HIV-associated dementia HIV-associated dementia independently predicts time to death in patients with advanced HIV infection, according to a report in the Archives of Neurology for January.

Dr. Jeffrey J. Sevigny from Beth Israel Medical Center, New York and colleagues investigated whether baseline neurocognitive status and plasma or cerebrospinal fluid (CSF) levels of TNF-alpha, MCP-1, MMP-2, or macrophage colony-stimulating factor (M-CSF) were associated with time to death in 329 patients with advanced HIV.

There were 50 deaths over a period of 25 months. Patients were more likely to die if they had an AIDS-defining illness, a lower hemoglobin level, a lower CD4 cell count, an abnormal neurocognitive status, a higher plasma HIV RNA level, and higher plasma and CSF levels of MCP-1 at baseline, the authors report.

In a regression analysis, only HIV-associated dementia, plasma MCP-1 level, and CD4 cell count were significantly associated with time to death, the report indicates.

"HIV-associated dementia but not minor cognitive and motor disorder (MCMD) was significantly associated with time to death after adjusting for immune markers (including CD4 cell count and plasma MCP-1 level) and other demographic and clinical covariates," the investigators conclude.

They suggest that poor medication adherence may be part of the reason why dementia increases the risk of dying, and if so, "rigorous adherence-enhancing programs should be implemented in patients identified as having cognitive impairment."

Arch Neurol 2007;64:97-102.

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