Cysique Lucette A J, Maruff Paul, Brew Bruce J
Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
Arch Neurol. 2004 Nov;61(11):1699-704. doi: 10.1001/archneur.61.11.1699.
The effect on neuropsychological function of antiretroviral drugs that are able to penetrate into the brain in effective concentration (neuroactive drugs) remains unclear.
To investigate whether highly active antiretroviral therapy (HAART) containing neuroactive drugs is associated with better neuropsychological performance in patients with human immunodeficiency virus disease.
Cross-sectional survey.
Tertiary referral hospital outpatient clinics.
The study population consisted of 97 individuals positive for human immunodeficiency virus (stage C3, 1993 Centers for Disease Control and Prevention classification) whose condition had been stable on their current HAART regimen for a mean +/- SD of 18.5 +/- 16.5 months and who were aged 48.14 +/- 9.38 years. The patient groups were analyzed according to whether their regimen contained 3 or more neuroactive drugs (neuroHAART group; n = 41) or not (HAART group; n = 56). Thirty seronegative men matched for age and education were recruited as controls.
Neuropsychological performance on 7 cognitive domains.
The neuroHAART and HAART groups did not differ from one another on neuropsychological performance, but both patient groups were impaired compared with controls. Impaired patients in each treatment group were compared, and the neuroHAART group showed significantly better memory performance, unrelated to plasma viral load, than the HAART group.
No direct benefit of neuroactive HAART therapy was found in patients with advanced human immunodeficiency virus infection. However, in neuropsychologically impaired patients, there was a benefit in memory function. This suggests that a threshold of neuropsychological impairment is required for the benefit of neuroactive HAART.
能够以有效浓度穿透血脑屏障的抗逆转录病毒药物（神经活性药物）对神经心理功能的影响尚不清楚。
探讨含神经活性药物的高效抗逆转录病毒治疗（HAART）是否与人类免疫缺陷病毒病患者更好的神经心理表现相关。
横断面调查。
三级转诊医院门诊。
研究人群包括97例人类免疫缺陷病毒阳性个体（1993年美国疾病控制与预防中心分类的C3期），他们在当前的HAART治疗方案下病情稳定，平均±标准差为18.5±16.5个月，年龄为48.14±9.38岁。根据治疗方案是否包含3种或更多神经活性药物，将患者分为两组（神经HAART组；n = 41）或不包含神经活性药物组（HAART组；n = 56）。招募30名年龄和教育程度相匹配的血清阴性男性作为对照。
7个认知领域的神经心理表现。
神经HAART组和HAART组在神经心理表现上无差异，但与对照组相比，两组患者均有受损。对每个治疗组中受损的患者进行比较，神经HAART组的记忆表现明显优于HAART组，且与血浆病毒载量无关。
在晚期人类免疫缺陷病毒感染患者中未发现神经活性HAART治疗有直接益处。然而，在神经心理受损的患者中，记忆功能有改善。这表明神经活性HAART的益处需要神经心理损伤达到一定阈值。
