San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA.
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA.
J Int Neuropsychol Soc. 2020 Feb;26(2):147-162. doi: 10.1017/S1355617719000985. Epub 2019 Oct 2.
Frascati international research criteria for HIV-associated neurocognitive disorders (HAND) are controversial; some investigators have argued that Frascati criteria are too liberal, resulting in a high false positive rate. Meyer et al. recommended more conservative revisions to HAND criteria, including exploring other commonly used methodologies for neurocognitive impairment (NCI) in HIV including the global deficit score (GDS). This study compares NCI classifications by Frascati, Meyer, and GDS methods, in relation to neuroimaging markers of brain integrity in HIV.
Two hundred forty-one people living with HIV (PLWH) without current substance use disorder or severe (confounding) comorbid conditions underwent comprehensive neurocognitive testing and brain structural magnetic resonance imaging and magnetic resonance spectroscopy. Participants were classified using Frascati criteria versus Meyer criteria: concordant unimpaired [Frascati(Un)/Meyer(Un)], concordant impaired [Frascati(Imp)/Meyer(Imp)], or discordant [Frascati(Imp)/Meyer(Un)] which were impaired via Frascati criteria but unimpaired via Meyer criteria. To investigate the GDS versus Meyer criteria, the same groupings were utilized using GDS criteria instead of Frascati criteria.
When examining Frascati versus Meyer criteria, discordant Frascati(Imp)/Meyer(Un) individuals had less cortical gray matter, greater sulcal cerebrospinal fluid volume, and greater evidence of neuroinflammation (i.e., choline) than concordant Frascati(Un)/Meyer(Un) individuals. GDS versus Meyer comparisons indicated that discordant GDS(Imp)/Meyer(Un) individuals had less cortical gray matter and lower levels of energy metabolism (i.e., creatine) than concordant GDS(Un)/Meyer(Un) individuals. In both sets of analyses, the discordant group did not differ from the concordant impaired group on any neuroimaging measure.
The Meyer criteria failed to capture a substantial portion of PLWH with brain abnormalities. These findings support continued use of Frascati or GDS criteria to detect HIV-associated CNS dysfunction.
弗朗西斯科国际艾滋病相关神经认知障碍研究标准（HAND）存在争议；一些研究人员认为弗朗西斯科标准过于宽松，导致假阳性率高。Meyer 等人建议对 HAND 标准进行更保守的修订，包括探索 HIV 神经认知障碍（NCI）的其他常用方法，包括全球缺陷评分（GDS）。本研究比较了弗朗西斯科、迈尔和 GDS 方法对 HIV 患者的 NCI 分类，以及与 HIV 患者脑结构磁共振成像和磁共振波谱的神经影像学标志物的关系。
241 名无当前物质使用障碍或严重（混杂）合并症的 HIV 感染者（PLWH）接受了全面的神经认知测试和脑结构磁共振成像和磁共振波谱检查。参与者根据弗朗西斯科标准与迈尔标准进行分类：一致无损[弗朗西斯科（Un）/迈尔（Un）]、一致受损[弗朗西斯科（Imp）/迈尔（Imp）]或不一致[弗朗西斯科（Imp）/迈尔（Un）]，即根据弗朗西斯科标准受损，但根据迈尔标准无损。为了研究 GDS 与迈尔标准的关系，使用 GDS 标准代替弗朗西斯科标准，对相同的分组进行了相同的分组。
当比较弗朗西斯科标准与迈尔标准时，不一致的弗朗西斯科（Imp）/迈尔（Un）个体的皮质灰质较少，脑沟脑脊液体积较大，神经炎症（即胆碱）证据较多，而一致的弗朗西斯科（Un）/迈尔（Un）个体则较少。GDS 与迈尔标准的比较表明，不一致的 GDS（Imp）/迈尔（Un）个体的皮质灰质较少，能量代谢（即肌酸）水平较低，而一致的 GDS（Un）/迈尔（Un）个体则较少。在这两组分析中，不一致组在任何神经影像学测量上与一致受损组均无差异。
迈尔标准未能捕捉到大量有脑异常的 HIV 感染者。这些发现支持继续使用弗朗西斯科或 GDS 标准来检测 HIV 相关的中枢神经系统功能障碍。
