Details

Autor(en) / Beteiligte

• Sevigny, Jeffrey J
• Albert, Steven M
• McDermott, Michael P
• Schifitto, Giovanni
• McArthur, Justin C
• Sacktor, Ned
• Conant, Katherine
• Selnes, Ola A
• Stern, Yaakov
• McClernon, Daniel R
• Palumbo, Donna
• Kieburtz, Karl
• Riggs, Garrett
• Cohen, Bruce
• Marder, Karen
• Epstein, Leon G

Titel

An evaluation of neurocognitive status and markers of immune activation as predictors of time to death in advanced HIV infection

Ist Teil von

• Archives of neurology (Chicago), 2007-01, Vol.64 (1), p.97

Ort / Verlag

United States

Erscheinungsjahr

2007

Quelle

MEDLINE

Beschreibungen/Notizen

• Several markers of immune activation have been identified as potential prognostic markers for human immunodeficiency virus (HIV)-associated morbidity and mortality, but the results from studies are conflicting. To evaluate whether neurocognitive status and baseline levels of plasma and cerebrospinal fluid tumor necrosis factor alpha (TNF-alpha), macrophage chemoattractant protein 1 (MCP-1), matrix metalloproteinase 2 (MMP-2), or macrophage colony-stimulating factor (M-CSF) are associated with time to death in a cohort with advanced HIV infection. Cohort study. Enrollees in the Northeast AIDS Dementia Study. Three hundred twenty-nine subjects who were positive for HIV-1 and had a CD4 cell count of less than 200/microL (or <300/microL but with cognitive impairment at baseline) were assessed for CD4 cell count, neurocognitive status, pertinent demographic and clinical variables, and plasma and cerebrospinal fluid HIV RNA, TNF-alpha, MCP-1, MMP-2, and M-CSF levels. Cox proportional hazards regression models were used to examine the associations between the variables of interest (using time-dependent covariates, where applicable) and time to death, adjusting for possible confounders. There were 50 deaths in the cohort after a median of 25.2 months of follow-up. The cumulative incidences of death were 7% at 1 year and 16% at 2 years. In Cox proportional hazards regression analyses adjusting for demographic, clinical, and immunological variables, HIV-associated dementia (hazard rate, 6.10; P = .001) was significantly associated with time to death; (log) plasma MCP-1 level (hazard rate, 3.38; P = .08) trended toward significance. In patients with advanced HIV infection, HIV-associated dementia is an independent predictor of time to death.