HIV 患者共病负担和年龄对大脑完整性的影响。
Effects of comorbidity burden and age on brain integrity in HIV.
机构信息
Department of Psychiatry, University of California San Diego, La Jolla.
San Diego State University/University of California at San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
出版信息
AIDS. 2019 Jun 1;33(7):1175-1185. doi: 10.1097/QAD.0000000000002192.
OBJECTIVE
The influence of confounding neurocognitive comorbidities in people living with HIV (PLWH) on neuroimaging has not been systematically evaluated. We determined associations between comorbidity burden and brain integrity and examined the moderating effect of age on these relationships.
DESIGN
Observational, cross-sectional substudy of the CNS HIV Antiretroviral Therapy Effects Research cohort.
METHODS
A total of 288 PLWH (mean age = 44.2) underwent structural MRI and magnetic resonance spectroscopy as well as neurocognitive and neuromedical assessments. Consistent with Frascati criteria for HIV-associated neurocognitive disorders (HAND), neuromedical and neuropsychiatric comorbidity burden was classified as incidental (mild), contributing (moderate), or confounding (severe-exclusionary) to a diagnosis of HAND. Multiple regression modeling predicted neuroimaging outcomes as a function of comorbidity classification, age, and their interaction.
RESULTS
Comorbidity classifications were 176 incidental, 77 contributing, and 35 confounded; groups did not differ in HIV disease characteristics. Relative to incidental and contributing participants, confounded participants had less cortical gray matter and more abnormal white matter and ventricular cerebrospinal fluid, alongside more neuroinflammation (choline, myo-inositol) and less neuronal integrity (N-acetylaspartate). Older age exacerbated the impact of comorbidity burden: to a greater extent in the confounded group, older age was associated with more abnormal white matter (P = 0.017), less total white matter (P = 0.015), and less subcortical gray matter (P = 0.014).
CONCLUSION
Neuroimaging in PLWH reveals signatures associated with confounding neurocognitive conditions, emphasizing the importance of evaluating these among individuals with suspected HAND. Older age amplifies subcortical and white matter tissue injury, especially in PLWH with severe comorbidity burden, warranting increased attention to this population as it ages.
目的
尚未系统评估合并存在的神经认知共病对 HIV 感染者（PLWH）神经影像学的影响。我们确定了共病负担与大脑完整性之间的关联，并研究了年龄对这些关系的调节作用。
设计
中枢神经系统 HIV 抗逆转录病毒治疗效果研究队列的观察性、横断面亚研究。
方法
共纳入 288 名 PLWH（平均年龄 44.2 岁），进行了结构磁共振成像和磁共振波谱检查以及神经认知和神经医学评估。根据 HIV 相关认知障碍（HAND）的 Frascati 标准，将神经医学和神经精神共病负担分类为偶然（轻度）、促成（中度）或混杂（重度-排除）HAND 诊断。多元回归模型预测了共病分类、年龄及其相互作用对神经影像学结果的影响。
结果
共病分类为 176 例偶然、77 例促成和 35 例混杂；各组在 HIV 疾病特征方面无差异。与偶然和促成组相比，混杂组的皮质灰质较少，白质异常和脑室脑脊液较多，神经炎症（胆碱、肌醇）较多，神经元完整性（N-乙酰天冬氨酸）较少。年龄较大加重了共病负担的影响：在混杂组中更为明显，年龄较大与更多的白质异常（P=0.017）、更少的总白质（P=0.015）和更少的皮质下灰质（P=0.014）相关。
结论
PLWH 的神经影像学显示与混杂性认知状况相关的特征，强调在疑似 HAND 个体中评估这些特征的重要性。年龄较大加重了皮质下和白质组织损伤，特别是在共病负担严重的 PLWH 中，随着这一人群年龄的增长，需要更加关注这一人群。
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