Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Okinawa Study Center, The Open University of Japan, Chiba, Japan.
PLoS One. 2018 Jun 14;13(6):e0199106. doi: 10.1371/journal.pone.0199106. eCollection 2018.
In this study, we demonstrated the pervasiveness of HIV-associated neurocognitive disorders (HAND) among a selection of Japanese patients as well as evaluated and compared the Mini Mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS) for use as a screening tool among combination anti-retroviral therapy (cART)-naïve and cART experienced patients. The MMSE and the IHDS have both been used as HAND screening tests around the world with variable success. It has been reported the increased usage of cART the utility of these screening tests may have been diminished due to the decreased severity of impairment and the altered pattern of neurocognitive impairments in cART era HAND patients. It is therefore possible the MMSE and the IHDS may still be useful among cART-naïve patients even in the cART era. However, only one study has investigated and compared the screening results of the IHDS among cART-naïve and cART experienced patients. All HIV positive patients who visited, or were admitted, to the Ryukyu University Hospital between January 2009 and March 2014 were evaluated for inclusion. Selected patients (n = 49) had data without omission for all tests. The overall prevalence of HAND in our cohort was 44%. The area under the curve (AUC), for all subjects using the MMSE and the IHDS, were 0.60 and 0.69, respectively. However, the AUC among cART-naïve patients were 0.58 and 0.76 for the MMSE and the IHDS, respectively. Whereas, cART experienced patients had an AUC of 0.60 and 0.61, respectively. Overall, the MMSE demonstrated a poor screening ability for HAND, regardless of cART usage (the cut-off value of 27 had a Youden's J-Index of 0.1, in all groups). Alternatively, the IHDS was moderately useful for HAND screening among cART-naïve patients (the cut-off value of 11 had a Youden's J-Index of 0.4), but performed poorly as a screening test among cART experienced patients (the cut-off value of 11 had a Youden's J-Index of 0.1).
在这项研究中，我们展示了一系列日本患者中普遍存在的与 HIV 相关的神经认知障碍（HAND），并评估和比较了简易精神状态检查（MMSE）和国际 HIV 痴呆量表（IHDS）作为未接受联合抗逆转录病毒治疗（cART）和接受 cART 治疗的患者的筛选工具。MMSE 和 IHDS 已被世界各地用于 HAND 筛查测试，但成功率不同。据报道，由于 cART 使用率的增加，这些筛查测试的效用可能降低，因为 cART 时代 HAND 患者的损伤严重程度降低，神经认知损伤模式发生改变。因此，即使在 cART 时代，MMSE 和 IHDS 可能仍对 cART 初治患者有用。然而，只有一项研究调查和比较了 IHDS 在 cART 初治和 cART 经验丰富的患者中的筛查结果。评估了 2009 年 1 月至 2014 年 3 月期间访问或住院的琉球大学医院的所有 HIV 阳性患者是否符合纳入标准。选择了（n=49）所有测试数据无缺失的患者。我们队列中的 HAND 总患病率为 44%。使用 MMSE 和 IHDS 对所有受试者的曲线下面积（AUC）分别为 0.60 和 0.69。然而，MMSE 在 cART 初治患者中的 AUC 分别为 0.58 和 0.76，而 IHDS 的 AUC 分别为 0.60 和 0.61。总的来说，无论 cART 的使用情况如何，MMSE 对 HAND 的筛查能力都较差（所有组的截断值为 27 时，Youden's J-Index 为 0.1）。相反，IHDS 对 cART 初治患者的 HAND 筛查具有中等的有用性（截断值为 11 时，Youden's J-Index 为 0.4），但作为 cART 经验丰富患者的筛查测试效果不佳（截断值为 11 时，Youden's J-Index 为 0.1）。
