Marquine María J, Montoya Jessica L, Umlauf Anya, Fazeli Pariya L, Gouaux Ben, Heaton Robert K, Ellis Ronald J, Letendre Scott L, Grant Igor, Moore David J
Department of Psychiatry.
Psychology Department, University of Alabama, Birmingham.
Clin Infect Dis. 2016 Sep 1;63(5):694-702. doi: 10.1093/cid/ciw328. Epub 2016 May 19.
The Veterans Aging Cohort Study (VACS) Index, a composite marker of disease severity among human immunodeficiency virus (HIV)-infected persons, has been associated with concurrent risk for neurocognitive impairment (NCI). The present study examined whether the VACS Index predicts longitudinal neurocognitive change.
Participants included 655 HIV-infected persons followed for up to 6 years in cohort studies at the University of California, San Diego, HIV Neurobehavioral Research Program (mean age at baseline, 42.5 years; 83% male; 60% white; AIDS in 67%; median current CD4(+) T-cell count, 346/μL; 61% receiving antiretroviral therapy). The VACS Index was calculated through standard methods. Participants completed a comprehensive neurocognitive battery. Neurocognitive status was plotted over time using demographically and practice-adjusted global and domain T scores. NCI was defined by global deficit scores derived from T scores.
Baseline VACS Index scores were not predictive of changes in global T scores during the follow-up period (P = .14). However, in time-dependent analyses adjusting for covariates, higher VACS Index scores were significantly associated with worse global and domain neurocognitive performance (Ps < .01), as well as increased risk for developing NCI in a subgroup of persons who were neurocognitively normal at baseline (hazard ratio [HR], 1.17; P < .001). We categorized VACS Index scores by quartiles and found that the upper-quartile group was significantly more likely to develop NCI than the lower quartile (HR, 2.16; P < .01) and middle groups (HR, 1.76; P < .01).
Changes in VACS Index scores correspond to changes in neurocognitive function. HIV-infected persons with high VACS Index scores are at increased risk for decline and incident NCI. The VACS Index shows promise as a tool for identifying HIV-infected persons at risk for NCI.
退伍军人老龄化队列研究（VACS）指数是人类免疫缺陷病毒（HIV）感染者疾病严重程度的综合标志物，与神经认知障碍（NCI）的并发风险相关。本研究旨在探讨VACS指数是否能预测神经认知的纵向变化。
参与者包括655名HIV感染者，他们在加利福尼亚大学圣地亚哥分校HIV神经行为研究项目的队列研究中接受了长达6年的随访（基线平均年龄42.5岁；83%为男性；60%为白人；67%患有艾滋病；当前CD4(+) T细胞计数中位数为346/μL；61%接受抗逆转录病毒治疗）。通过标准方法计算VACS指数。参与者完成了一套全面的神经认知测试。使用人口统计学和练习调整后的总体及领域T分数绘制神经认知状态随时间的变化情况。NCI由从T分数得出的总体缺陷分数定义。
基线VACS指数分数不能预测随访期间总体T分数的变化（P = 0.14）。然而，在对协变量进行调整的时间依赖性分析中，较高的VACS指数分数与较差的总体及领域神经认知表现显著相关（P < 0.01），并且在基线时神经认知正常的亚组人群中发生NCI的风险增加（风险比[HR]，1.17；P < 0.001）。我们将VACS指数分数按四分位数分类，发现上四分位数组比下四分位数组（HR，2.16；P < 0.01）和中间组（HR，1.76；P < 0.01）发生NCI的可能性显著更高。
VACS指数分数的变化与神经认知功能的变化相对应。VACS指数分数高的HIV感染者发生衰退和新发NCI的风险增加。VACS指数有望成为识别有NCI风险的HIV感染者的工具。
