Monocyte Activation Is Associated With Worse Cognitive Performance in HIV-Infected Women With Virologic Suppression

Abstract

Background: Cognitive impairment persists despite suppression of plasma human immunodeficiency virus (HIV) RNA. Monocyte-related immune activation is a likely mechanism. We examined immune activation and cognition in a cohort of HIV-infected and uninfected women from the Women's Interagency HIV Study (WIHS).

Methods: Blood levels of activation markers, soluble CD163 (sCD163), soluble CD14 (sCD14), CRP, IL-6, and a gut microbial translocation marker (intestinal fatty acid binding protein (I-FABP)) were measured in 253 women (73% HIV-infected). Markers were compared to concurrent (within ± one semiannual visit) neuropsychological testing performance.

Results: Higher sCD163 levels were associated with worse overall performance and worse verbal learning, verbal memory, executive function, psychomotor speed, and fine motor skills (P < .05 for all comparisons). Higher sCD14 levels were associated with worse verbal learning, verbal memory, executive function, and psychomotor speed (P < .05 for all comparisons). Among women with virological suppression, sCD163 remained associated with overall performance, verbal memory, psychomotor speed, and fine motor skills, and sCD164 remained associated with executive function (P < .05 for all comparisons). CRP, IL-6, and I-FABP were not associated with worse cognitive performance.

Conclusions: Monocyte activation was associated with worse cognitive performance, and associations persisted despite viral suppression. Persistent inflammatory mechanisms related to monocytes correlate to clinically pertinent brain outcomes.

Keywords: CD14; CD163; HIV infection; cognition disorders; intesticial fatty acid-binding protein (1-19); women.

Figure 1.

Associations between plasma soluble CD163 (sCD163) and sCD14 and cognitive performance in virally suppressed HIV-infected women. Circles denote the standardized β weight from the regression model, and the line denotes the 95% confidence interval around the β weight. Lines not crossing 0 are significant. For sCD163, significance was noted for the global summary score (β = −0.24, P = .04), verbal memory (β = −0.36, P = .003), psychomotor speed (β = −0.28, P = .01), and fine motor skills (β = −0.34, P = .004). For sCD14, significance was noted for executive function (β = −0.25, P = .02), and a trend for significance was noted for psychomotor speed (β = −0.19, P = .05). The sample size range was 100–115.