Szanyi Jana, Kremlacek Jan, Kubova Zuzana, Kuba Miroslav, Gebousky Pavel, Kapla Jaroslav, Szanyi Juraj, Vit Frantisek, Langrova Jana
Department of Pathological Physiology, Charles University - Faculty of Medicine in Hradec Kralove, Simkova 870, 500 03, Hradec Kralove, Czech Republic.
Department of Infectious Diseases, Faculty Hospital in Hradec Kralove, Hradec Kralove, Czech Republic.
Doc Ophthalmol. 2019 Oct;139(2):83-97. doi: 10.1007/s10633-019-09697-4. Epub 2019 Apr 16.
The aim of this neurophysiological study was to monitor changes in the visual and cognitive function of HIV-infected patients treated with combination antiretroviral therapy.
Eleven adult Czech HIV+ patients, with a mean age of 35 years and CD4 cell count ≥ 230 × 10 cells/L of blood at the time of enrollment, underwent four to six examinations over the course of 2.5 years to evaluate pattern-reversal and motion-onset visual evoked potentials (P-VEPs and M-VEPs), visually driven oddball event-related potentials (ERPs) and Montreal Cognitive Assessments. In addition to evaluating the intraindividual change in the observed parameters, we also compared patient data to data from eleven age- and gender-matched controls.
We did not find any significant differences in P-VEPs between the patients and controls or in the paired comparison of the first and last visit. The only significant finding for P-VEPs was a linear trend in prolongation of the 20' P-VEP P100 peak time. In M-VEPs, we found a significant intergroup difference in the N160 peak time recorded during the first visit for peripheral M-VEPs only. During the last visit, all N160 peak times for patients differed significantly from those of the control group. The only intervisit difference close to the level of significance was for peripheral M-VEPs, which confirmed the trend analysis. No significant differences between patients and controls were found in the ERPs, but the P300 peak time showed a significant difference between the first and last visits, as confirmed by the trend. Patient reaction time was not significantly delayed at the first visit; however, it was prolonged with time, as confirmed by the trend.
Our aim was to evaluate whether antiretroviral treatment in HIV+ patients is sufficient to preserve brain visual function. The optic nerve and primary visual cortex function tested by the P-VEPs seem to be preserved. The prolongation of the M-VEPs suggests an individually detectable decline in CNS function, but these changes did not show a progression during the follow-up. From a longitudinal perspective, the trends in peak time prolongation of the 20' P-VEP, peripheral M-VEP, ERP and reaction time suggest a faster decline than that caused by aging in healthy populations, as previously described in a cross-sectional study.
这项神经生理学研究的目的是监测接受联合抗逆转录病毒治疗的HIV感染患者视觉和认知功能的变化。
11名成年捷克HIV阳性患者，平均年龄35岁，入组时CD4细胞计数≥230×10⁶个/升血液，在2.5年的时间里接受了4至6次检查，以评估模式翻转和运动起始视觉诱发电位（P-VEP和M-VEP）、视觉驱动的奇偶数事件相关电位（ERP）以及蒙特利尔认知评估。除了评估观察参数的个体内变化外，我们还将患者数据与11名年龄和性别匹配的对照组数据进行了比较。
我们发现患者和对照组之间的P-VEP以及首次和末次就诊的配对比较中均未发现任何显著差异。P-VEP唯一的显著发现是20' P-VEP P100峰时间延长的线性趋势。在M-VEP中，仅在首次就诊时记录的外周M-VEP的N160峰时间存在显著的组间差异。在末次就诊时，患者的所有N160峰时间与对照组均有显著差异。唯一接近显著水平的就诊间差异是外周M-VEP，这证实了趋势分析。患者和对照组在ERP方面未发现显著差异，但P300峰时间在首次和末次就诊之间存在显著差异，趋势分析证实了这一点。患者首次就诊时反应时间未显著延迟；然而，随着时间的推移反应时间延长，趋势分析证实了这一点。
我们的目的是评估HIV阳性患者的抗逆转录病毒治疗是否足以保护大脑视觉功能。通过P-VEP测试的视神经和初级视觉皮层功能似乎得以保留。M-VEP的延长表明中枢神经系统功能存在个体可检测到的下降，但这些变化在随访期间并未显示出进展。从纵向角度来看，20' P-VEP、外周M-VEP、ERP和反应时间的峰时间延长趋势表明，其下降速度比健康人群衰老导致的下降速度更快，正如之前横断面研究中所描述的那样。
