Jacks Amy, Wainwright D' Arcy, Salazar Lucrecia, Grimes Richard, York Michele, Strutt Adriana M, Shahani Lokesh, Woods Steven Paul, Hasbun Rodrigo
aDepartment of Internal Medicine, University of Texas Health Science Center in Houston bDepartment of Neurology, Division of Neuropsychology, Baylor College of Medicine, Houston cDepartment of Internal Medicine, Baylor College of Medicine dDepartment of Psychology, University of Houston, Texas, USA.
AIDS. 2015 Aug 24;29(13):1711-4. doi: 10.1097/QAD.0000000000000700.
To evaluate the role of neurocognitive impairment on retention in care across the lifespan in antiretroviral-naïve persons newly diagnosed with HIV.
A prospective observational study of 138 antiretroviral-naive newly diagnosed HIV-positive participants who presented to an urban clinic between August 2010 and April 2013.
All participants underwent a baseline evaluation that included a neuromedical examination and brief neuropsychological test battery. Retention in care was operationalized as attending at least two visits separated by more than 90 days during the 12-month follow-up period.
Fifty-five per cent of participants were retained in care over the study observation period. In a logistic regression controlling for ethnicity, there was a significant interaction between age and neurocognitive impairment in predicting retention in care (P = 0.009). Planned post-hoc analyses showed that neurocognitive impairment was associated with a significantly lower likelihood of retention in care among participants aged 50 years and older (P = .007), but not among younger participants (P > 0.05).
Extending prior research on antiretroviral adherence and medication management, findings from this study indicate that neurocognitive impairment may be an especially salient risk factor for poor retention in care among older adults with newly diagnosed HIV infection.
评估神经认知障碍对新诊断为HIV且未接受过抗逆转录病毒治疗的患者在其整个生命周期内坚持治疗的影响。
对2010年8月至2013年4月期间到一家城市诊所就诊的138名新诊断为HIV阳性且未接受过抗逆转录病毒治疗的参与者进行前瞻性观察研究。
所有参与者均接受了基线评估，包括神经医学检查和简短的神经心理测试组。坚持治疗的定义为在12个月的随访期内至少就诊两次，且两次就诊间隔超过90天。
在研究观察期内，55%的参与者坚持治疗。在控制种族因素的逻辑回归分析中，年龄与神经认知障碍在预测坚持治疗方面存在显著交互作用（P = 0.009）。计划中的事后分析表明，神经认知障碍与50岁及以上参与者坚持治疗的可能性显著降低相关（P = 0.007），而在年轻参与者中则无此关联（P > 0.05）。
本研究结果扩展了先前关于抗逆转录病毒药物依从性和药物管理的研究，表明神经认知障碍可能是新诊断为HIV感染的老年人坚持治疗不佳的一个特别突出的风险因素。
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