Anemia and Red Blood Cell Indices Predict HIV-Associated Neurocognitive Impairment in the Highly Active Antiretroviral Therapy Era.

Kallianpur AR, Wang Q, Jia P, Hulgan T, Zhao Z, Letendre SL, Ellis RJ, Heaton RK, Franklin DR, Barnholtz-Sloan J, Collier AC, Marra CM, Clifford DB, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Grant I, CHARTER Study Group
J Infect Dis. 2016 213 (7): 1065-73

PMID: 26690344 · PMCID: PMC4779306 · DOI:10.1093/infdis/jiv754

BACKGROUND - Anemia has been linked to adverse human immunodeficiency virus (HIV) outcomes, including dementia, in the era before highly active antiretroviral therapy (HAART). Milder forms of HIV-associated neurocognitive disorder (HAND) remain common in HIV-infected persons, despite HAART, but whether anemia predicts HAND in the HAART era is unknown.

METHODS - We evaluated time-dependent associations of anemia and cross-sectional associations of red blood cell indices with neurocognitive impairment in a multicenter, HAART-era HIV cohort study (N = 1261), adjusting for potential confounders, including age, nadir CD4(+) T-cell count, zidovudine use, and comorbid conditions. Subjects underwent comprehensive neuropsychiatric and neuromedical assessments.

RESULTS - HAND, defined according to standardized criteria, occurred in 595 subjects (47%) at entry. Mean corpuscular volume and mean corpuscular hemoglobin were positively associated with the global deficit score, a continuous measure of neurocognitive impairment (both P < .01), as well as with all HAND, milder forms of HAND, and HIV-associated dementia in multivariable analyses (all P < .05). Anemia independently predicted development of HAND during a median follow-up of 72 months (adjusted hazard ratio, 1.55; P < .01).

CONCLUSIONS - Anemia and red blood cell indices predict HAND in the HAART era and may contribute to risk assessment. Future studies should address whether treating anemia may help to prevent HAND or improve cognitive function in HIV-infected persons.

© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail

MeSH Terms (18)

Adult AIDS Dementia Complex Anemia Anti-HIV Agents Antiretroviral Therapy, Highly Active Cohort Studies Cross-Sectional Studies Erythrocyte Count Erythrocyte Indices Female HIV Infections Humans Male Middle Aged Multivariate Analysis Odds Ratio Predictive Value of Tests Risk Factors

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