Body Mass Index and Cognitive Function among HIV-1 Infected Individuals in China, India and Nigeria.

BACKGROUND: Risk of cognitive impairment is increased among persons with high or low body mass index (BMI) in HIV- and HIV+ populations in resource-rich settings. We examined this association among HIV+ patients in three resource-limited settings.

METHODS: This secondary analysis included data of 761 HIV+ volunteers pooled from 3 prospective cohort studies conducted in China (n=404; 53%), India (n=200; 26%) and Nigeria (n=157; 21%). World Health Organization (WHO) weight classifications were based on BMI. T scores, adjusted for demographics and practice effects, were derived from a 7-domain neuropsychological battery. Neurocognitive impairment (NCI) was defined as global deficit score (GDS) of ≥ 0.5.

RESULTS: Overall prevalence of NCI at baseline was 27.7% (similar across all cohorts). The overweight/obese and underweight constituted 37.3% and 15.5% of the total participants respectively. In a multivariable logistic regression of pooled longitudinal data, adjusting for clinical and demographic variables, the odds of global neurocognitive impairment were 38% higher among the overweight/obese as compared to normal weight participants (OR: 1.38 [95% CI: 1.1, 1.72]; P=0.005). Similarly, the odds of global neurocognitive impairment were 39% higher among the underweight as compared to normal weight participants (OR: 1.39 [95% CI: 1.03, 1.87]; P=0.029).

CONCLUSION: Neurocognitive impairment among HIV-1 infected patients was more prevalent in both overweight/obese and underweight than normal weight individuals in three resource-limited settings, confirming observations in resource rich settings. Mechanisms underlying these associations are unclear, but likely differ for underweight and overweight persons.