Valcour Victor, Rubin Leah H, Tien Phyllis, Anastos Kathryn, Young Mary, Mack Wendy, Cohen Mardge, Golub Elizabeth T, Crystal Howard, Maki Pauline M
Memory and Aging Center, Sandler Neurosciences Center, University of California San Francisco, Suite 190, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA,
J Neurovirol. 2015 Aug;21(4):415-21. doi: 10.1007/s13365-015-0330-6. Epub 2015 Mar 5.
Cognitive impairment (CI) remains common despite access to combination antiretroviral therapy (cART); it has been linked to HIV-specific, HIV-related, and HIV-unrelated factors. Insulin resistance (IR) was associated with CI in the early cART era, when antiretroviral medications had greater mitochondrial and metabolic toxicity. We sought to examine these relationships in the current cART era of reduced antiretroviral toxicities. This study examined IR among non-diabetics in relation to a 1-h neuropsychological test battery among 994 women (659 HIV-infected and 335 HIV-uninfected controls) assessed between 2009 and 2011. The mean (standard deviation (SD)) age of the sample was 45.1 (9.3) years. The HIV-infected sample had a median interquartile range (IQR) cluster of differentiation 4 (CD4) T-lymphocyte count of 502 (310-727) cells/μL, and 54 % had undetectable plasma HIV RNA levels. Among all, the homeostasis model assessment (HOMA) of IR ranged from 0.25 to 37.14. In adjusted models, increasing HOMA was significantly associated with reduced performance on Letter-Number Sequencing (LNS) attention task (β = -0.10, p < 0.01) and on Hopkins Verbal Learning Test (HVLT) recognition (β = -0.10, p < 0.01) with weaker but statistically significant associations on phonemic fluency (β = -0.09, p = 0.01). An HIV*HOMA interaction effect was identified on the LNS attention task and Stroop trials 1 and 2, with worse performance in HIV-infected vs. HIV-uninfected women. In separate analyses, cohort members who had diabetes mellitus (DM) performed worse on the grooved pegboard test of psychomotor speed and manual dexterity. These findings confirm associations between both IR and DM on some neuropsychological tests and identify an interaction between HIV status and IR.
尽管可以使用联合抗逆转录病毒疗法（cART），认知障碍（CI）仍然很常见；它与HIV特异性、HIV相关和HIV无关的因素有关。在早期cART时代，当抗逆转录病毒药物具有更大的线粒体和代谢毒性时，胰岛素抵抗（IR）与CI相关。我们试图在当前抗逆转录病毒毒性降低的cART时代研究这些关系。本研究在2009年至2011年期间对994名女性（659名HIV感染者和335名HIV未感染者对照）进行了1小时神经心理测试，以检查非糖尿病患者中的IR情况。样本的平均（标准差（SD））年龄为45.1（9.3）岁。HIV感染样本的分化簇4（CD4）T淋巴细胞计数的中位数四分位间距（IQR）为502（310 - 727）个细胞/μL，54%的患者血浆HIV RNA水平检测不到。在所有人中，IR的稳态模型评估（HOMA）范围为0.25至37.14。在调整模型中，HOMA增加与字母数字排序（LNS）注意力任务的表现降低显著相关（β = -0.10，p < 0.01）以及霍普金斯言语学习测试（HVLT）识别方面（β = -0.10，p < 0.01），在音素流畅性方面有较弱但具有统计学意义的关联（β = -0.09，p = 0.01）。在LNS注意力任务以及斯特鲁普试验1和2中发现了HIV*HOMA交互作用效应，HIV感染女性的表现比未感染HIV的女性更差。在单独分析中，患有糖尿病（DM）的队列成员在心理运动速度和手动灵活性的槽式钉板测试中表现更差。这些发现证实了IR和DM在一些神经心理测试中的关联，并确定了HIV状态与IR之间的相互作用。
