Su Tanja, Wit Ferdinand W N M, Caan Matthan W A, Schouten Judith, Prins Maria, Geurtsen Gert J, Cole James H, Sharp David J, Richard Edo, Reneman Liesbeth, Portegies Peter, Reiss Peter, Majoie Charles B
aDepartment of Radiology, Academic Medical Center bDepartment of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development (AIGHD) cDepartment of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center dDepartment of Neurology, Academic Medical Center eCluster Infectious Diseases Research, Public Health Service of Amsterdam fDepartment of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands gThe Computational, Cognitive, and Clinical Neuroimaging Laboratory, Department of Medicine, Imperial College London, London, UK hDepartment of Neurology, Radboud University Medical Centre, Nijmegen iDepartment of Neurology, Onze Lieve Vrouwe Gasthuis jHIV Monitoring Foundation, Amsterdam, The Netherlands.
AIDS. 2016 Sep 24;30(15):2329-39. doi: 10.1097/QAD.0000000000001133.
OBJECTIVES: The objective of this study was to assess whether HIV-infected patients on long-term successful combination antiretroviral therapy (cART) have more extensive white matter hyperintensities (WMH) of presumed vascular origin compared with uninfected controls and whether these intensities are associated with cognitive impairment. Furthermore, we explored potential determinants of increased WMH load long-term suppressed HIV infection. DESIGN: A cross-sectional comparison of WMH in an observational cohort. METHODS: Clinical, cognitive, and MRI data were collected from 103 middle-aged, aviremic HIV-infected men on cART, and 70 HIV-uninfected, otherwise similar controls. In the MRI data, WMH load was quantified by automated approaches and qualitatively reviewed by an experienced neuroradiologist using the Fazekas scale. RESULTS: HIV-infected men had an increased WMH load. Among HIV-infected patients, increased WMH load was independently associated with older age, higher DBP, higher D-dimer levels, and longer time spent with a CD4 cell count below 500 cells/μl. HIV-associated cognitive deficits were associated with increased WMH load. CONCLUSIONS: WMH are more extensive and associated with cognitive deficits in middle-aged, aviremic cART-treated HIV-infected men. The extent of WMH load was associated with both cardiovascular risk factors and past immune deficiency. As cognitive impairment in these same patients is also associated with these risk factors, this may suggest that in the setting of HIV, WMH, and cognitive deficits share a common cause. This supports the importance of optimizing cardiovascular risk management, and early, effective treatment of HIV infection.
目的：本研究的目的是评估与未感染的对照组相比，长期接受成功的联合抗逆转录病毒疗法（cART）的HIV感染患者是否有更多假定为血管源性的脑白质高信号（WMH），以及这些高信号是否与认知障碍相关。此外，我们探讨了长期抑制HIV感染导致WMH负荷增加的潜在决定因素。 设计：在一个观察性队列中对WMH进行横断面比较。 方法：收集了103名接受cART治疗的中年、无病毒血症的HIV感染男性以及70名未感染HIV但其他方面相似的对照组的临床、认知和MRI数据。在MRI数据中，通过自动化方法对WMH负荷进行量化，并由一名经验丰富的神经放射科医生使用Fazekas量表进行定性评估。 结果：HIV感染男性的WMH负荷增加。在HIV感染患者中，WMH负荷增加与年龄较大、舒张压较高、D-二聚体水平较高以及CD4细胞计数低于500个/μl的时间较长独立相关。HIV相关的认知缺陷与WMH负荷增加相关。 结论：在接受cART治疗的中年、无病毒血症的HIV感染男性中，WMH更为广泛且与认知缺陷相关。WMH负荷的程度与心血管危险因素和既往免疫缺陷均相关。由于这些患者的认知障碍也与这些危险因素相关，这可能表明在HIV感染的情况下，WMH和认知缺陷有共同的病因。这支持了优化心血管风险管理以及早期、有效治疗HIV感染的重要性。
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