Vitamin D deficiency is associated with neurocognitive impairment in HIV-infected subjects

Research output: Contribution to journalArticle

Abstract

Purpose: Low vitamin D levels are associated with higher odds of cognitive dysfunction in the older population, and in subjects with mental disorders or with chronic neurologic diseases. With combination antiretroviral therapy (cART), incidence of HIV-associated dementia has reduced, while the prevalence of milder forms of neurocognitive impairment (NCI) persisted stable over time. Hypovitaminosis D is often found in HIV infection but its association with NCI has not been investigated yet. The aim was to explore this association in a clinic-based HIV-positive population. Methods: A retrospective, cross-sectional analysis of an existing monocenter dataset obtained from patients undergoing neuropsychological assessment in routine clinical care between January, 2011 and December, 2016 was carried out. NCI was assessed through a standardized battery of 13 tests on 5 different cognitive domains and HIV-associated neurocognitive deficit (HAND) was classified according to Frascati’s criteria. Vitamin D deficiency was defined by 25 hydroxy-vitamin D 25(OH)D levels < 10 ng/mL. Logistic regression was adjusted for main associated covariates and seasonality. Results: 542 patients were included: 96.7% were receiving cART, median CD4 count was 611/mmc (IQR, 421–809), HIV RNA was < 40 cp/mL in 85.8%. Median 25(OH)D was 23.2 ng/mL (IQR, 15.6–29.2), with vitamin D insufficiency 67.7% and deficiency in 9.4%. Overall, NCI was found in 37.1% and HAND in 22.7%. Compared to patients with higher vitamin D levels, subjects with vitamin D deficiency had increased proportions of NCI (52.9% versus 35.4%; p = 0.014) or of HAND (42.9% versus 24.9%; p = 0.012). Median NPZ-8 scores were significantly different based on vitamin D levels (p = 0.021). At multivariable analyses, vitamin D deficiency was the only risk factor of NCI (OR 2.05; 95% CI 1.04–4.05; p = 0.038) or of HAND (OR 2.12; 95% CI 0.99–4.54; p = 0.052). Conclusions: In HIV-positive persons, severe hypovitaminosis D was independently associated with a higher risk of neurocognitive impairment in general, and of HIV-associated neurocognitive disorders in particular. Future studies are needed to elucidate causal relationship and whether vitamin D supplementation may reverse this risk.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalInfection
DOIs
Publication statusPublished - Jun 10 2019

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Vitamin D Deficiency
Vitamin D
HIV
AIDS Dementia Complex
CD4 Lymphocyte Count
Nervous System Diseases
Mental Disorders
Population
HIV Infections
Chronic Disease
Cross-Sectional Studies
Logistic Models
RNA
Incidence
Therapeutics

Keywords

  • HAD
  • HIV
  • Neurocognitive impairment
  • Vitamin D

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{88838eccf2454a18880f790ed94d6fd6,
title = "Vitamin D deficiency is associated with neurocognitive impairment in HIV-infected subjects",
abstract = "Purpose: Low vitamin D levels are associated with higher odds of cognitive dysfunction in the older population, and in subjects with mental disorders or with chronic neurologic diseases. With combination antiretroviral therapy (cART), incidence of HIV-associated dementia has reduced, while the prevalence of milder forms of neurocognitive impairment (NCI) persisted stable over time. Hypovitaminosis D is often found in HIV infection but its association with NCI has not been investigated yet. The aim was to explore this association in a clinic-based HIV-positive population. Methods: A retrospective, cross-sectional analysis of an existing monocenter dataset obtained from patients undergoing neuropsychological assessment in routine clinical care between January, 2011 and December, 2016 was carried out. NCI was assessed through a standardized battery of 13 tests on 5 different cognitive domains and HIV-associated neurocognitive deficit (HAND) was classified according to Frascati’s criteria. Vitamin D deficiency was defined by 25 hydroxy-vitamin D 25(OH)D levels < 10 ng/mL. Logistic regression was adjusted for main associated covariates and seasonality. Results: 542 patients were included: 96.7{\%} were receiving cART, median CD4 count was 611/mmc (IQR, 421–809), HIV RNA was < 40 cp/mL in 85.8{\%}. Median 25(OH)D was 23.2 ng/mL (IQR, 15.6–29.2), with vitamin D insufficiency 67.7{\%} and deficiency in 9.4{\%}. Overall, NCI was found in 37.1{\%} and HAND in 22.7{\%}. Compared to patients with higher vitamin D levels, subjects with vitamin D deficiency had increased proportions of NCI (52.9{\%} versus 35.4{\%}; p = 0.014) or of HAND (42.9{\%} versus 24.9{\%}; p = 0.012). Median NPZ-8 scores were significantly different based on vitamin D levels (p = 0.021). At multivariable analyses, vitamin D deficiency was the only risk factor of NCI (OR 2.05; 95{\%} CI 1.04–4.05; p = 0.038) or of HAND (OR 2.12; 95{\%} CI 0.99–4.54; p = 0.052). Conclusions: In HIV-positive persons, severe hypovitaminosis D was independently associated with a higher risk of neurocognitive impairment in general, and of HIV-associated neurocognitive disorders in particular. Future studies are needed to elucidate causal relationship and whether vitamin D supplementation may reverse this risk.",
keywords = "HAD, HIV, Neurocognitive impairment, Vitamin D",
author = "Alessandra Vergori and Carmela Pinnetti and Patrizia Lorenzini and Brita, {Anna Clelia} and Raffaella Libertone and Ilaria Mastrorosa and Stefania Cicalini and Andrea Antinori and Adriana Ammassari",
year = "2019",
month = "6",
day = "10",
doi = "10.1007/s15010-019-01313-6",
language = "English",
pages = "1--7",
journal = "Infection",
issn = "0300-8126",
publisher = "Urban und Vogel GmbH",

}

TY - JOUR

T1 - Vitamin D deficiency is associated with neurocognitive impairment in HIV-infected subjects

AU - Vergori, Alessandra

AU - Pinnetti, Carmela

AU - Lorenzini, Patrizia

AU - Brita, Anna Clelia

AU - Libertone, Raffaella

AU - Mastrorosa, Ilaria

AU - Cicalini, Stefania

AU - Antinori, Andrea

AU - Ammassari, Adriana

PY - 2019/6/10

Y1 - 2019/6/10

N2 - Purpose: Low vitamin D levels are associated with higher odds of cognitive dysfunction in the older population, and in subjects with mental disorders or with chronic neurologic diseases. With combination antiretroviral therapy (cART), incidence of HIV-associated dementia has reduced, while the prevalence of milder forms of neurocognitive impairment (NCI) persisted stable over time. Hypovitaminosis D is often found in HIV infection but its association with NCI has not been investigated yet. The aim was to explore this association in a clinic-based HIV-positive population. Methods: A retrospective, cross-sectional analysis of an existing monocenter dataset obtained from patients undergoing neuropsychological assessment in routine clinical care between January, 2011 and December, 2016 was carried out. NCI was assessed through a standardized battery of 13 tests on 5 different cognitive domains and HIV-associated neurocognitive deficit (HAND) was classified according to Frascati’s criteria. Vitamin D deficiency was defined by 25 hydroxy-vitamin D 25(OH)D levels < 10 ng/mL. Logistic regression was adjusted for main associated covariates and seasonality. Results: 542 patients were included: 96.7% were receiving cART, median CD4 count was 611/mmc (IQR, 421–809), HIV RNA was < 40 cp/mL in 85.8%. Median 25(OH)D was 23.2 ng/mL (IQR, 15.6–29.2), with vitamin D insufficiency 67.7% and deficiency in 9.4%. Overall, NCI was found in 37.1% and HAND in 22.7%. Compared to patients with higher vitamin D levels, subjects with vitamin D deficiency had increased proportions of NCI (52.9% versus 35.4%; p = 0.014) or of HAND (42.9% versus 24.9%; p = 0.012). Median NPZ-8 scores were significantly different based on vitamin D levels (p = 0.021). At multivariable analyses, vitamin D deficiency was the only risk factor of NCI (OR 2.05; 95% CI 1.04–4.05; p = 0.038) or of HAND (OR 2.12; 95% CI 0.99–4.54; p = 0.052). Conclusions: In HIV-positive persons, severe hypovitaminosis D was independently associated with a higher risk of neurocognitive impairment in general, and of HIV-associated neurocognitive disorders in particular. Future studies are needed to elucidate causal relationship and whether vitamin D supplementation may reverse this risk.

AB - Purpose: Low vitamin D levels are associated with higher odds of cognitive dysfunction in the older population, and in subjects with mental disorders or with chronic neurologic diseases. With combination antiretroviral therapy (cART), incidence of HIV-associated dementia has reduced, while the prevalence of milder forms of neurocognitive impairment (NCI) persisted stable over time. Hypovitaminosis D is often found in HIV infection but its association with NCI has not been investigated yet. The aim was to explore this association in a clinic-based HIV-positive population. Methods: A retrospective, cross-sectional analysis of an existing monocenter dataset obtained from patients undergoing neuropsychological assessment in routine clinical care between January, 2011 and December, 2016 was carried out. NCI was assessed through a standardized battery of 13 tests on 5 different cognitive domains and HIV-associated neurocognitive deficit (HAND) was classified according to Frascati’s criteria. Vitamin D deficiency was defined by 25 hydroxy-vitamin D 25(OH)D levels < 10 ng/mL. Logistic regression was adjusted for main associated covariates and seasonality. Results: 542 patients were included: 96.7% were receiving cART, median CD4 count was 611/mmc (IQR, 421–809), HIV RNA was < 40 cp/mL in 85.8%. Median 25(OH)D was 23.2 ng/mL (IQR, 15.6–29.2), with vitamin D insufficiency 67.7% and deficiency in 9.4%. Overall, NCI was found in 37.1% and HAND in 22.7%. Compared to patients with higher vitamin D levels, subjects with vitamin D deficiency had increased proportions of NCI (52.9% versus 35.4%; p = 0.014) or of HAND (42.9% versus 24.9%; p = 0.012). Median NPZ-8 scores were significantly different based on vitamin D levels (p = 0.021). At multivariable analyses, vitamin D deficiency was the only risk factor of NCI (OR 2.05; 95% CI 1.04–4.05; p = 0.038) or of HAND (OR 2.12; 95% CI 0.99–4.54; p = 0.052). Conclusions: In HIV-positive persons, severe hypovitaminosis D was independently associated with a higher risk of neurocognitive impairment in general, and of HIV-associated neurocognitive disorders in particular. Future studies are needed to elucidate causal relationship and whether vitamin D supplementation may reverse this risk.

KW - HAD

KW - HIV

KW - Neurocognitive impairment

KW - Vitamin D

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U2 - 10.1007/s15010-019-01313-6

DO - 10.1007/s15010-019-01313-6

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JO - Infection

JF - Infection

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