Both HIV-infection and end stage renal disease (ESRD) are independently associated with neurocognitive decline. However, the combined impact of these diseases remains unclear, particularly among kidney transplant (KT) candidates.

METHODS: In a prospective cohort study of 767 ESRD patients, we measured cognitive function at KT evaluation using the Modified Mini-Mental State (3MS) exam, which tests memory, recall, and abstract thinking. Cognitive impairment was defined as 3MS<80. We used t-tests for pairwise comparisons of candidate characteristics and 3MS scores by HIV status. We used a logistic regression model to estimate the association of cognitive impairment with HIV, adjusting for age, sex, and race.

RESULTS: The 39 HIV+ KT candidates (5.1%) were younger and more likely to be African American (Table 1). On average, 3MS scores were 2.4 points lower for HIV+ candidates compared to HIV- candidates (mean: 89.8, SD: 8.9 vs mean: 92.2, SD: 6.8; p=0.037). Fifteen percent of HIV+ candidates were impaired, versus 6% of HIV- candidates. Adjusting for age, sex, and race, HIV was associated with 3.08-fold higher odds of cognitive impairment at the time of KT evaluation (OR: 3.08; 95%CI: 1.14-8.32; p=0.027).CONCLUSION: In this study of KT candidates, HIV was independently associated with cognitive impairment in ESRD patients evaluated for KT. ESRD patients should be assessed for cognitive impairment at KT evaluation, and candidates with HIV should be monitored more closely over time to detect neurocognitive decline.

CITATION INFORMATION: Shaffer A, Ying H, Haugen C, McAdams DeMarco M, Segev D. HIV and Cognitive Impairment in Kidney Transplant Candidates. Am J Transplant. 2017;17 (suppl 3).

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