Kristine Erlandson, MD, MS, on the Connection Between Obesity and Neurocognitive Decline in HIV

In an oral abstract session at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019), Kristine Erlandson, MD, MS, associate professor of medicine at the University of Colorado, presented research on the connection between obesity and neurocognitive decline in persons living with HIV (PLWHIV).

Contagion® sat down with Dr. Erlandson for an exclusive interview on her research and to discuss more about the interconnectivity between obesity, frailty, and neurocognitive decline, and the significance of these factors in PLWHIV.

Interview Transcript (modified slightly for readability):

Contagion®: What was the major takeaway from your research?

Dr. Erlandson: "So our main focus initially was to look at whether or not neurocognitive function precedes frailty and contributes to the development of frailty or whether or not frailty worsens the trajectory of neurocognitive impairment. We've seen some associations just in cross-sectional studies before, both in our cohort and then there's another poster actually presented at the meeting looking at cross-sectional associations between neurocognitive impairment and frailty. In contrast to what our initial thought was, however, we didn't really find any association between any impact of frailty on the decline in neurocognitive function over time. In fact, the 1 factor that really stood out was obesity or overweight BMI, [which] seemed to contribute most to the decline in neurocognitive function outside of just increasing age. It was a bit of a surprise to us in that it was not what we intended to investigate, but that was what the data showed and really what seemed to come out as the important message."

Contagion®: Why is it so important to get to the bottom of how these different factors (weight gain, obesity, advancing age, neurocognitive decline) affect PLWHIV?

Dr. Erlandson: "In this portion we didn't collect some of the impact of neurocognitive function on daily function. Some other studies can get a little bit more at the "how does this neurocognitive function impact daily activities?" We've looked at that in this cohort of older adults with HIV, the HAILO [AIDS Clinical Trials Group (ACTG) A5322] cohort, and in those other studies we have shown that neurocognitive impairment has a direct impact on things like how well can people manage their finances, how well do they do preparing meals, so we have seen that it does have an impact in prior studies.

In this particular analysis, we didn't look at how that obesity fact specifically impacts things like daily function as much, rather just this measure of neurocognitive impairment. I certainly think it will have an impact over time and I think that's something we need to learn more about is how, if we have interventions that target obesity and we can help people decrease to a healthier weight through things like diet and exercise, can that have a longer-term impact on their quality of life?"

Contagion®: What’s the next step in this line of research?

Dr. Erlandson: "The first next step for us is to look at how neurocognitive impairment and frailty track together. I think they probably are very similarly related concepts, and certainly have a similar on people's daily function. Seeing how they kind of track together over time may give us a clue both at some of the mechanisms and specific places to intervene, as well as a better idea of the impact on daily function. But I think that both looking at the closer association over time and then as well as interventions and other mechanisms."