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Department of Neurology (Drs. McArthur, Selnes, and Concha), Johns Hopkins University School of Medicine, and the Department of Epidemiology (Drs. McArthur, Hoover, Graham, and Saah, and H. Bacellar, J.H. McArthur, and L.P. Jacobson), Johns Hopkins School of Hygiene and Public Health, Baltimore, MD; the Xeuropsychiatric Institute (Dr. Miller), University of California at Los Angeles, Los Angeles, CA; the Department of Neurology (Dr. Cohen), Northwestern University Medical School, Chicago, IL; the Department of Psychiatry (Dr. Becker), University of Pittsburgh School of Medicine, Pittsburgh, PA and the Department of Epidemiology (Dr. Visscher), University of California at Los Angeles School of Public Health, Los Angeles, CA.
We determined incidence and future projections of dementia after AIDS onset in 492 homosexual men with AIDS in the Baltimore/Los Angeles sites of the Multicenter AIDS Cohort Study, 64 of whom developed dementia. We studied various risk factors for dementia, including demographic and clinical features, medical history, markers of immune status before AIDS, and zidovudine use. During the first 2 years after AIDS, HIV dementia developed at an annual rate of 7%. Overall, 15% of the cohort followed through death developed dementia. The median survival after dementia was 6.0 months. Using a proportional hazards model, risk factors for more rapid development of dementia were lower hemoglobin (relative hazard, 0.59 per additional 2 g/dl;p = 0.0005) and body mass index (relative hazard, 0.64 per additional 5 kg/m2; p = 0.05) 1 to 6 months before AIDS, more constitutional symptoms 7 to 12 months before AIDS (relative hazard, 1.68 per additional symptom, p = 0.005), and older age at AIDS onset (relative hazard, 1.60 per decade older; p = 0.009). In a multivariate model, pre-AIDS hemoglobin remained the most significant predictor of dementia. There were no significant risks defined from demographic characteristics, specific AIDS-defining illnesses, zidovudine use before AIDS, or CD4+ lymphocyte count before AIDS. We project that 12 months after the first AIDS diagnosis, 7.1% of survivors will have dementia. The observed association between anemia, low weight, constitutional symptoms, and dementia suggests a role for cytokines inducing both systemic and neurologic disease.
Address correspondence and reprint requests to Dr. Justin C. McArthur, Johns Hopkins Hospital, Meyer 6–109, 600 N. Wolfe Street, Baltimore, MD 21287–7609.
*The Multicenter AIDS Cohort Study (MACS) consist of the following investigators in addition to the cited authors: Baltimore—The Johns Hopkins University School of Hygiene and Public Health: John Palenicek, Haroutune Armenian, Homayoon Farzadegan, Joseph Margolick. Chicago—Howard Brown Memorial Clinic-Northwestern University Medical School: John P. Phair, Principal Investigator; Joan S. Chmiel, Kenneth Hauer, Daina Variakojis, Jerry Wesch, Steven M. Wolinsky. Los Angeles—University of California at Los Angeles, Schools of Public Health and Medicine and the Jonsson Comprehensive Cancer Center: Roger Detels, Principal Investigator; Irvin Chen, Jan Dudley, John L. Fahey, Janis V. Giorgi, Oto Martinez-Maza, Pari Nishanian, Jeremy Taylor, derry Zack. Pittsburgh—University of Pittsburgh Graduate School of Public Health: Charles R. Rinaldo, Jr., Principal Investigator; Lawrence Kingsley, Phalguni Gupta, Monto Ho. Data Coordinating Center—The Johns Hopkins School of Hygiene and Public Health: Alvaro Muñoz, Principal Investigator; Terri Beaty, Noya Galai, Curtis Meinert, Kenrad Nelson, Steven Piantadosi, Sol Su. NIH—National Institute of Allergy and Infectious Diseases: Lewis Schrager, Project Officer; Sten H. Vermund, Richard A. Kaslow, Mark J. Van Raden; Xational Cancer Institute: Iris Obrams, Daniela Seminara.
Supported by AI-72634, AI-72676, AI-32535, AI-72631, AI-72632, NS 26643, and RR 00722.
Received December 21,1992. Accepted for publication in final form April 5,1993.
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