TY - JOUR
T1 - Platelet decline as a predictor of brain injury in HIV infection
AU - Ragin, Ann B.
AU - D'Souza, Gypsyamber
AU - Reynolds, Sandra
AU - Miller, Eric
AU - Sacktor, Ned
AU - Selnes, Ola A.
AU - Martin, Eileen
AU - Visscher, Barbara R.
AU - Becker, James T.
N1 - Funding Information:
The authors are grateful to the volunteers and the staff of the Multicenter AIDS Cohort Study for the time and effort contributed to the successful completion of this project. This study was supported in part by funds from the National Institute for Allergy and Infectious Diseases to the collaborating MACS sites: UO1-AI-35042, 5-MO1-RR-00052 (GCRC), UO1-AI-35043, UO1-AI-37984, UO1-AI-35039, UO1-AI-35040, UO1-AI-37613, and UO1-AI-35041 and by the National Institute of Mental Health: R01- MH-80636 (AR). The corresponding author, Ann Ragin, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
PY - 2011/10
Y1 - 2011/10
N2 - An association between platelet decline and increased risk of progression to dementia has been observed in an advanced HIV infection cohort study. This investigation evaluated the prognostic significance of platelet decline for dementia, for psychomotor slowing, and for brain injury, as quantified in vivo, in a much larger population of HIV+ men. Platelet counts and neurocognitive data were available from biannual visits of 2,125 HIV+ men participating in the prospective, Multicenter AIDS Cohort Study from 1984 to 2009. Brain volumetric data were also available from an imaging substudy of 83 seropositive participants aged 50 and older. The association of platelet counts with neurocognitive outcome was assessed using Cox proportional hazard models where change in platelet count from baseline was a time-updated variable. Marked platelet decline was associated with increased risk of dementia in univariate analysis (hazard ratio [HR]=2.5, 95% confidence interval [CI]=1.8-3.5), but not after adjustment for CD4 cell count, HIV viral load, age, study site, hemoglobin, race, education, smoking, and alcohol use (HR=1.4, 95% CI=0.78-2.5). Platelet decline did not predict psychomotor slowing in either univariate (HR=0.79, 95% CI=0.58-1.08) or multivariate (HR=1.10, 95% CI=0.73-1.67) analysis. Analysis of brain volumetric data, however, indicated a relationship between platelet decline and reduced gray matter volume fraction in univariate (p=0.06) and multivariate (p<0.05) analyses. Platelet decline was not an independent predictor of dementia or psychomotor slowing, after adjusting for stage of disease. Findings from a structural brain imaging substudy of older participants, however, support a possible relationship between platelet decline and reduced gray matter.
AB - An association between platelet decline and increased risk of progression to dementia has been observed in an advanced HIV infection cohort study. This investigation evaluated the prognostic significance of platelet decline for dementia, for psychomotor slowing, and for brain injury, as quantified in vivo, in a much larger population of HIV+ men. Platelet counts and neurocognitive data were available from biannual visits of 2,125 HIV+ men participating in the prospective, Multicenter AIDS Cohort Study from 1984 to 2009. Brain volumetric data were also available from an imaging substudy of 83 seropositive participants aged 50 and older. The association of platelet counts with neurocognitive outcome was assessed using Cox proportional hazard models where change in platelet count from baseline was a time-updated variable. Marked platelet decline was associated with increased risk of dementia in univariate analysis (hazard ratio [HR]=2.5, 95% confidence interval [CI]=1.8-3.5), but not after adjustment for CD4 cell count, HIV viral load, age, study site, hemoglobin, race, education, smoking, and alcohol use (HR=1.4, 95% CI=0.78-2.5). Platelet decline did not predict psychomotor slowing in either univariate (HR=0.79, 95% CI=0.58-1.08) or multivariate (HR=1.10, 95% CI=0.73-1.67) analysis. Analysis of brain volumetric data, however, indicated a relationship between platelet decline and reduced gray matter volume fraction in univariate (p=0.06) and multivariate (p<0.05) analyses. Platelet decline was not an independent predictor of dementia or psychomotor slowing, after adjusting for stage of disease. Findings from a structural brain imaging substudy of older participants, however, support a possible relationship between platelet decline and reduced gray matter.
KW - HIV
KW - HIV dementia
KW - Hematologic
KW - Platelets
KW - Volumetric MRI
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U2 - 10.1007/s13365-011-0053-2
DO - 10.1007/s13365-011-0053-2
M3 - Article
C2 - 21956288
AN - SCOPUS:84856192540
SN - 1355-0284
VL - 17
SP - 487
EP - 495
JO - Journal of neurovirology
JF - Journal of neurovirology
IS - 5
ER -