Baker Laurie M, Paul Robert H, Heaps-Woodruff Jodi M, Chang Jee Yoon, Ortega Mario, Margolin Zachary, Usher Christina, Basco Brian, Cooley Sarah, Ances Beau M
Department of Psychology, University of Missouri- Saint Louis, Saint Louis, MO, USA.
J Neuroimmune Pharmacol. 2015 Sep;10(3):487-92. doi: 10.1007/s11481-015-9610-4. Epub 2015 Apr 22.
The incidence of HIV-associated dementia has been greatly reduced in the era of highly active antiretroviral therapy (HAART); however milder forms of cognitive impairment persist. It remains uncertain whether HAART regimens with a high degree of central nervous system penetration effectiveness (CPE) exert beneficial neurological outcomes in HIV-infected (HIV+) individuals on stable treatment. Sixty-four HIV-infected adults on HAART were assigned a CPE score using a published ranking system and divided into high (≥7; n = 35) and low (<7; n = 29) CPE groups. All participants completed neuropsychological testing in addition to structural neuroimaging. Neuropsychological tests included measures known to be sensitive to HIV with values converted into standardized scores (NPZ-4) based on published normative scores. A semi-automated methodology was utilized to assess brain volumetrics within cortical (grey and white matter) and subcortical (thalamus, caudate, putamen) regions of interest. Analyses assessed NPZ-4 and brain volumetric differences between HIV+ individuals with high and low CPE scores. No significant differences in brain integrity were observed between the two groups. Long-term HAART regimens with a high degree of CPE were not associated with significantly improved neuropsychological or neuroimaging outcomes in HIV+ adults. Results suggest that alternate mechanisms may potentially contribute to better neurological outcomes in the era of HAART.
在高效抗逆转录病毒治疗（HAART）时代，与HIV相关的痴呆发病率已大幅降低；然而，较轻形式的认知障碍仍然存在。对于接受稳定治疗的HIV感染（HIV+）个体，具有高度中枢神经系统穿透效能（CPE）的HAART方案是否能产生有益的神经学结果仍不确定。使用已发表的排名系统为64名接受HAART治疗的HIV感染成人分配CPE评分，并将其分为高CPE组（≥7；n = 35）和低CPE组（<7；n = 29）。除了结构神经影像学检查外，所有参与者均完成了神经心理学测试。神经心理学测试包括已知对HIV敏感的测量指标，并根据已发表的标准分数将数值转换为标准化分数（NPZ-4）。采用半自动方法评估感兴趣的皮质（灰质和白质）和皮质下（丘脑、尾状核、壳核）区域的脑容量。分析评估了高CPE评分和低CPE评分的HIV+个体之间的NPZ-4和脑容量差异。两组之间未观察到脑完整性的显著差异。在HIV+成人中，具有高度CPE的长期HAART方案与神经心理学或神经影像学结果的显著改善无关。结果表明，在HAART时代，其他机制可能有助于产生更好的神经学结果。
