Department of Medicine, University of Alberta, Edmonton, AB, Canada.
HIV Med. 2013 Feb;14(2):99-107. doi: 10.1111/j.1468-1293.2012.01043.x. Epub 2012 Sep 20.
The aim of the study was to determine the risk factors predictive of symptomatic HIV-associated neurocognitive disorders (sHAND) among HIV-infected patients receiving active medical care.
Baseline demographic and clinical characteristics were analysed in patients with sHAND (HIV-associated dementia and minor neurocognitive disorder) in a population-based longitudinal cohort of HIV-infected patients with access to universal health care, including combination antiretroviral therapy (cART) from 1999 to 2008. Variables evaluated for their association with sHAND included age and ethnicity, survival duration with HIV-1 infection, vascular disease risk factors, and laboratory indices such as blood CD4 T-cell count at its nadir and at cART initiation, using both univariable and multivariable logistic regression models.
A total of 1320 patients were investigated, including the patients diagnosed with sHAND (n = 90) during the study period. In univariable analyses, increased age, increased length of survival with HIV, low nadir CD4 and CD8 T-cell counts, high baseline viral load (> 1,000,000 HIV-1 RNA copies/mL), and African origin were predictive of a diagnosis of sHAND (P < 0.05). In multivariable analysis, increased age, increased length of survival, low nadir CD4 T-cell counts, and high baseline viral load remained predictive of sHAND (P < 0.05). Remarkably, CD4 T-cell counts at cART initiation, hepatitis C virus coinfection, and vascular disease risk factors failed to predict sHAND in both analyses.
Increased age and survival duration, lower nadir CD4 T-cell counts, and higher baseline viral load were consistent predictors of the development of sHAND among persons with HIV/AIDS in universal health care, underscoring the importance of attention to these variables in clinical care.
本研究旨在确定接受积极医疗护理的 HIV 感染者发生有症状的 HIV 相关神经认知障碍（sHAND）的预测因素。
在一项基于人群的、接受普遍卫生保健的 HIV 感染者纵向队列研究中，对有 sHAND（HIV 相关痴呆和轻度神经认知障碍）的患者进行了基线人口统计学和临床特征分析。评估了与 sHAND 相关的变量包括年龄和种族、HIV-1 感染的存活时间、血管疾病危险因素以及实验室指标，如 CD4 T 细胞计数的最低点和 cART 起始时的 CD4 T 细胞计数，使用单变量和多变量逻辑回归模型。
共调查了 1320 名患者，包括研究期间诊断为 sHAND（n = 90）的患者。在单变量分析中，年龄增加、HIV 存活时间延长、CD4 和 CD8 T 细胞计数最低点较低、基线病毒载量较高（>1,000,000 HIV-1 RNA 拷贝/mL）和非洲血统是 sHAND 诊断的预测因素（P < 0.05）。在多变量分析中，年龄增加、存活时间延长、CD4 T 细胞计数最低点较低和基线病毒载量较高仍然是 sHAND 的预测因素（P < 0.05）。值得注意的是，在这两种分析中，cART 起始时的 CD4 T 细胞计数、丙型肝炎病毒合并感染和血管疾病危险因素均未能预测 sHAND。
在普遍卫生保健中，年龄增加和存活时间延长、CD4 T 细胞计数最低点较低以及基线病毒载量较高是 HIV/AIDS 患者发生 sHAND 的一致预测因素，这凸显了在临床护理中关注这些变量的重要性。
