Farinpour Roxanna, Miller Eric N, Satz Paul, Selnes Ola A, Cohen Bruce A, Becker James T, Skolasky Richard L, Visscher Barbara R
UCLA Neuropsychiatric Institute, Los Angeles, CA 90095, USA.
J Clin Exp Neuropsychol. 2003 Aug;25(5):654-70. doi: 10.1076/jcen.25.5.654.14577.
Despite the use of laboratory markers in estimating HIV prognosis, significant variation in the natural history of HIV-1 infection remains unexplained. Recent studies suggest psychosocial risk factors have important prognostic significance in HIV disease. The objective of the present study was to examine the prognostic influence of age, general intellectual functioning, and emotional distress across the spectrum of HIV disease progression. The study sample was drawn from the Multicenter AIDS Cohort Study (MACS), a 13-year, prospective study of HIV-seropositive men recruited from four study centers across the country. The participants were 1,231 HIV-seropositive MACS participants, followed from baseline (median 8/15/87) to the end of the observation period (12/15/98). HIV disease progression was evaluated with respect to three outcome measures: (1) number of years from baseline testing to the first AIDS defining illness (progression to AIDS), (2) years from baseline to HIV-dementia (progression to dementia), and (3) years from baseline to death (survival). The influence of psychosocial risk factors on outcome measures was evaluated using survival analyses. General intellectual functioning, age, and somatic symptoms of depression, were found to be significant predictors of HIV disease progression and survival. Older age at baseline was associated with a more rapid progression to dementia and death. Lower Shipley IQ estimates were associated with a more rapid disease progression (AIDS and dementia) and shortened survival. Somatic symptoms of depression were associated with shortened survival. In addition, age, IQ, and somatic symptoms of depression, had an additive effect with an increase in the number of risk factors associated with accelerated disease progression and shortened time to death. These findings remained consistent, despite controlling for baseline CD4 and HIV medication use. Psychosocial cofactors are important in understanding HIV disease progression. Methods for estimating HIV prognosis may become more reliable if psychosocial factors are considered. Future research will clarify if psychosocial risk factors reflect central nervous system integrity, brain reserve capacity or mediate morbidity and mortality through social economic status, access to health care and other social correlates.
尽管使用实验室指标来评估HIV预后，但HIV-1感染自然史中的显著差异仍无法解释。最近的研究表明，心理社会风险因素在HIV疾病中具有重要的预后意义。本研究的目的是探讨年龄、一般智力功能和情绪困扰在HIV疾病进展全过程中的预后影响。研究样本取自多中心艾滋病队列研究（MACS），这是一项为期13年的前瞻性研究，研究对象是从全国四个研究中心招募的HIV血清阳性男性。参与者为1231名HIV血清阳性的MACS参与者，从基线（中位数为1987年8月15日）随访至观察期结束（1998年12月15日）。根据以下三项结局指标评估HIV疾病进展：（1）从基线检测到首次出现艾滋病定义疾病的年数（进展至艾滋病），（2）从基线到出现HIV痴呆的年数（进展至痴呆），以及（3）从基线到死亡的年数（生存）。使用生存分析评估心理社会风险因素对结局指标的影响。发现一般智力功能、年龄和抑郁的躯体症状是HIV疾病进展和生存的显著预测因素。基线时年龄较大与更快进展至痴呆和死亡相关。较低的希普利智商估计值与更快的疾病进展（艾滋病和痴呆）及缩短的生存期相关。抑郁的躯体症状与缩短的生存期相关。此外，年龄、智商和抑郁的躯体症状具有累加效应，随着与疾病加速进展和死亡时间缩短相关的风险因素数量增加而增加。尽管对基线CD4和HIV药物使用进行了控制，但这些发现仍然一致。心理社会辅助因素在理解HIV疾病进展方面很重要。如果考虑心理社会因素，估计HIV预后的方法可能会变得更可靠。未来的研究将阐明心理社会风险因素是否反映中枢神经系统完整性、脑储备能力，或通过社会经济地位、获得医疗保健的机会及其他社会相关因素介导发病率和死亡率。
