Larussa Dora, Lorenzini Patrizia, Cingolani Antonella, Bossolasco Simona, Grisetti Susanna, Bongiovanni Marco, Moretti Francesca, Uccella Ilaria, Zannoni Paolo, Foresti Sergio, Mazzarello Giovanni, Arcidiacono Maria Irene, Pedale Rosa, Ammassari Adriana, Tozzi Valerio, Perno Carlo Federico, Monforte Antonella D'Arminio, Cinque Paola, Antinori Andrea
Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy.
AIDS Res Hum Retroviruses. 2006 May;22(5):386-92. doi: 10.1089/aid.2006.22.386.
Historically, older patients have shown a higher risk of HIV-1-associated dementia (HIVD). The objective of this study was to evaluate the association of aging with HIVD and minor cognitive motor disorders (MCMDs) during the late-highly active antiretroviral therapy (HAART) era and to analyze characteristics, predictive factors, and survival of older HIV-1-infected individuals affected by these disorders. A nested longitudinal study was designed for a cohort of HIV-1-infected individuals with neurological diseases. Multiple logistic regression and Cox regression for survival were employed. From 2000 to 2003, 195 patients with HIVD (53%) or MCMD (47%) were enrolled. The cumulative prevalence of these two disorders was 21%, with an increasing rate for calendar year (p < 0.001). Previous antiretroviral exposure occurred in 46% of patients. Mean CD4(+) cell count and plasma HIV-1 RNA were 144 cells/microl and 4.5 log10 copies/ml, respectively. The mean age was 44 years (SD, 9.9), with 35% of patients aged 20-39 years (I), 45% aged 40-49 years (II), and 20% aged >/=50 years (III). Among drug-naive patients, the prevalence of HIVD progressively increased in older subjects: 7.2% (I), 15.3% (II), and 27.3% (III) (p < 0.001), whereas no significant increase in HIVD with older age was observed in drug-treated subjects. Older age was independently associated with an increased risk of HIVD (odds ratio, 6.44; 95% confidence interval, 2.82-14.69) in naive but not in experienced individuals, but had no significant effect on survival. No significant effect of age was observed for MCMD. We conclude that in our cohort, HAART seems to alter the relationship between aging and HIVD, conferring a neuroprotective effect to older patients. These results may have significant implications for the clinical management of the older HIV population.
从历史上看，老年患者感染HIV-1相关痴呆（HIVD）的风险更高。本研究的目的是评估在高效抗逆转录病毒治疗（HAART）后期，衰老与HIVD和轻微认知运动障碍（MCMD）之间的关联，并分析受这些疾病影响的老年HIV-1感染者的特征、预测因素和生存率。针对一组患有神经系统疾病的HIV-1感染者设计了一项嵌套纵向研究。采用多因素logistic回归和生存Cox回归分析。2000年至2003年，共纳入195例HIVD患者（53%）或MCMD患者（47%）。这两种疾病的累积患病率为21%，且逐年上升（p<0.001）。46%的患者曾接受过抗逆转录病毒治疗。CD4(+)细胞计数平均值和血浆HIV-1 RNA分别为144个细胞/微升和4.5 log10拷贝/毫升。平均年龄为44岁（标准差9.9），其中35%的患者年龄在20-39岁（I组），45%年龄在40-49岁（II组），20%年龄≥50岁（III组）。在未接受过治疗的患者中，HIVD的患病率在老年受试者中逐渐增加：I组为7.2%，II组为15.3%，III组为27.3%（p<0.001），而在接受过治疗的受试者中，未观察到HIVD患病率随年龄增长有显著增加。在未接受过治疗的个体中，年龄较大独立增加了HIVD的风险（优势比，6.44；95%置信区间，2.82-14.69），但在接受过治疗的个体中并非如此，且年龄对生存率无显著影响。年龄对MCMD无显著影响。我们得出结论，在我们的队列中，HAART似乎改变了衰老与HIVD之间的关系，对老年患者具有神经保护作用。这些结果可能对老年HIV人群的临床管理具有重要意义。
