Ciccarelli Nicoletta, Grima Pierfrancesco, Fabbiani Massimiliano, Baldonero Eleonora, Borghetti Alberto, Milanini Benedetta, Limiti Silio, Colafigli Manuela, Tamburrini Enrica, Cauda Roberto, De Luca Andrea, Di Giambenedetto Simona
Department of Public Health, Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
Antivir Ther. 2015;20(4):433-40. doi: 10.3851/IMP2925. Epub 2014 Dec 11.
The aim of our study was to better understand the dynamics between cardiovascular risk factors and immunological parameters in the evolution of cognitive performance in HIV+ patients.
We conducted a prospective longitudinal study, consecutively enrolling asymptomatic HIV+ subjects during routine outpatient visits at two clinical centres. At baseline and after 2 years, all patients underwent a comprehensive neuropsychological battery. Common carotid intima-media thickness (cIMT) was also measured.
A total of 150 patients completed the study (77% males, median age 46 years, 20% with past AIDS-defining events, 95% on cART, 88% with HIV-RNA<50 copies/ml). After a 2-year follow-up, there was no difference in the proportion of patients with cognitive impairment (32% versus 33% at baseline; P=1.00). However, a significantly worse memory performance was observed (z score mean change -0.51, sd 1.05; P=0.001). At multivariate analysis, baseline dyslipidaemia (OR 2.7, 95% CI 1.1, 7.1; P=0.037) showed a significant association with a higher risk of memory impairment at 2-year follow-up, while higher baseline CD4(+) T-cell count (OR 0.80 per 100 cells/μl higher; 95% CI 0.66, 0.97; P=0.026) was found to be a protective factor, adjusting for the presence of a memory impairment at baseline. When the analysis was restricted to patients who did not change antiretroviral therapy during the study period (n=109), baseline cIMT (OR 14.6 per 0.1 mm higher; 95% CI 1.1, 189.9; P=0.041) also emerged as an independent risk factor for memory impairment at 2-year follow-up.
Immunological parameters and cardiovascular risk factors are independently associated with the evolution of cognitive status in HIV+ patients.
我们研究的目的是更好地了解HIV阳性患者认知功能演变过程中心血管危险因素与免疫参数之间的动态关系。
我们进行了一项前瞻性纵向研究，在两个临床中心的常规门诊就诊期间连续纳入无症状HIV阳性受试者。在基线和2年后，所有患者均接受了全面的神经心理测试。还测量了颈总动脉内膜中层厚度（cIMT）。
共有150名患者完成了研究（77%为男性，中位年龄46岁，20%有既往艾滋病定义事件，95%接受抗逆转录病毒治疗，88%的HIV-RNA<50拷贝/ml）。经过2年的随访，认知障碍患者的比例没有差异（基线时为32%，2年后为33%；P=1.00）。然而，观察到记忆表现明显更差（z评分平均变化-0.51，标准差1.05；P= 0.001）。在多变量分析中，基线血脂异常（比值比2.7，95%置信区间1.1，7.1；P=0.037）显示与2年随访时记忆障碍风险较高显著相关，而基线CD4(+)T细胞计数较高（每高100个细胞/μl比值比0.80；95%置信区间0.66，0.97；P=0.026）被发现是一个保护因素，对基线时存在记忆障碍进行了校正。当分析仅限于研究期间未改变抗逆转录病毒治疗的患者（n=109）时，基线cIMT（每高0.1mm比值比14.6；95%置信区间1.1，189.9；P=0.041）也成为2年随访时记忆障碍的独立危险因素。
免疫参数和心血管危险因素与HIV阳性患者认知状态的演变独立相关。
