Justice Amy C, McGinnis Kathleen A, Atkinson J Hampton, Heaton Robert K, Young Corinna, Sadek Joseph, Madenwald Tamra, Becker James T, Conigliaro Joseph, Brown Sheldon T, Rimland David, Crystal Steve, Simberkoff Michael
Veterans Aging Cohort Study Center, VA Pittsburgh Healthcare System, and University of Pittsburgh Center for Research on Health Care, School of Medicine, Division of General Internal Medicine, Pennsylvania, USA.
AIDS. 2004 Jan 1;18 Suppl 1:S49-59.
The risk for psychiatric and neurocognitive disorders among middle-aged and older individuals with HIV infection has not been well characterized.
The Veterans Aging Cohort 5-Site Study enrolled 1803 patients (1047 HIV-positive) from VA infectious disease and general medicine clinics from September 2001 to June 2002. A convenience subset of 10 patients from each site (n = 50) was consented for formal neurocognitive and psychiatric (NCP) testing. Data from this subset were linked to the larger sample.
Kappa scores for agreement beyond chance were fair for available measures when compared with formal NCP testing. Using available measures, depressive symptoms (PHQ-9 and provider reported), alcohol abuse or dependence (ICD-9 codes), and drug abuse or dependence (DAST-10) decreased with age in HIV-negative subjects (P trend <0.05) but did not among HIV-positive subjects (P > 0.05). HIV-positive subjects demonstrated higher prevalence of these conditions with increasing age when compared to HIV-negative subjects. Patient report of memory problems increased with age among both groups after excluding those reporting symptoms of depression (PHQ-9e > or = 10).
Available measures were no substitute for formal NCP testing. Older HIV-positive veterans demonstrate greater prevalence of depressive symptoms, alcohol abuse or dependence, and drug abuse or dependence than age-matched, HIV-negative veterans. Both groups reported increased memory problems with advancing age. This preliminary work suggests a substantial prevalence of psychiatric and neurocognitive problems among middle-aged and older HIV-infected individuals.
感染艾滋病毒的中老年人患精神疾病和神经认知障碍的风险尚未得到充分描述。
退伍军人老龄化队列5个地点研究在2001年9月至2002年6月期间从退伍军人事务部传染病和普通内科诊所招募了1803名患者（1047名艾滋病毒呈阳性）。每个地点选取10名患者（n = 50）组成一个便利性子集，同意进行正式的神经认知和精神（NCP）测试。该子集的数据与更大的样本相关联。
与正式的NCP测试相比，可用测量方法的卡帕评分一致性超出偶然的程度一般。使用可用测量方法，艾滋病毒阴性受试者中，抑郁症状（PHQ - 9和提供者报告）、酒精滥用或依赖（ICD - 9编码）以及药物滥用或依赖（DAST - 10）随年龄增长而减少（P趋势<0.05），但艾滋病毒阳性受试者中并非如此（P>0.05）。与艾滋病毒阴性受试者相比，艾滋病毒阳性受试者中这些情况的患病率随年龄增长而升高。排除报告抑郁症状（PHQ - 9≥10）的患者后，两组患者报告的记忆问题均随年龄增长而增加。
可用测量方法无法替代正式的NCP测试。与年龄匹配的艾滋病毒阴性退伍军人相比，年龄较大的艾滋病毒阳性退伍军人抑郁症状、酒精滥用或依赖以及药物滥用或依赖的患病率更高。两组均报告随着年龄增长记忆问题增加。这项初步研究表明，中年及老年艾滋病毒感染者中精神和神经认知问题的患病率相当高。
