University of California, San Diego, USA.
Neurology. 2010 Dec 7;75(23):2087-96. doi: 10.1212/WNL.0b013e318200d727.
This is a cross-sectional, observational study to determine the frequency and associated features of HIV-associated neurocognitive disorders (HAND) in a large, diverse sample of infected individuals in the era of combination antiretroviral therapy (CART).
A total of 1,555 HIV-infected adults were recruited from 6 university clinics across the United States, with minimal exclusions. We used standardized neuromedical, psychiatric, and neuropsychological (NP) examinations, and recently published criteria for diagnosing HAND and classifying 3 levels of comorbidity (minimal to severe non-HIV risks for NP impairment).
Fifty-two percent of the total sample had NP impairment, with higher rates in groups with greater comorbidity burden (40%, 59%, and 83%). Prevalence estimates for specific HAND diagnoses (excluding severely confounded cases) were 33% for asymptomatic neurocognitive impairment, 12% for mild neurocognitive disorder, and only 2% for HIV-associated dementia (HAD). Among participants with minimal comorbidities (n = 843), history of low nadir CD4 was a strong predictor of impairment, and the lowest impairment rate on CART occurred in the subset with suppressed plasma viral loads and nadir CD4 ≥200 cells/mm(3) (30% vs 47% in remaining subgroups).
The most severe HAND diagnosis (HAD) was rare, but milder forms of impairment remained common, even among those receiving CART who had minimal comorbidities. Future studies should clarify whether early disease events (e.g., profound CD4 decline) may trigger chronic CNS changes, and whether early CART prevents or reverses these changes.
本研究为横断面观察性研究，旨在确定在联合抗逆转录病毒治疗（cART）时代，大量感染个体中 HIV 相关神经认知障碍（HAND）的发生频率及其相关特征。
共招募了来自美国 6 所大学诊所的 1555 名 HIV 感染成年人，排除了极少数有禁忌症的患者。我们使用了标准化的神经医学、精神病学和神经心理学（NP）检查，并采用了最近发表的 HAND 诊断标准和 3 级合并症分类（对 NP 损害的非 HIV 风险最小到严重）。
总样本中有 52%的人存在 NP 损害，合并症负担较重的组发生率更高（40%、59%和 83%）。特定 HAND 诊断（排除严重混杂病例）的患病率估计值为无症状性神经认知障碍 33%、轻度神经认知障碍 12%和 HIV 相关痴呆（HAD）仅 2%。在合并症最小的参与者（n = 843）中，低 CD4 最低值的病史是损害的强烈预测因素，在那些抑制血浆病毒载量和 CD4 最低值≥200 个细胞/mm3的亚组中，发生损害的比率最低（分别为 30%和 47%，在其余亚组中）。
最严重的 HAND 诊断（HAD）很少见，但即使在接受 cART 治疗且合并症最小的患者中，仍有较常见的轻度损害。未来的研究应阐明早期疾病事件（如 CD4 显著下降）是否可能引发慢性中枢神经系统变化，以及早期 cART 是否可以预防或逆转这些变化。
