感染HIV的女性的认知功能：妇女机构间HIV研究的结果
Cognitive function in women with HIV: findings from the Women's Interagency HIV Study.
作者信息
Maki Pauline M, Rubin Leah H, Valcour Victor, Martin Eileen, Crystal Howard, Young Mary, Weber Kathleen M, Manly Jennifer, Richardson Jean, Alden Christine, Anastos Kathryn
机构信息
From the Departments of Psychiatry (P.M.M., L.H.R.) and Psychology (P.M.M.), University of Illinois at Chicago; the Department of Neurology (V.V.), University of California, San Francisco; the Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; the Department of Neurology (H.C.), SUNY Downstate Medical Center, New York, NY; Georgetown University School of Medicine (M.Y.), Washington, DC; The Core Center (K.M.W.), Bureau of Health Services of Cook County, Chicago, IL; the Department of Neurology (J.M.), Columbia University Medical Center, New York, NY; the Department of Preventative Medicine (J.R.), University of Southern California, Los Angeles; the Department of Epidemiology (C.A.), Johns Hopkins University School of Public Health, Baltimore, MD; and the Departments of Medicine and Epidemiology & Population Health (K.A.), Albert Einstein College of Medicine, New York, NY.
出版信息
Neurology. 2015 Jan 20;84(3):231-40. doi: 10.1212/WNL.0000000000001151. Epub 2014 Dec 24.
OBJECTIVE
In the largest cohort study of neuropsychological outcomes among HIV-infected women to date, we examined the association between HIV status and cognition in relation to other determinants of cognitive function (aim 1) and the pattern and magnitude of impairment across cognitive outcomes (aim 2).
METHODS
From 2009 to 2011, 1,521 (1,019 HIV-infected) participants from the Women's Interagency HIV Study (WIHS) completed a comprehensive neuropsychological test battery. We used multivariable regression on raw test scores for the first aim and normative regression-based analyses (t scores) for the second aim. The design was cross-sectional.
RESULTS
The effect sizes for HIV status on cognition were very small, accounting for only 0.05 to 0.09 SD units. The effect of HIV status was smaller than that of years of education, age, race, income, and reading level. In adjusted analyses, HIV-infected women performed worse than uninfected women on verbal learning, delayed recall and recognition, and psychomotor speed and attention. The largest deficit was observed in delayed memory. The association of low reading level with cognition was greater in HIV-infected compared to HIV-uninfected women. HIV biomarkers (CD4 count, history of AIDS-defining illness, viral load) were associated with cognitive dysfunction.
CONCLUSIONS
The effect of HIV on cognition in women is very small except among women with low reading level or HIV-related comorbidities. Direct comparisons of rates of impairment in well-matched groups of HIV-infected men and women are needed to evaluate possible sex differences in cognition.
目的
在迄今为止针对感染HIV的女性进行的最大规模神经心理学结局队列研究中，我们考察了HIV感染状况与认知之间的关联，并分析了其与认知功能其他决定因素的关系（目标1），以及认知结局中损害的模式和程度（目标2）。
方法
2009年至2011年期间，来自女性机构间HIV研究（WIHS）的1521名参与者（其中1019名感染HIV）完成了一套全面的神经心理学测试。对于第一个目标，我们对原始测试分数进行多变量回归分析；对于第二个目标，我们进行基于常模回归的分析（t分数）。研究设计为横断面研究。
结果
HIV感染状况对认知的效应量非常小，仅占0.05至0.09个标准差单位。HIV感染状况的影响小于受教育年限、年龄、种族、收入和阅读水平的影响。在调整分析中，感染HIV的女性在言语学习、延迟回忆和识别、心理运动速度和注意力方面的表现比未感染女性差。延迟记忆方面的缺陷最为明显。与未感染HIV的女性相比，感染HIV的女性中低阅读水平与认知的关联更强。HIV生物标志物（CD4细胞计数、艾滋病定义疾病史、病毒载量）与认知功能障碍有关。
结论
除了阅读水平低或患有与HIV相关合并症的女性外，HIV对女性认知的影响非常小。需要对匹配良好的感染HIV的男性和女性群体的损害率进行直接比较，以评估认知方面可能存在的性别差异。
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