Proteinuria is associated with neurocognitive impairment in antiretroviral therapy treated HIV-infected individuals.

TitleProteinuria is associated with neurocognitive impairment in antiretroviral therapy treated HIV-infected individuals.
Publication TypeJournal Article
Year of Publication2014
AuthorsKalayjian RC, Wu K, Evans S, Clifford DB, Pallaki M, Currier JS, Smryzynski M
JournalJ Acquir Immune Defic Syndr
Volume67
Issue1
Pagination30-5
Date Published2014 Sep 1
ISSN1944-7884
KeywordsAdult, Anti-HIV Agents, Cohort Studies, Female, Glomerular Filtration Rate, HIV Infections, HIV-1, Humans, Logistic Models, Male, Mild Cognitive Impairment, Multivariate Analysis, Prospective Studies, Proteinuria, Surveys and Questionnaires
Abstract

BACKGROUND: Proteinuria is a marker of vascular dysfunction that predicted increased cardiovascular mortality and is associated with neurocognitive impairment (NCI) in population-based studies. We examined associations between proteinuria and HIV-associated NCI.

METHODS: Multivariable logistic regression was used to examine associations between NCI at the first neurocognitive assessment (baseline) and simultaneous, clinically significant proteinuria [as random spot urine protein-to-creatinine ratios (UP/Cr) ≥200 mg/g] in a prospective multicenter observational cohort study. Generalized estimating equations were used to examine associations between baseline proteinuria and subsequent NCI among subjects without NCI at baseline. NCI was defined as a Z-score, derived from the combination of normalized scores from the Trailmaking A and B and the Wechsler Adult Intelligence Scale-Revised Digit Symbol tests.

RESULTS: A total of 1972 subjects were included in this analysis. Baseline proteinuria was associated with increased odds of NCI [odds ratio (OR): 1.41, 95% confidence interval (CI): 1.08 to 1.85; P = 0.01] and with subsequent NCI among subjects without NCI at baseline (OR: 1.39, 95% CI: 1.01 to 1.93; P = 0.046) in multivariable models adjusted for risk factors and potential confounders. Similar associations were evident when these analyses were limited to visits at which time study subjects maintained plasma HIV RNA levels <200 copies per milliliter.

CONCLUSIONS: The association between proteinuria and NCI observed in this study adds to a growing body of evidence implicating contributions by vascular disease to NCI in antiretroviral treated individuals. Studies examining interventions that improve vascular function are warranted.

DOI10.1097/QAI.0000000000000237
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID25118793
PubMed Central IDPMC4133749
Grant ListAI 036219 / AI / NIAID NIH HHS / United States
AI 069424 / AI / NIAID NIH HHS / United States
AI 069501 / AI / NIAID NIH HHS / United States
P30 AI036219 / AI / NIAID NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI069424 / AI / NIAID NIH HHS / United States
UL1 TR000439 / TR / NCATS NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069439 / AI / NIAID NIH HHS / United States
UM1 AI069501 / AI / NIAID NIH HHS / United States
UM1 AI106701 / AI / NIAID NIH HHS / United States