Garvey Lucy, Surendrakumar Veena, Winston Alan
Department of Medicine, Faculty of Medicine, Imperial College London, St Mary's Hospital Campus, London, UK.
HIV Clin Trials. 2011 Nov-Dec;12(6):333-8. doi: 10.1310/hct1206-333.
Few studies investigating the rate of neurocognitive (NC) impairment in effectively treated neuro-asymptomatic HIV-infected subjects have been performed.
We assessed NC function via a computerized cognitive test in HIV-infected subjects on stable combination antiretroviral therapy (cART) with plasma HIV RNA<50 copies/mL for at least 3 months. Neurologically symptomatic subjects were excluded. Current cART was evaluated for drug class (protease inhibitor [PI]- vs non-nucleoside reverse transcriptase inhibitor [NNRTI]-based) and Clinical Penetration Effectiveness (CPE) score. NC impairment was defined as a NC domain score>1 SD below mean age-matched population scores in at least 2 cognitive domains and global NC composite z-score calculated. Associations between NC scores and clinical parameters were evaluated using linear regression.
101 (88% male) subjects participated. Median (IQR) age was 53 (43-62) years, with current CD4+ 525 (373-710) and nadir CD4+ 185 (83-260) cells/µL. 25 subjects (25%) had chronic hepatitis C. Median (IQR) CPE score was 1.5 (1.5-2.5), and 53% were receiving NNRTI-based cART. Overall 19 (19%) subjects had NC impairment. No association between presence of NC impairment and clinical parameters were observed (P>.14, all values). Poorer global NC composite z-score was independently associated with lower nadir CD4+ lymphocyte count (P=.04) and older age (P<.001) but not other study parameters (P>.10 all values).
In neuro-asymptomatic HIV-infected adults on stable cART, rates of NC impairment are low. HIV disease status (lower nadir CD4+ count) and older age, but not CPE score or cART drug class, are associated with poorer NC performance.
很少有研究对接受有效治疗的神经无症状HIV感染受试者的神经认知（NC）损害发生率进行调查。
我们通过计算机化认知测试评估了接受稳定联合抗逆转录病毒治疗（cART）且血浆HIV RNA<50拷贝/mL至少3个月的HIV感染受试者的NC功能。排除有神经系统症状的受试者。评估当前cART的药物类别（蛋白酶抑制剂[PI]与基于非核苷类逆转录酶抑制剂[NNRTI]）和临床渗透有效性（CPE）评分。NC损害定义为至少2个认知领域的NC领域评分比年龄匹配的人群平均评分低>1个标准差，并计算总体NC综合z评分。使用线性回归评估NC评分与临床参数之间的关联。
101名（88%为男性）受试者参与。中位（IQR）年龄为53（43 - 62）岁，当前CD4 +细胞计数为525（373 - 710），最低CD4 +细胞计数为185（83 - 260）个/µL。25名受试者（25%）患有慢性丙型肝炎。中位（IQR）CPE评分为1.5（1.5 - 2.5），53%的受试者接受基于NNRTI的cART。总体而言，19名（19%）受试者存在NC损害。未观察到NC损害的存在与临床参数之间的关联（P>.14，所有值）。较差的总体NC综合z评分与较低的最低CD4 +淋巴细胞计数（P = .04）和较高年龄（P<.001）独立相关，但与其他研究参数无关（P>.10，所有值）。
在接受稳定cART的神经无症状HIV感染成年人中，NC损害发生率较低。HIV疾病状态（较低的最低CD4 +计数）和较高年龄与较差的NC表现相关，而CPE评分或cART药物类别与之无关。
