King's College London, Institute of Psychiatry, London, UK.
Cortex. 2012 Feb;48(2):230-41. doi: 10.1016/j.cortex.2011.03.006. Epub 2011 Mar 15.
Over the past decade the developments made in treating people with human immune deficiency virus (HIV) have greatly improved quality of life and life expectancy. However, the nature of asymptomatic HIV-associated minor neurocognitive disorder (HAND) remains unclear. In this study we explored the occurrence of neuropsychological and neuroimaging changes in medically and psychiatrically stable HIV-1 infected patients on highly active antiretroviral treatment (HAART) from two separate age groups.
Participants included 20 HIV-1 infected younger (aged 20-40) and 20 HIV-1 older patients (aged 50-75). Comparisons were made with 20 age- and education-matched younger and 22 matched older healthy seronegative males. Participants were stable on treatment and asymptomatic at study onset with undetectable HIV-1 viral loads, and free of medical or psychiatric co-morbidity, alcohol or substance misuse. A detailed neuropsychological assessment was used and volumetric-magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) performed to assess grey and white-matter integrity.
We found significant effects of ageing on memory, grey and white matter measures. Comparison of the HIV-positive and HIV-negative groups did not show significant differences on the neuropsychological tests after Bonferroni correction, and there were no significant age by HIV status interactions. However, we did find reduced grey matter volume on MRI in our HIV-positive participants within the medial and superior frontal gyri. We also found significant ageing effects in fronto-temporal grey and white matter, independent of the effect of HIV.
The results from this study suggest that HIV-1 disease by itself does not significantly impair cognitive function when patients are otherwise asymptomatic. Nevertheless, the imaging techniques were sensitive enough to detect subtle grey matter changes not normally evident until much later in the disease. If confirmed in a longitudinal study this frontal grey matter change could represent an important biomarker for trials in HIV disease.
在过去的十年中，针对人类免疫缺陷病毒（HIV）感染者的治疗方法取得了重大进展，大大提高了生活质量和预期寿命。然而，无症状性 HIV 相关轻度认知障碍（HAND）的性质仍不清楚。在这项研究中，我们探讨了来自两个不同年龄组的接受高效抗逆转录病毒治疗（HAART）的医学和精神稳定的 HIV-1 感染者中神经心理学和神经影像学变化的发生。
参与者包括 20 名 HIV-1 感染的年轻（20-40 岁）和 20 名 HIV-1 感染的老年患者（50-75 岁）。将他们与 20 名年龄和教育程度匹配的年轻和 22 名匹配的老年健康血清阴性男性进行比较。参与者在研究开始时处于稳定的治疗状态，无症状，HIV-1 病毒载量无法检测到，并且没有医学或精神共病，没有酗酒或药物滥用。使用详细的神经心理学评估，并进行容积磁共振成像（MRI）和弥散张量成像（DTI）以评估灰质和白质完整性。
我们发现年龄对记忆、灰质和白质测量有显著影响。在 Bonferroni 校正后，与 HIV 阴性组相比，HIV 阳性组的神经心理学测试无显著差异，并且年龄与 HIV 状态之间没有显著的相互作用。但是，我们确实发现我们的 HIV 阳性参与者的内侧和额上回的 MRI 灰质体积减少。我们还发现，无论 HIV 状态如何，额颞叶灰质和白质的老化效应都很明显。
这项研究的结果表明，当患者无症状时，HIV-1 疾病本身不会显著损害认知功能。尽管如此，这些成像技术足够敏感，可以检测到在疾病后期才会出现的细微灰质变化。如果在纵向研究中得到证实，这种额叶灰质变化可能代表 HIV 疾病试验中的一个重要生物标志物。
