Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
J Neurovirol. 2012 Jun;18(3):191-9. doi: 10.1007/s13365-012-0097-y. Epub 2012 Apr 18.
In Nigeria, the incidence and prevalence of human immunodeficiency virus (HIV)-related neurocognitive impairment (NCI) are unknown and there currently exists little information related to the viral correlates rates of NCI. Therefore, studies were performed to examine the potential utility of applying an established neuropsychological (NP) screening battery and detailed NP testing to detect NCI and correlations with functional impairment and the presence of specific viral signatures among infected subjects. A total of 60 HIV-1 seropositive antiretroviral-naive individuals and 56 seronegative control subjects were administered the International HIV Dementia Scale (IHDS) and assessed for functional impairment using the Karnofsky performance status scale. Fifteen HIV-infected patients and 11 controls were also administered a detailed NP battery. Blood samples from eight infected subjects, three with evidence of NCI, were obtained for molecular analysis of HIV-1 strain. Unadjusted scores on the IHDS showed that, using a recommended total score cutoff of 10, 28.8% of the HIV-1 seropositive and 16.0% of seropositive individuals scored abnormally. Results from testing using the full NP battery showed that, overall, the HIV seropositive group performed worse than the seronegative group, with effect sizes spanning from small (0.25 on the trail making test A) to large (0.82 on action fluency), and an average effect size across the battery of 0.45, which approaches that which has been recorded in other international settings. Sequencing of partial pol amplicons from viral isolates revealed that two of three patients with NCI were infected with subtype G virus and 1 with the circulating recombinant form (CRF)02_AG; all four individuals without NCI were infected with CRF_02AG. These studies demonstrate the utility of the IHDS in identifying cognitive impairment among HIV infected individuals in Nigeria. Future studies aimed at examining the burden of NCI among the population of individuals with HIV-1 infection in Nigeria and which assess the virologic correlates will contribute to the evolving understanding of the pathogenetic factors that underlie this disorder.
在尼日利亚，人类免疫缺陷病毒（HIV）相关神经认知障碍（NCI）的发病率和患病率尚不清楚，目前与 NCI 相关的病毒学指标的相关信息也很少。因此，进行了这些研究，以检验应用既定的神经心理学（NP）筛查工具包和详细的 NP 测试来检测 NCI 以及与功能障碍和感染个体中特定病毒特征的相关性的潜在效用。共对 60 名 HIV-1 血清阳性、未接受抗病毒治疗的个体和 56 名血清阴性对照者进行了国际 HIV 性痴呆量表（IHDS）评估，并使用卡诺夫斯基表现状态量表评估了功能障碍。还对 15 名 HIV 感染患者和 11 名对照者进行了详细的 NP 电池测试。从 8 名感染患者中获得了 3 名有 NCI 证据的患者的血液样本，以进行 HIV-1 株的分子分析。IHDS 的未经调整得分表明，使用推荐的总分截止值 10，28.8%的 HIV-1 血清阳性和 16.0%的血清阳性个体的得分异常。使用完整的 NP 电池进行测试的结果表明，总体而言，HIV 血清阳性组的表现不如血清阴性组，其效应大小从小（在追踪测试 A 中为 0.25）到大（在行动流畅性中为 0.82），整个电池的平均效应大小为 0.45，接近在其他国际环境中记录的水平。对病毒分离株的部分 pol 扩增子进行测序显示，3 名 NCI 患者中有 2 名感染了 G 型病毒，1 名感染了循环重组型（CRF）02_AG；所有 4 名无 NCI 的个体均感染了 CRF_02AG。这些研究表明，IHDS 可用于在尼日利亚的 HIV 感染者中识别认知障碍。未来旨在检查尼日利亚 HIV-1 感染者人群中 NCI 的负担并评估病毒学指标的研究将有助于了解导致这种疾病的发病机制因素的不断发展。
