Wilkie F L, Morgan R, Fletcher M A, Blaney N, Baum M, Komaroff E, Szapocznik J, Eisdorfer C
Department of Psychiatry, University of Miami School of Medicine, FL 33136.
AIDS. 1992 Sep;6(9):977-81. doi: 10.1097/00002030-199209000-00011.
To determine (1) whether there were differences in cognition between HIV-1-seropositive and HIV-1-seronegative homosexual men and (2), if so, whether these differences could be explained by the degree of immunosuppression [i.e., CD4 cell count and immunoglobulin A (IgA) levels].
A cross-sectional design was used to compare 66 HIV-1-seropositives (Centers for Disease Control stages II and III, n = 56; stages IVA and IVC-2, n = 10) and 37 HIV-1-seronegatives. The HIV-1-seropositives were classified into three immune groups based on their CD4 cell count (x 10(6)/l) and serum IgA level (mg/dl): (1) moderate [(n = 35) CD4 greater than 400, IgA less than 300]; (2) mixed [(n = 22) either CD4 greater than 400 and IgA greater than 300 or CD4 less than 400 and IgA less than 300] and (3) poor [(n = 9) CD4 less than 400, IgA greater than 300]. HIV-1-seronegatives formed the 'good' immune group (CD4 greater than 400 and IgA less than 300).
The four groups were compared on tests of verbal and visual memory, information-processing speeds, visuospatial skills, language processes, attention, psychomotor reaction time, and mental status. Factors other than HIV-1 sero-status that can influence cognitive performance were tested as covariates.
HIV-1-seropositives had slower information-processing speeds and decreased verbal and visual memory, compared with HIV-1-seronegatives. These differences in cognition were not due to differential immunosuppression or to clinical status among the HIV-1-seropositives.
Cognitive alterations occur in HIV-1-infected individuals before AIDS and appear to be independent of clinical status and degree of immunosuppression as measured by CD4 cell count and IgA levels.
确定（1）HIV-1血清阳性和HIV-1血清阴性同性恋男性在认知方面是否存在差异；（2）如果存在差异，这些差异是否可以用免疫抑制程度[即CD4细胞计数和免疫球蛋白A（IgA）水平]来解释。
采用横断面设计比较66名HIV-1血清阳性者（疾病控制中心II期和III期，n = 56；IVA期和IVC-2期，n = 10）和37名HIV-1血清阴性者。根据CD4细胞计数（x 10(6)/l）和血清IgA水平（mg/dl），将HIV-1血清阳性者分为三个免疫组：（1）中度组[（n = 35）CD4大于400，IgA小于300]；（2）混合组[（n = 22）CD4大于400且IgA大于300或CD4小于400且IgA小于300]；（3）差组[（n = 9）CD4小于400，IgA大于300]。HIV-1血清阴性者构成“良好”免疫组（CD4大于400且IgA小于300）。
对四组进行言语和视觉记忆、信息处理速度、视觉空间技能、语言处理、注意力、心理运动反应时间和精神状态测试。将可能影响认知表现的HIV-1血清状态以外的因素作为协变量进行测试。
与HIV-1血清阴性者相比，HIV-1血清阳性者的信息处理速度较慢，言语和视觉记忆下降。这些认知差异并非由于免疫抑制程度不同或HIV-1血清阳性者的临床状态不同所致。
认知改变在艾滋病之前就出现在HIV-1感染者中，并且似乎与临床状态以及通过CD4细胞计数和IgA水平衡量的免疫抑制程度无关。
