Robertson Kevin R, Smurzynski Marlene, Parsons Thomas D, Wu Kunling, Bosch Ronald J, Wu Julia, McArthur Justin C, Collier Ann C, Evans Scott R, Ellis Ron J
Department of Neurology, UNC, Chapel Hill, North Carolina 27599, USA.
AIDS. 2007 Sep 12;21(14):1915-21. doi: 10.1097/QAD.0b013e32828e4e27.
HAART suppresses HIV viral replication and restores immune function. The effects of HAART on neurological disease are less well understood. The aim of this study was to assess the prevalence and incidence of neurocognitive impairment in individuals who initiated HAART as part of an AIDS clinical trial.
A prospective cohort study of HIV-positive patients enrolled in randomized antiretroviral trials, the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) study.
We examined the association between baseline and demographic characteristics and neurocognitive impairment among 1160 subjects enrolled in the ALLRT study.
A history of immunosuppression (nadir CD4 cell count < 200 cells/microl) was associated with an increase in prevalent neurocognitive impairment. There were no significant virological and immunological predictors of incident neurocognitive impairment. Current immune status (low CD4 cell count) was associated with sustained prevalent impairment.
The association of previous advanced immunosuppression with prevalent and sustained impairment suggests that there is a non-reversible component of neural injury that tracks with a history of disease progression. The association of sustained impairment with worse current immune status (low CD4 cell count) suggests that restoring immunocompetence increases the likelihood of neurocognitive recovery. Finally, the lack of association between incident neurocognitive impairment and virological and immunological indicators implies that neural injury continues in some patients regardless of the success of antiretroviral therapy on these laboratory measures.
高效抗逆转录病毒治疗（HAART）可抑制HIV病毒复制并恢复免疫功能。HAART对神经疾病的影响尚鲜为人知。本研究旨在评估作为艾滋病临床试验一部分开始接受HAART治疗的个体中神经认知障碍的患病率和发病率。
对参与随机抗逆转录病毒试验的HIV阳性患者进行的前瞻性队列研究，即艾滋病临床试验组（ACTG）纵向关联随机试验（ALLRT）研究。
我们在ALLRT研究纳入的1160名受试者中，研究了基线和人口统计学特征与神经认知障碍之间的关联。
免疫抑制病史（最低CD4细胞计数<200个/微升）与神经认知障碍患病率增加相关。对于新发神经认知障碍，不存在显著的病毒学和免疫学预测因素。当前免疫状态（低CD4细胞计数）与持续性普遍障碍相关。
既往严重免疫抑制与普遍及持续性障碍之间的关联表明，存在与疾病进展史相关的神经损伤不可逆成分。持续性障碍与当前较差免疫状态（低CD4细胞计数）之间的关联表明，恢复免疫能力会增加神经认知恢复的可能性。最后，新发神经认知障碍与病毒学和免疫学指标之间缺乏关联，这意味着在某些患者中，无论抗逆转录病毒治疗在这些实验室指标上是否成功，神经损伤仍会持续。
