Robertson K, Jiang H, Evans S R, Marra C M, Berzins B, Hakim J, Sacktor N, Silva M Tulius, Campbell T B, Nair A, Schouten J, Kumwenda J, Supparatpinyo K, Tripathy S, Kumarasamy N, la Rosa A, Montano S, Mwafongo A, Firnhaber C, Sanne I, Naini L, Amod F, Walawander A
Department of Neurology, University of North Carolina, 2127 Physician Office Building, 170 Manning Drive, Chapel Hill, NC, 27599-7025, USA.
Harvard University, Boston, MA, USA.
J Neurovirol. 2016 Aug;22(4):472-8. doi: 10.1007/s13365-015-0415-2. Epub 2016 Jan 5.
Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (<10 and ≥10 years), and age (<35 and ≥35 years). Of 2400 enrolled, 770 completed the 6-month follow-up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p < 0.0001). There was variation between the age, gender, and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance, and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the necessary neurocognitive normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers.
在资源有限的环境（RLS）中开展神经学研究的基础设施十分有限。缺乏临床解读所需的神经学和神经心理学（NP）评估及规范数据阻碍了研究和临床护理工作。在此，我们报告ACTG 5271研究，该研究为临床站点人员提供了神经学培训，并在不同环境中收集了神经认知规范比较数据。在7个资源有限国家的10个站点，我们提供了NP评估培训。我们收集了来自巴西（n = 240）、印度（n = 480）、马拉维（n = 481）、秘鲁（n = 239）、南非（480）、泰国（n = 240）和津巴布韦（n = 240）的HIV阴性参与者的规范比较数据。在基线标准化NP检查前30天内HIV检测呈阴性的参与者有770人，6个月时为770人。参与者按性别（女性和男性）、教育程度（<10年和≥10年）和年龄（<35岁和≥35岁）分为八个层次。在登记的2400人中，770人完成了6个月的随访。正如预期的那样，所有神经认知测试分数在国家间存在显著差异（p < 0.0001）。神经认知测试在年龄、性别和教育层次之间存在差异。年龄和教育程度是所有测试的重要变量；年龄较大的参与者表现较差，而受教育程度较高的参与者表现较好。女性在言语学习/记忆和加工速度测试中表现较好，而男性在运动测试中表现较好。本研究提供了必要的神经认知规范数据，可为未来在不同资源有限环境中开展神经学和神经认知研究建立基础设施。这些规范数据是临床医生和研究人员急需的资源。
