Institute for Global Health, University College London, London, UK.
Division of Infectious Diseases, Imperial College London, London, UK.
HIV Med. 2019 Apr;20(4):274-285. doi: 10.1111/hiv.12714. Epub 2019 Feb 8.
We investigated whether differences in cognitive performance between people living with HIV (PLWH) and comparable HIV-negative people were mediated or moderated by depressive symptoms and lifestyle factors.
A cross-sectional study of 637 'older' PLWH aged ≥ 50 years, 340 'younger' PLWH aged < 50 years and 276 demographically matched HIV-negative controls aged ≥ 50 years enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study was performed. Cognitive function was assessed using a computerized battery (CogState). Scores were standardized into Z-scores [mean = 0; standard deviation (SD) = 1] and averaged to obtain a global Z-score. Depressive symptoms were evaluated via the Patient Health Questionnaire (PHQ-9). Differences between the three groups and the effects of depression, sociodemographic factors and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education.
After adjustment for sociodemographic factors, older and younger PLWH had poorer overall cognitive scores than older HIV-negative controls (P < 0.001 and P = 0.006, respectively). Moderate or severe depressive symptoms were more prevalent in both older (27%; P < 0.001) and younger (21%; P < 0.001) PLWH compared with controls (8%). Depressive symptoms (P < 0.001) and use of hashish (P = 0.01) were associated with lower cognitive function; alcohol consumption (P = 0.02) was associated with better cognitive scores. After further adjustment for these factors, the difference between older PLWH and HIV-negative controls was no longer significant (P = 0.08), while that between younger PLWH and older HIV-negative controls remained significant (P = 0.01).
Poorer cognitive performances in PLWH compared with HIV-negative individuals were, in part, mediated by the greater prevalence of depressive symptoms and recreational drug use reported by PLWH.
我们研究了艾滋病毒感染者（PLWH）和可比的 HIV 阴性人群之间认知表现的差异是否受到抑郁症状和生活方式因素的调节或中介。
对参加 Pharmacokinetic 和 Clinical Observations in People over Fifty (POPPY) 研究的 637 名年龄≥50 岁的“老年”PLWH、340 名年龄<50 岁的“年轻”PLWH和 276 名年龄≥50 岁的匹配的 HIV 阴性对照者进行了一项横断面研究。使用计算机化电池（CogState）评估认知功能。分数标准化为 Z 分数[平均值=0；标准差（SD）=1]，并平均获得全局 Z 分数。通过患者健康问卷（PHQ-9）评估抑郁症状。使用中位数回归评估三组之间的差异以及抑郁、社会人口统计学因素和生活方式因素对认知表现的影响。所有分析均考虑了年龄、性别、种族和教育水平。
在调整了社会人口统计学因素后，老年和年轻的 PLWH 的整体认知评分均低于老年 HIV 阴性对照组（P<0.001 和 P=0.006）。与对照组（分别为 27%和 21%，P<0.001）相比，老年（27%，P<0.001）和年轻（21%，P<0.001）PLWH 中更普遍存在中度或重度抑郁症状。抑郁症状（P<0.001）和大麻使用（P=0.01）与认知功能降低相关；而饮酒（P=0.02）与认知评分提高相关。在进一步调整这些因素后，老年 PLWH 与 HIV 阴性对照组之间的差异不再显著（P=0.08），而年轻 PLWH 与老年 HIV 阴性对照组之间的差异仍然显著（P=0.01）。
与 HIV 阴性个体相比，PLWH 的认知表现较差，部分原因是 PLWH 报告的抑郁症状和娱乐性药物使用更为普遍。
