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Arch Neurol. 2007 Jan;64(1):97-102.

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

Author information

1
Department of Neurology and Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA. jsevigny@chpnet.org

Abstract

BACKGROUND:

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.

OBJECTIVE:

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.

DESIGN:

Cohort study.

SETTING:

Enrollees in the Northeast AIDS Dementia Study.

PARTICIPANTS:

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.

MAIN OUTCOME MEASURES:

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.

RESULTS:

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.

CONCLUSION:

In patients with advanced HIV infection, HIV-associated dementia is an independent predictor of time to death.

PMID:
17210815
DOI:
10.1001/archneur.64.1.97
[Indexed for MEDLINE]

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