撒哈拉以南非洲地区与 HIV 相关的神经认知障碍（HAND）的风险因素：以喀麦隆雅温得为例。
Risk factors for HIV-associated neurocognitive disorders (HAND) in sub-Saharan Africa: the case of Yaoundé-Cameroon.
机构信息
Neurology Department, Central Hospital & Faculty of Med. & Biomed. Sciences (FMBS), University of Yaounde 1 (UY1), BP 25625, Yaounde, Cameroon.
出版信息
J Neurol Sci. 2009 Oct 15;285(1-2):149-53. doi: 10.1016/j.jns.2009.06.043. Epub 2009 Jul 24.
BACKGROUND
The prevalence of HIV-associated neurocognitive disorders (HAND), especially HIV-associated dementia (HAD) is influenced by several risk factors. The prevalence as well as risk factors for HAD are not well known in sub-Saharan Africa (SSA). We have shown that the International HIV Dementia Scale (IHDS) is a useful screening tool for HAND in Yaoundé [Njamnshi AK, Djientcheu VdP, Fonsah JY, Yepnjio FN, Njamnshi DM, Muna WFT. The IHDS is a useful screening tool for HAD/Cognitive Impairment in HIV-infected adults in Yaoundé-Cameroon. Journal of Acquired Immune Deficiency Syndromes 2008;49(4):393-397], but no study in Cameroon has yet investigated the risk factors for HAND or HAD.
PATIENTS AND METHODS
A cross-sectional study was conducted in Yaoundé, the capital of Cameroon from September to December 2006. One hundred and eighty-five HIV-positive subjects were included. Diagnosis of HAND was done using the IHDS with a score < or = 10 considered as abnormal. Age, sex, level of education, IV drug use, body mass index (BMI), CDC clinical stage, CD4 counts, hemoglobin levels, administration of highly active antiretroviral therapy (HAART) and type of regimen used, were considered in univariate analysis, with level of significance set at P < or = 0.05. A binary logistic regression was used to determine independent risk factors.
RESULTS
The following factors were independent predictors of HAND: advanced clinical stage (OR=7.43, P=0.001), low CD4 count especially CD4 < or = 200 cells/microL (OR=4.88, P=0.045) and low hemoglobin concentration (OR=1.16, P=0.048).
CONCLUSION
This first study of the risk factors for HAND in Yaoundé-Cameroon shows findings similar to those described in other studies. These results call for rapid action by policy makers to include HAND prevention strategies such as providing early universal access to HAART based on these risk factors, in the management of HIV patients at risk of HAND in resource-limited settings of SSA like ours.
背景
HIV 相关神经认知障碍（HAND），特别是 HIV 相关痴呆（HAD）的流行受到多种危险因素的影响。撒哈拉以南非洲（SSA）的 HAD 患病率和危险因素尚不清楚。我们已经表明，国际 HIV 痴呆量表（IHDS）是雅温得进行 HAND 筛查的有用工具[Njamnshi AK、Djientcheu VdP、Fonsah JY、Yepnjio FN、Njamnshi DM、Muna WFT。IHDS 是喀麦隆雅温得 HIV 感染成人 HAD/Cognitive 障碍的有用筛查工具。艾滋病获得性免疫缺陷综合征杂志 2008；49(4):393-397]，但喀麦隆尚无研究调查 HAND 或 HAD 的危险因素。
患者和方法
2006 年 9 月至 12 月在喀麦隆首都雅温得进行了一项横断面研究。共纳入 185 名 HIV 阳性患者。使用 IHDS 诊断 HAND，得分<或=10 被认为异常。单因素分析中考虑了年龄、性别、受教育程度、静脉注射吸毒、体重指数（BMI）、CDC 临床分期、CD4 计数、血红蛋白水平、高效抗逆转录病毒治疗（HAART）的应用以及所用方案的类型，显著水平设为 P<或=0.05。使用二项逻辑回归确定独立危险因素。
结果
HAND 的独立预测因素包括：晚期临床分期（OR=7.43，P=0.001）、低 CD4 计数尤其是 CD4<或=200 个细胞/微升（OR=4.88，P=0.045）和低血红蛋白浓度（OR=1.16，P=0.048）。
结论
这是雅温得 HAND 危险因素的第一项研究，结果与其他研究描述的结果相似。这些结果呼吁决策者采取迅速行动，根据这些危险因素，在资源有限的 SSA 国家，如我们的国家，为 HAND 高危 HIV 患者提供早期普遍获得基于 HAART 的预防策略。
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