Rubin Leah H, Maki Pauline M, Springer Gayle, Benning Lorie, Anastos Kathryn, Gustafson Deborah, Villacres Maria C, Jiang Xiong, Adimora Adaora A, Waldrop-Valverde Drenna, Vance David E, Bolivar Hector, Alden Christine, Martin Eileen M, Valcour Victor G
From the Departments of Psychiatry (L.H.R., P.M.M.) and Psychology (P.M.M.), University of Illinois at Chicago; Department of Neurology (L.H.R.), Johns Hopkins University School of Medicine; Department and Epidemiology (G.S., L.B., C.A.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Albert Einstein College of Medicine and Montefiore Medical Center (K.A.), Bronx; Department of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, NY; University of Southern California (M.C.V.), Los Angeles; Department of Neuroscience (X.J.), Georgetown University Medical Center, Washington, DC; Division of Infectious Disease (A.A.A.), University of North Carolina at Chapel Hill; Nell Hodgson Woodruff School of Nursing (D.W.-V.), Emory University, Atlanta, GA; School of Nursing (D.E.V.), University of Alabama at Birmingham; University of Miami Miller School of Medicine (H.B.), FL; Department of Psychiatry (E.M.M.), Rush University Medical Center, Chicago, IL; and Memory and Aging Center (V.G.C.), Department of Neurology, University of California, San Francisco.
Neurology. 2017 Oct 10;89(15):1594-1603. doi: 10.1212/WNL.0000000000004491. Epub 2017 Sep 13.
To determine whether persistent viral suppression alters cognitive trajectories among HIV-infected (HIV+) women on combination antiretroviral therapy (cART) by investigating performance longitudinally in uninfected (HIV-) and 3 groups of HIV+ women: those with consistent viral suppression after continuous cART use (VS), those without consistent virologic suppression despite continuous cART use (NVS), and those without consistent virologic suppression after intermittent cART use (Int NVS).
Two hundred thirty-nine VS, 220 NVS, 172 Int NVS, and 301 HIV- women from the Women's Interagency HIV Study (WIHS) completed neuropsychological testing every 2 years for 3 visits between 2009 and 2013. Mixed-effects regressions were used to examine group differences on continuous T scores and categorical measures of impairment (T score <40).
On global function, VS women demonstrated lower scores and were more likely to score in the impaired range than HIV- women ( = 0.01). These differences persisted over time (group × time, > 0.39). VS women demonstrated lower learning and memory scores than HIV- women ( < 0.05) and lower attention/working memory and fluency scores than HIV- and NVS women ( < 0.05). Group differences in scores persisted over time. Categorically, VS women were more likely to be impaired on attention/working memory and executive function than HIV- women ( < 0.05). On motor skills, VS and NVS women showed a greater decline and were more likely to be impaired than HIV- women ( < 0.05).
Cognitive difficulties remain among HIV+ women despite persistent viral suppression. In some instances, VS women are worse than NVS women, reinforcing the need for novel adjunctive therapies to attenuate cognitive problems.
通过对未感染（HIV-）女性以及三组HIV感染（HIV+）女性进行纵向研究，以确定持续病毒抑制是否会改变接受联合抗逆转录病毒治疗（cART）的HIV感染（HIV+）女性的认知轨迹。这三组HIV+女性分别为：持续使用cART后病毒得到持续抑制的女性（VS）、尽管持续使用cART但病毒未得到持续抑制的女性（NVS）以及间歇性使用cART后病毒未得到持续抑制的女性（Int NVS）。
来自女性机构间HIV研究（WIHS）的239名VS女性、220名NVS女性、172名Int NVS女性和301名HIV-女性在2009年至2013年期间每两年完成一次神经心理学测试，共进行3次。采用混合效应回归分析来检验连续T分数和损伤分类指标（T分数<40）上的组间差异。
在整体功能方面，VS女性的得分低于HIV-女性，且比HIV-女性更有可能处于受损范围（P = 0.01）。这些差异随时间持续存在（组×时间，P>0.39）。VS女性的学习和记忆得分低于HIV-女性（P<0.05），注意力/工作记忆和流畅性得分低于HIV-女性和NVS女性（P<0.05）。得分的组间差异随时间持续存在。从分类上看，VS女性在注意力/工作记忆和执行功能方面比HIV-女性更有可能受损（P<0.05）。在运动技能方面，VS和NVS女性比HIV-女性表现出更大的下降，且更有可能受损（P<0.05）。
尽管病毒得到持续抑制，但HIV+女性仍存在认知困难。在某些情况下，VS女性比NVS女性情况更糟，这凸显了需要新的辅助疗法来减轻认知问题。
