Barcelona 2013
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| Abstract #576 - E-Posters English | ||||
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Session: 50.20: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Dr. Sean B. Rourke - The Ontario HIV Treatment Network, Canada |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: The Veterans Aging Cohort Study (VACS) Index was developed to assess the risk of mortality. The index is generated by summing pre-assigned "risk" points for age, gender, race, HIV disease indicators (CD4 count and HIV-1 RNA), hepatic measures (i.e., platelets, aspartate and alanine transaminase, viral hepatitis C infection), and renal measures (i.e., creatinine and glomerular infiltration rate). It has been validated and shown to predict mortality, hospitalization, medical intensive care unit admission, functional performance, and physiologic fragility features. A recent study from the HIV Neurobehavioral Research Program (HNRP) in San Diego has shown that the VACS index also predicts neurocognitive functioning and performance-based impairment of everyday functioning in the CHARTER cohort (Franklin et al, CROI 2013). The objective of this study is to extend this initial work by the HNRP to determine whether the VACS Index is associated with neuropsychological status among people with HIV in Ontario, Canada. | ||||
| Method / Issue: The study sample included 317 people with HIV who were receiving care in an inner city hospital in Toronto, Canada. Mean age of the sample was 42.3 years, 78% were men, 57 % were gay, lesbian, or bisexual, 49% were Caucasian, 76% were on antiretroviral (ARV) treatment, and 63% had undetectable plasma HIV viral load. Demographic data was collected through interviewer-administered questionnaire. Clinical data were obtained from medical charts. The VACS Index was computed based on published guidelines and ranged from 0 to 111 (median: 15; interquartile range: 6-26) in our sample. Data on medical comorbidities including diabetes, cardiovascular diseases, and other comorbidities were also obtained. A brief neuropsychological test battery including the Hopkins Verbal Learning Test ? Revised, Grooved Pegboard Test, WAIS-R Digit Symbol, and WMS-III Spatial Span was administered. Test scores were converted to demographically corrected T-scores using published normative data. Global Deficit Score (GDS) was computed using published algorithms and individuals were then classified into impaired and unimpaired using a GDS cut-off of 0.5 (Carey et al, 2004). Univariate and multivariate logistic regression methods were used to determine the contributions of the VACS index with neuropsychological status. | ||||
| Results / Comments: In bivariate logistic regression, the VACS Index was significantly associated with neuropsychological impairment (OR=1.03; 95% CI: [1.01-1.05], p < 0.001), with higher VACS Index predicting higher odds of neuropsychological impairment. To determine the independent association between the VACS index and neuropsychological status, we fitted a multivariate regression model adjusting for education, alcohol use, illicit drug use, depressive symptoms, ARV therapy, cigarette smoking, diabetes, cardiovascular diseases, and other comorbidities. Results of the multivariate model showed significant independent association between the VACS Index and neuropsychological impairment (AOR=1.03; 95% CI: [1.01-1.05], p = 0.004). In addition to the VACS index, diabetes was also associated with greater odds of neuropsychological impairment (AOR=3.76; 95% CI: [1.11-12.76], p = 0.034). | ||||
| Discussion: The VACS index independently predicts neuropsychological status and may be useful in the assessment and management of HIV-associated neurocognitive disorders (HAND). The clinical management of cardiovascular risk factors, such as diabetes, may help to prevent or further delay onset / progression of HAND. | ||||
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