.
Methods: This case-control study would recruit 80 subjects (40 in each group) from the 314 active participants of the Cardiovascular Adverse Risk Examination (CARE) study, which is a sub-study for former participants of Nutrition for Healthy Living (NFHL). CARE is designed to examine the risk of heart disease in HIV-infected individuals, and extensive data on demographics, cardiac health risks, HIV status, and metabolism are obtained during participants' semi-annual visits. The proposed project would add cognitive testing to the already existing CARE data.
Preliminary data: A preliminary look at CARE participant data showed that 22.9% fit the criteria for MetS, with 26.8% of participants having abdominal obesity, 43.8% high triglycerides, 58.8% low HDL-cholesterol, 25.7% high blood pressure, and 5.8% high glucose. Cognitive testing has been done on 5 NFHL subjects to determine the feasibility of the cognitive testing battery.
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