Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
J Neurovirol. 2011 Oct;17(5):469-76. doi: 10.1007/s13365-011-0052-3. Epub 2011 Oct 18.
Despite the use of highly active anti-retroviral treatment (HAART), cognitive impairment remains prevalent in HIV. Indeed a recent study suggested that in certain instances, stopping HAART was associated with improved cognitive function (Robertson et al. Neurology 74(16):1260-1266 2010). HAART is occasionally associated with cardiovascular pathology and such pathology may be associated with cognitive impairment. To explore these associations, we assessed the relative contributions of cardiovascular variables such as hypertension and atherosclerosis, of HIV and HAART to cognition. The participants were members of the Women's Interagency HIV Study. In the analysis of cross-sectional data using general linear models, we assessed the relationship between each cardiovascular variable and Stroop interference time and symbol digit modalities test while adjusting for age, HIV, education, depression, and race/ethnicity. We also analyzed the association of summary measures of HAART use with cognition. In multivariate models, significance was limited to carotid lesions and carotid intima-medial thickness quintile (CIMT) with Stroop interference time (for carotid lesions, coefficient = 10.5, CI 3.5 to 17.5, p = 0.003, N = 1,130; for CIMT quintile, coefficient = 8.6, CI = 1.7 to 15.4, p = 0.025, N = 1,130). The summary measures of protease inhibitor use and other HAART measures were in most cases not associated with cognitive score in multivariate models. We conclude that in the HAART era among middle-aged women with HIV, carotid disease may be significantly associated with some measures of cognitive impairment. In this cross-sectional study, we could detect neither positive nor negative effects of HAART on cognition.
尽管采用了高效抗逆转录病毒治疗（HAART），但 HIV 患者仍普遍存在认知障碍。事实上，最近的一项研究表明，在某些情况下，停止 HAART 与认知功能改善有关（Robertson 等人，神经病学 74(16):1260-1266,2010）。HAART 偶尔与心血管病理学有关，这种病理学可能与认知障碍有关。为了探讨这些关联，我们评估了心血管变量（如高血压和动脉粥样硬化）、HIV 和 HAART 对认知的相对贡献。参与者是妇女机构间艾滋病毒研究（Women's Interagency HIV Study）的成员。在使用一般线性模型分析横断面数据时，我们评估了每个心血管变量与 Stroop 干扰时间和符号数字模态测试之间的关系，同时调整了年龄、HIV、教育、抑郁和种族/民族。我们还分析了 HAART 使用的综合指标与认知的关联。在多变量模型中，颈动脉病变和颈动脉内膜中层厚度五分位数（CIMT）与 Stroop 干扰时间之间的关联具有统计学意义（颈动脉病变的系数为 10.5，CI 为 3.5 至 17.5，p=0.003，N=1,130；CIMT 五分位数的系数为 8.6，CI 为 1.7 至 15.4，p=0.025，N=1,130）。蛋白酶抑制剂使用和其他 HAART 措施的综合指标在多变量模型中，大多数情况下与认知评分无关。我们的结论是，在接受 HAART 治疗的中年 HIV 女性中，颈动脉疾病可能与某些认知障碍指标显著相关。在这项横断面研究中，我们既不能检测到 HAART 对认知的积极影响，也不能检测到其消极影响。
