Division of Neurology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
S Afr Med J. 2013 Sep 18;103(10):758-62. doi: 10.7196/samj.6677.
The human immunodeficiency virus (HIV) can give rise to a spectrum of neuropsychological impairments known collectively as HIV-associated neurocognitive disorders (HAND). Although antiretroviral therapy (ART) has reduced the incidence of HIV dementia, the prevalence of milder forms of HAND has increased. It has been postulated that incomplete central nervous system (CNS) viral suppression or potential drug toxicity, both of which could be related to the CNS penetration effectiveness (CPE) of ART regimens, may contribute to this phenomenon.
This study compared cognitive outcomes in clade C-infected HIV patients in South Africa treated for 1 year with ART regimens with differing CPE scores.
We assessed 111 HIV-positive patients with varying levels of cognitive function at baseline (pre-ART) and then a year later. A neuropsychological battery was administered at both visits to derive global deficit scores. ART regimen data were collected at the follow-up visit. Some participants remained ART-naïve during this period, thus providing a non-treatment control group.
Significantly more ART recipients maintained or improved cognitive function compared with patients not on ART (p=0.017). There was no significant difference in cognitive outcomes between higher and lower CPE regimen groups (p=0.473).
ART preserves or improves cognition in HIV-infected patients after 1 year, irrespective of the regimen's CPE. South Africa's current low CPE-scored first-line regimen performed as well as higher CPE-scored regimens. These findings are reassuring for South Africa, but larger, longer-term studies would be more definitive.
人类免疫缺陷病毒（HIV）可引起一系列统称为 HIV 相关神经认知障碍（HAND）的神经心理学损害。尽管抗逆转录病毒疗法（ART）降低了 HIV 痴呆的发病率，但HAND 较温和形式的患病率却有所增加。据推测，中枢神经系统（CNS）病毒抑制不完全或潜在的药物毒性，这两者都可能与 ART 方案的中枢神经系统穿透效率（CPE）有关，可能导致这种现象。
本研究比较了南非感染 clade C 的 HIV 患者在接受不同 CPE 评分的 ART 方案治疗 1 年后的认知结果。
我们评估了 111 名 HIV 阳性患者，他们在基线（ART 前）和 1 年后的认知功能水平不同。在两次就诊时均进行神经心理测试，以得出总体缺陷评分。在随访就诊时收集 ART 方案的数据。在此期间，一些参与者仍保持未接受 ART 治疗，因此提供了非治疗对照组。
与未接受 ART 治疗的患者相比，接受 ART 治疗的患者保持或改善认知功能的比例显著更高（p=0.017）。高 CPE 和低 CPE 方案组之间的认知结果没有显著差异（p=0.473）。
无论方案的 CPE 如何，ART 在 1 年后都能维持或改善 HIV 感染患者的认知功能。南非目前的一线低 CPE 评分方案与高 CPE 评分方案的表现一样好。这些发现令人感到欣慰，但更大、更长期的研究将更具确定性。
