Su Tanja, Schouten Judith, Geurtsen Gert J, Wit Ferdinand W, Stolte Ineke G, Prins Maria, Portegies Peter, Caan Matthan W A, Reiss Peter, Majoie Charles B, Schmand Ben A
aDepartment of Radiology, Academic Medical Center bDepartment of Neurology, Academic Medical Center cDepartment of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development dDepartment of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center eInfectious Diseases Research, Public Health Service fDepartment of Neurology, Onze Lieve Vrouwe Gasthuis gHIV Monitoring Foundation hDepartment of Psychology, University of Amsterdam, Amsterdam, The Netherlands. *Both Tanja Su and Judith Schouten shared first authorship.
AIDS. 2015 Mar 13;29(5):547-57. doi: 10.1097/QAD.0000000000000573.
The objective of this study is to assess whether multivariate normative comparison (MNC) improves detection of HIV-1-associated neurocognitive disorder (HAND) as compared with Frascati and Gisslén criteria.
One-hundred and three HIV-1-infected men with suppressed viremia on combination antiretroviral therapy (cART) for at least 12 months and 74 HIV-uninfected male controls (comparable regarding age, ethnicity, sexual orientation, premorbid intelligence and educational level), aged at least 45 years, underwent neuropsychological assessment covering six cognitive domains (fluency, attention, information processing speed, executive function, memory, and motor function). Frascati and Gisslén criteria were applied to detect HAND. Next, MNC was performed to compare the cognitive scores of each HIV-positive individual against the cognitive scores of the control group.
HIV-infected men showed significantly worse performance on the cognitive domains of attention, information processing speed and executive function compared with HIV-uninfected controls. HAND by Frascati criteria was highly prevalent in HIV-infected [48%; 95% confidence interval (95% CI) 38-58] but nearly equally so in HIV-uninfected men (36%; 95% CI 26-48), confirming the low specificity of this method. Applying Gisslén criteria, HAND-prevalence was reduced to 5% (95% CI 1-9) in HIV-infected men and to 1% (95% CI 1-3) among HIV-uninfected controls, indicating better specificity but reduced sensitivity. MNC identified cognitive impairment in 17% (95% CI 10-24) of HIV-infected men and in 5% (95% CI 0-10) of the control group (P = 0.02, one-tailed), showing an optimal balance between sensitivity and specificity.
Prevalence of cognitive impairment in HIV-1-infected men with suppressed viremia on cART estimated by MNC was much higher than that estimated by Gisslén criteria, while the false positive rate was greatly reduced compared with the Frascati criteria.
本研究的目的是评估与弗拉斯卡蒂标准和吉斯伦标准相比，多变量规范比较（MNC）是否能改善对HIV-1相关神经认知障碍（HAND）的检测。
103名接受联合抗逆转录病毒治疗（cART）至少12个月且病毒血症得到抑制的HIV-1感染男性和74名未感染HIV的男性对照（年龄、种族、性取向、病前智力和教育水平相当），年龄至少45岁，接受了涵盖六个认知领域（流畅性、注意力、信息处理速度、执行功能、记忆和运动功能）的神经心理学评估。应用弗拉斯卡蒂标准和吉斯伦标准来检测HAND。接下来，进行MNC以将每个HIV阳性个体的认知分数与对照组的认知分数进行比较。
与未感染HIV的对照组相比，HIV感染男性在注意力、信息处理速度和执行功能的认知领域表现明显更差。根据弗拉斯卡蒂标准，HAND在HIV感染者中非常普遍[48%；95%置信区间（95%CI）38 - 58]，但在未感染HIV的男性中几乎同样普遍（36%；95%CI 26 - 48），证实了该方法的低特异性。应用吉斯伦标准，HIV感染男性中HAND的患病率降至5%（95%CI 1 - 9），未感染HIV的对照组中降至1%（95%CI 1 - 3），表明特异性更好但敏感性降低。MNC在17%（95%CI 10 - 24）的HIV感染男性和5%（95%CI 0 - 10）的对照组中识别出认知障碍（P = 0.02，单尾），显示出敏感性和特异性之间的最佳平衡。
通过MNC估计，接受cART且病毒血症得到抑制的HIV-1感染男性中认知障碍的患病率远高于通过吉斯伦标准估计的患病率，而与弗拉斯卡蒂标准相比，假阳性率大大降低。
