Factors associated with incident human immunodeficiency virus-dementia

Background: Antecedents to human immunodeficiency virus-dementia (HIV-D) ar e poorly understood. Objective: To identify risk factors for HIV-D. Methods : Subjects who are positive for HIV who have CD4(+) counts either below 200 /muL or below 300/muL with evidence of cognitive impairment were enrolled i n this study. Neurologic, cognitive, functional, and laboratory assessments were done semiannually for up to 30 months, Human immunodeficiency virus-d ementia was diagnosed using American Academy of Neurology criteria for prob able HIV-l-associatcd dementia complex. Results: One hundred forty-six nond emented patients were enrolled, 45 of whom subsequently met criteria for in cident HIV-D. In univariate analyses using the Cox proportional hazards reg ression model, the following variables were significantly associated with t ime to develop dementia: cognitive: abnormal scores on Timed Gait, Verbal F luency, Grooved Pegboard, and Digit Symbol tests; attention-memory, psychom otor, and executive function domain scores; and the diagnosis of minor cogn itive/motor disorder; neurologic and medical: increased abnormalities on th e neurologic examination, extrapyramidal signs, history of HIV-related medi cal symptoms; functional: higher reported role or physical function difficu lties. Depression was also a strong risk factor, along with sex, hematocrit , hemoglobin, and beta (2)-microglobulin levels. In a multivariate model th at used cognitive domain scores, covariates with significant hazard ratios included depression, executive dysfunction, and the presence of minor cogni tive/motor disorder. Conclusion: Cognitive deficits, minor cognitive/motor disorder, and depression may be early manifestations of HIV-D.