Department of Psychiatry, HIV Neurobehavioral Research Center (HNRC), University of California at San Diego, La Jolla, CA 92093-0603, USA.
AIDS. 2010 Apr 24;24(7):983-90. doi: 10.1097/QAD.0b013e32833336c8.
To quantify and characterize the nature of cognitive change over 1 year in a cohort of HIV-positive former plasma donors in rural China.
The present study is an observational cohort study.
One hundred and ninety-two HIV-positive and 101 demographically comparable HIV-negative individuals, all former plasma donors, who lived in a rural part of China, received comprehensive medical and neuropsychological examinations. At study entry, 56% of HIV-positive group was on combination antiretroviral treatment and 60.9% at follow-up. Multiple regression change score approach was used with the HIV-negative sample to develop norms for change that would be then applied to the HIV-positive participants. Follow-up test scores adjusted for the control group practice effect.
Fifty-three HIV-positive individuals (27%) developed significant cognitive decline as compared with five (5%) HIV-negative individuals. Cognitive decline was predicted at baseline by AIDS status, lower nadir CD4, and worse processing speed; at follow-up, it was associated with lower current CD4 cell count and failure of viral suppression on combination antiretroviral treatment. Neuropsychological decline also was associated with decreased independence in activities of daily living. Using neuropsychological impairment scores that were corrected for 'practice' on repeated testing, we found that among the decliners, 41.5% (N = 22) had incident impairment, whereas 38% (N = 20) declined within the impaired range and another 20.7% (N = 11) declined within the normal range.
The present study demonstrates that despite ongoing combination antiretroviral treatment, cognitive decline in HIV-positive people is common over a 1-year follow-up. Regression-based norms for change on western neuropsychological tests can be used to detect disease-related cognitive decline in a developing country.
在中国农村地区，对一组 HIV 阳性前血浆供者进行为期 1 年的队列研究，以量化和描述认知变化的性质。
本研究为观察性队列研究。
192 名 HIV 阳性和 101 名在人口统计学上可比的 HIV 阴性个体（均为前血浆供者）居住在中国农村地区，接受了全面的医学和神经心理学检查。在研究开始时，56%的 HIV 阳性组接受了联合抗逆转录病毒治疗，60.9%在随访时接受了联合抗逆转录病毒治疗。采用多元回归变化评分方法，利用 HIV 阴性组建立变化的正常范围，然后应用于 HIV 阳性组参与者。随访测试成绩调整了对照组的练习效果。
与 5%的 HIV 阴性个体相比，53 名 HIV 阳性个体（27%）出现了显著的认知能力下降。认知能力下降在基线时与艾滋病状态、最低 CD4 水平和较差的处理速度有关；在随访时，与当前 CD4 细胞计数较低以及联合抗逆转录病毒治疗未能抑制病毒有关。神经认知能力下降也与日常生活活动的独立性下降有关。使用经过重复测试“练习”修正的神经心理学损伤评分，我们发现，在下降者中，41.5%（N=22）有新的损伤，而 38%（N=20）在损伤范围内下降，另有 20.7%（N=11）在正常范围内下降。
本研究表明，尽管正在进行联合抗逆转录病毒治疗，但在 1 年的随访中，HIV 阳性者的认知能力下降很常见。基于回归的西方神经心理学测试变化的正常范围可用于检测发展中国家与疾病相关的认知能力下降。
