Disparities in Metabolic Syndrome and Neurocognitive Function Among Older Hispanics/Latinos with Human Immunodeficiency Virus

María J Marquine; Lily Kamalyan; Zvinka Z Zlatar; David Yassai-Gonzalez; Alán Perez-Tejada; Anya Umlauf; Tala Al-Rousan; Verónica González; Jordana Breton; Lesley A Guareña; Lilla Brody; Mariana Cherner; Ronald J Ellis; Maria Luisa Zúñiga; Dan M Mungas; Raeanne C Moore; David J Moore; Valerie Wojna; Rasheeda K Hall; Donald R Franklin Jr; Robert K Heaton

doi:10.1089/apc.2024.0043

Disparities in Metabolic Syndrome and Neurocognitive Function Among Older Hispanics/Latinos with Human Immunodeficiency Virus

AIDS Patient Care STDS. 2024 Apr 25. doi: 10.1089/apc.2024.0043. Online ahead of print.

Authors

María J Marquine^{1

2

3

4

5}, Lily Kamalyan^{1

6}, Zvinka Z Zlatar², David Yassai-Gonzalez¹, Alán Perez-Tejada¹, Anya Umlauf^{1

2}, Tala Al-Rousan⁷, Verónica González³, Jordana Breton^{1

8}, Lesley A Guareña^{1

9}, Lilla Brody^{1

10}, Mariana Cherner^{1

2}, Ronald J Ellis^{1

2

11}, Maria Luisa Zúñiga¹², Dan M Mungas¹³, Raeanne C Moore^{1

2}, David J Moore^{1

2}, Valerie Wojna¹⁴, Rasheeda K Hall^{4

5}, Donald R Franklin Jr^{1

2}, Robert K Heaton^{1

2}

Affiliations

¹ HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA.
² Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA.
³ Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA.
⁴ Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
⁵ Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA.
⁶ Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA.
⁷ Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.
⁸ Department of Psychology, University of Texas at Austin, Austin, Texas, USA.
⁹ Department of Psychology, University of Arizona, Tucson, Arizona, USA.
¹⁰ Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA.
¹¹ Department of Neurosciences, University of California San Diego, La Jolla, California, USA.
¹² School of Social Work, San Diego State University, San Diego, California, USA.
¹³ Department of Neurology, University of California Davis, Davis, California, USA.
¹⁴ Neurology Division, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.

PMID: 38662469
DOI: 10.1089/apc.2024.0043

Abstract

Neurocognitive impairment and metabolic syndrome (MetS) are prevalent in persons with HIV (PWH). We examined disparities in HIV-associated neurocognitive function between Hispanic and non-Hispanic White older PWH, and the role of MetS in explaining these disparities. Participants included 116 community-dwelling PWH aged 50-75 years enrolled in a cohort study in southern California [58 Hispanic (53% Spanish speaking) and 58 age-comparable non-Hispanic White; overall group: age: M = 57.9, standard deviation (SD) = 5.7; education (years): M = 13, SD = 3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy]. Global neurocognition was derived from T-scores adjusted for demographics (age, education, sex, ethnicity, language) on a battery of 10 cognitive tests. MetS was ascertained via standard criteria that considered central obesity, and fasting elevated triglycerides, low high-density lipoprotein cholesterol and elevated glucose, or medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV disease characteristics. Compared with non-Hispanic Whites, Hispanics showed worse global neurocognitive function (Cohen's d = 0.56, p < 0.05) and had higher rates of MetS (38% vs. 56%, p < 0.05). A stepwise regression model including ethnicity and significant covariates showed Hispanic ethnicity was the sole significant predictor of worse global neurocognition (B = -3.82, SE = 1.27, p < 0.01). A model also including MetS showed that both Hispanic ethnicity (B = -3.39, SE = 1.31, p = 0.01) and MetS (B = -2.73, SE = 1.31, p = 0.04) were independently associated with worse neurocognition. In conclusion, findings indicate that increased MetS is associated with worse neurocognitive function in both Hispanic and non-Hispanic White older PWH, but does not explain neurocognitive disparities. MetS remains an important target for intervention efforts to ameliorate neurocognitive dysfunction among diverse older PWH.

Keywords: HIV; aging; cardiovascular risk factors; cognition disorders; ethnicity; minority health.