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Abstract
Objective:
Since a sizeable portion of the brain is composed of cholesterol, which serves various vital functions, we investigated interrelationships among hypocholesterolemia (HypoCHL ? 150 mg/dL) and neurocognitive impairment for people living with HIV (PLWH).
Methods:
Fasting blood samples were obtained in 125 PLWH younger than 45 years of age (Group 1) and 40 PLWH older than 46 years old (Group 2) at baseline and after 24 weeks on highly active antiretroviral therapy (HAART). Participants with HypoCHL were compared with non-HypoCHL on learning/memory (California Verbal Learning Test = CVLT) and global neurocognitive status (HIV Dementia Scale = HDS).
Results:
HypoCHL was prevalent in Group 1 (35%) and Group 2 (30%) and associated with lower CVLT (P = 0.03) and HDS (P = 0.02) scores. After HAART in Group 1, non-HypoCHL subjects improved in every neurocognitive parameter, but progress was limited and non-significant in the HypoCHL subjects. Despite better adherence and lower viral loads (P = 0.05) exhibited by Group 2, the HypoCHL participants showed declines in HDS scores (−2.5) and total CVLT (−0.86 words). After adjusting for relevant variables, HypoCHL subjects from Group 1 showed a three-fold increased risk for scoring in the dementia range (P < 0.01), and the risk was even higher for HypoCHL participants in Group 2 (OR = 5.0, 95% CI: 1.25–21.3, P = 0.008).
Conclusions:
The association of HypoCHL with limited HAART neurocognitive recovery and even a continuous decline indicates the importance of restoring lipid balance.