CONHIV14 - HIV-related Infections, Co-infections and Cancers, etc. – Part three - page 9

APRI and FIB-4 scores are not associated
with neurocognitive impairment in HIV-infected persons
Libertone R, Balestra P, Lorenzini P, Pinnetti C, Ricottini M, Menichetti S, Plazzi MM, Giannetti
A, Tozzi V, Antinori A, Ammassari A
National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy.
Background
Chronic liver disease leads to neurocognitive impairment (NCI)
and more advanced liver fibrosis is associated with greater
deficits.
Cognitive performances do not differ significantly among
patients affected by diverse types of chronic liver diseases
It would be useful to have a clinical tool associated with early
cognitive change applicable to the HIV-infected population with
high HCV prevalence.
Aim of the analysis was to assess the association between NCI
and APRI or FIB-4, which are non-invasive scores used to
assess liver fibrosis
Methods
Single-centre, retrospective, cross-sectional analysis of cART-treated HIV-
infected patients undergoing neuropsychological assessment (NPA)
NPA was carried out by a set of 14 standardized and comprehensive tests on 5
different domains: concentration and speed of mental processing; mental
flexibility; memory, fine motor functioning; visual-spatial and constructional
abilities.
Patients were classified with HIV-associated neurocognitive disorders (HAND)
according to Frascati’s criteria, if they scored >1 SD below the normative mean in
at least 2 tests, or below >2 SD in 1 test and after controlling for confounding
comorbidities.
Univariable analysis and multivariable logistic regression analysis were carried
out. Variables were retained in multivariable analysis if they were significantly
associated with the outcome in univariable (p<0.05).
Conclusions
In this large HIV-infected patient population, HAND was not associated with commonly used non-invasive liver fibrosis scores.
As aetiology of cognitive dysfunction in HIV mono- and HCV co-infected patients is multifactorial and partially unknown, our results support the hypothesis
of a direct or indirect effect on cognitive function of the viruses, rather than the consequence of alterations residing outside the brain.
Further investigation of this evolving field is needed.
Results
P 126
Male gender, n(%)
435
78.2
Age, years , median (IQR)
48
41-55
Years of education, median (IQR)
13
8-13
Mode of HIV transmission, n(%)
heterosexual
213
38.3
homosexual
234
42.1
IVDU
80
14.4
other/unknown
29
5.2
HCV-Ab positivity, n(%)
150
29.5
CDC stage C, n(%)
109
30.9
CD4 nadir, cell/mmc, median (IQR)
200
91-315
CD4 at NPA, cell/mmc, median (IQR)
501
326-713
HIV-RNA at NPA, log
10
cp/mL , median (IQR)
1.7
0-2.5
e-GFR at CG <60 ml/min, n(%)
135
24.8
BMI, n(%) normal
28
5.1
underweight
340
61.8
overweight/obesity
182
33.1
FIB4 score, n(%) min/1.44
404
73.4
1.45-3.25
118
21.4
>3.25
28
5.1
APRI score, n(%) min/0.5
414
75.3
0.5-1.5
112
20.4
>1.5
24
4.4
Patients’ characteristics, N=556
2.2%
16.4%
13.1%
OR
95%CI
P-value
Age at NPA,
per 10 yrs older
1.47
1.23
1.75
<0.01
HIV transmission route
heterosexual
1.00
homosexual
0.53
0.35
0.81
<0.01
IVDU
2.12
1.26
3.57
<0.01
other/unknown
1.01
0.45
2.28
0.98
Years of education
0.79
0.75
0.84
<0.01
CDC C stage vs A/B
2.88
1.87
4.43
<0.01
HCV-Ab positivity
2.68
1.79
3.99
<0.01
Nadir CD4 (per 100 cell/mmc increase)
0.79
0.70
0.89
<0.01
CD4 at NPA (100 cell/mmc increase)
0.91
0.85
0.97
<0.01
BMI
underweigth
2.98
1.36
6.49
0.01
normal
1.00
overweigth
1.28
0.85
1.91
0.23
obesity
1.88
0.73
4.81
0.19
GFR estimated by CG<60 ml/min
1.92
1.28
2.88
<0.01
FIB-4 score
<1.44
1.00
1.45/3.25
1.46
0.95
2.25
0.09
>3.25
3.93
1.79
8.65
<0.01
APRI score
<0.5
1.00
0.5/1.5
1.88
1.22
2.90
<0.01
>1.5
2.60
1.14
5.95
0.02
Gender, HBV positivity, HIV RNA at NPA, hypertension, lipodistrophy, smoking were analyzed,
but they were not significant.
Variables associated with NCI at univariable analysis
Findings at 556
NPAs
0
1
2
3
4
FIB-4
unimpaired
ANI
MND/HAD
Box plots of FIB-4 and APRI scores according to neurocognitive impairment
0
.2
.4
.6
.8
1
APRI
unimpaired
ANI
MND/HAD
Model - 1
Model - 2
OR
95%CI
p
OR
95%CI
p
Years of education,
(each yr more)
0.81
0.76-0.87
<0.01
0.81
0.76-0.87
<0.01
BMI <18 vs normal BMI
2.19
0.85-5.66
n.s.
2.08
0.80-5.40
n.s.
CDC stage C vs A/B
1.96
1.15-3.36
0.01
1.94
1.14-3.32
0.01
HCV-Ab positivity vs negative
1.75
1.02-3.00
0.04
1.63
0.95-2.81
n.s.
CD4/mmc at nadir,
(each 100 cells)
0.98
0.83-1.16
n.s.
0.98
0.83-1.17
n.s.
CD4/mmc at NPA,
(each 100 cells)
0.94
0.85-1.04
n.s.
0.89
0.77-1.03
n.s.
e-GFR at CG <60 ml/min vs >=60
1.49
0.87-2.56
n.s.
1.49
0.87-2.54
n.s.
FIB-4 score
-
<1.44
-
1.45-3.25
-
>3.25
1.00
0.94
1.23
0.55-1.60
0.44-3.41
n.s.
n.s.
APRI score
-
<0.5
-
0.5-1.5
-
>1.5
1.00
1.37
1.35
0.79-2.37
0.50-3.65
n.s.
n.s.
Multivariable logistic regression: factors independently associated to risk of NCI
in the study population
Model- 1
Model - 2
HR
95%CI
p
HR
95%CI
p
Years of education ,
(each yr more)
0.85
0.76-0.95
0.004
0.85
0.76-0.95
0.005
BMI <18 vs normal BMI
3.13
0.55-17.89
n.s.
2.78
0.48-15.99
n.s.
CDC stage C vs A/B
1.85
0.82-4.13
n.s.
1.83
0.81-4.12
n.s.
HCV-Ab positivity vs negative
0.82
0.62-1.09
n.s.
0.81
0.61-1.08
n.s.
CD4/mmc at nadir,
(each 100 cells)
1.05
0.91-1.21
n.s.
1.04
0.91-1.19
n.s.
CD4/mmc at NPA,
(each 100 cells)
1.31
0.60-2.86
n.s.
1.31
0.60-2.88
n.s.
FIB-4 score
-
<1.44
-
1.45-3.25
-
>3.25
1.00
0.95
1.46
0.43-2.09
0.51-4.13
n.s.
n.s.
APRI score
-
<0.5
-
0.5-1.5
-
>1.5
1.00
1.23
1.23
0.56-2.70
0.43-3.50
n.s.
n.s.
Multivariable logistic regression: factors independently associated to risk of
NCI in 150 HCV-Ab positive subjects
unimpaired
unimpaired
ANI
ANI
MND/HAD
MND/HAD
FIB-4
APRI
68.4%
1,2,3,4,5,6,7,8 10,11,12
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