Men with HIV who are antiretroviral (ART)-adherent run the risk of cognitive decline due to high cholesterol and the APOE4 allele genotype, according to a study published in Clinical Infectious Diseases. These risk factors are independent, and may be mitigated by dyslipidemia treatment, researchers say.

Shibani S Mukerji, MD, PhD, of the Department of Cancer Immunology and Virology at the Dana-Farber Cancer Institute and The Department of Neurology at Massachusetts General Hospital in Boston and colleagues performed a longitudinal nested study of 273 HIV-1 positive men aged 50-65 who were ART-adherent. The men had 400 copies/ml baseline HIV RNA and were compared with a control group of 516 non-HIV infected men who had matching sociodemographic variables.

According to the study, the researchers used mixed-effects models to examine associations between cognitive decline, lipid markers, and the APOE4 allele genotype.

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“HIV+ men had similar baseline total cholesterol and LDL-C, but lower HDL-C and higher triglycerides than controls (P < .001). Higher total cholesterol and LDL-C were associated with faster rates of cognitive decline (P < .01), whereas higher HDL-C attenuated decline (P = .02) in HIV+ men,” the researchers reported.

Dr Mukerji and colleagues explained that the use of statins decreased the amount of cognitive decline (P = .02).

In an interview with Infectious Disease Advisor, Dr Mukerji said that, “Given current interest in understanding the benefits of statins for treatment of dyslipidemia in HIV-infected individuals, we anticipate that further studies will investigate the effects of statins on midlife cognitive function in HIV-infected individuals within the next year.”

When asked what practicing physicians should take away from the study, Dr Mukerji said, “this study holds clinical relevance for HIV-providers because it suggests that early clinical management of dyslipidemia may be important not only for reducing cardiovascular risk, but also for reducing cognitive decline in HIV-infected men over age 50.”

Dr Mukerji also noted that, “High-density lipoprotein-cholesterol levels attenuated the rate of cognitive decline, suggesting that approaches to raise blood HDL levels could have beneficial effects that reduce age-related cognitive decline in HIV-infected individuals.”


1. Mukerji SS, Locascio JJ, Misra V et al. Lipid profiles and APOE4 allele impact midlife cognitive decline in HIV-infected men on antiretroviral therapy. Clin Infect Dis. 2016; doi: 10.1093/cid/ciw495.