Division of Infectious Diseases, Department of Medicine.
Department of Neurology, Washington University School of Medicine.
AIDS. 2019 Jul 15;33(9):1477-1483. doi: 10.1097/QAD.0000000000002236.
Neuropsychiatric symptoms have been reported in people living with HIV (PLWH) on integrase strand transfer inhibitors (INSTIs) in postmarketing analysis. Limited data exist regarding brain integrity (function and structure) in PLWH prescribed INSTIs compared with other HIV treatment regimens.
A cross-sectional analysis of PLWH on combined antiretroviral therapy aged more than 18 years at a single institution.
Neuropsychological tests were administered to calculate domain deficit scores in learning/memory, executive function and motor/psychomotor domains. Cortical and subcortical volumes from MRI were obtained using the FreeSurfer software suite (v5.3).
Of 202 participants, median age 55 (48, 60) years old, 49% were on INSTI-based combined antiretroviral therapy. PLWH on INSTIs were similar to individuals on non-INSTIs in terms of age, sex, race, education years, smoking history, depression scores, psychiatric medication use, presence of hepatitis C infection, history of substance use, HIV infection duration and recent or nadir CD4 T-cell count. Participants in the INSTI group performed worse than non-INSTI users in the verbal learning and memory domain [1.5 (interquartile range 0, 2.5) versus 1 (0, 2); P = 0.016]. The INSTI and non-INSTI groups were similar for other cognitive domains. Frontal, brain stem and cerebellar volumes were reduced in INSTI compared with non-INSTI users (all P = <0.05).
We demonstrated modest differences in learning/memory performance and smaller brain volumes in PLWH on INSTI-based regimens compared with non-INSTI users. Prospective studies are needed to define mechanisms and the clinical significance of reduced brain integrity in PLWH on INSTIs.
在上市后分析中，有报道称接受整合酶链转移抑制剂（INSTI）治疗的艾滋病毒感染者（PLWH）出现神经精神症状。与其他 HIV 治疗方案相比，接受 INSTI 治疗的 PLWH 脑完整性（功能和结构）的相关数据有限。
在一家机构内对接受联合抗逆转录病毒疗法的年龄超过 18 岁的 PLWH 进行横断面分析。
对接受联合抗逆转录病毒疗法的 PLWH 进行神经心理学测试，以计算学习/记忆、执行功能和运动/精神运动等领域的域缺陷评分。使用 FreeSurfer 软件套件（v5.3）从 MRI 中获得皮质和皮质下体积。
在 202 名参与者中，中位年龄 55（48，60）岁，49%接受基于 INSTI 的联合抗逆转录病毒治疗。在 INSTI 组和非 INSTI 组中，年龄、性别、种族、教育年限、吸烟史、抑郁评分、精神药物使用、丙型肝炎感染、物质使用史、HIV 感染持续时间和最近或最低 CD4 T 细胞计数无差异。在言语学习和记忆领域，INSTI 组的参与者表现不如非 INSTI 使用者[1.5（四分位距 0，2.5）与 1（0，2）；P=0.016]。在其他认知领域，INSTI 组和非 INSTI 组相似。与非 INSTI 使用者相比，INSTI 组的额、脑干和小脑体积较小（均 P<0.05）。
我们发现，与非 INSTI 使用者相比，接受基于 INSTI 的方案治疗的 PLWH 在学习/记忆表现和脑体积较小方面存在差异。需要前瞻性研究来确定 INSTI 治疗的 PLWH 脑完整性降低的机制和临床意义。
