Janssen Research and Development, Johnson and Johnson, Raritan, New Jersey.
Division of Biostatistics, College of Public Health, The Ohio State University.
AIDS. 2020 May 1;34(6):893-902. doi: 10.1097/QAD.0000000000002491.
The aim of this study was to evaluate associations of antiretroviral therapy (ART) and comorbidities with neurocognitive impairments (NCIs) in ART-naive HIV-1-infected patients in clinical practice.
A retrospective study was conducted in ART-naive patients with HIV-1 diagnosis between January 2009 and December 2013 in the United States.
The primary outcome was any NCI that included HIV-associated neurocognitive disorders (HAND), Alzheimer's disease, Parkinson's disease, multiple sclerosis, and other dementias.
A total of 47 862 patients met eligibility criteria (30 828 antiretroviral-treated and 17 034 antiretroviral-untreated). The median age was 45 years [interquartile range (IQR) 35--52] with 31% of patients aged at least 50 years. Seventy-five percent were men. Overall, ART was associated with reduced risks of any NCI (hazard ratio 0.41, 95% CI: 0.37--0.45), HAND (hazard ratio 0.57, 95% CI: 0.48--0.69), Alzheimer's disease (hazard ratio 0.36, 95% CI: 0.24--0.54), Parkinson's disease (hazard ratio 0.36, 95% CI: 0.25--0.51), multiple sclerosis (hazard ratio 0.26, 95% CI: 0.18--0.37), and other dementias (hazard ratio 0.50, 95% CI: 0.45--0.55). Meanwhile, the risk of any NCI was significantly increased in patients with various comorbidities including cardiac arrhythmia, paralysis, other neurological disorders, complicated diabetes, hypothyroidism, renal failure, lymphoma, rheumatoid arthritis, weight loss, and depression as compared with patients without those comorbidities.
ART may reduce the risk of NCIs in HIV-infected patients in general. Further research to investigate NCIs on specific antiretroviral regimens and comorbidities may provide insights regarding the long-term clinical care of these patients.
本研究旨在评估抗逆转录病毒疗法（ART）和合并症与临床实践中未接受 ART 的 HIV-1 感染患者的神经认知障碍（NCI）之间的关联。
这是一项在美国 2009 年 1 月至 2013 年 12 月间进行的、针对 HIV-1 初诊患者的回顾性研究。
主要结局为任何 NCI，包括 HIV 相关神经认知障碍（HAND）、阿尔茨海默病、帕金森病、多发性硬化症和其他痴呆。
共有 47862 名患者符合入选标准（30828 名接受抗逆转录病毒治疗和 17034 名未接受抗逆转录病毒治疗）。中位年龄为 45 岁[四分位距（IQR）35-52]，至少 50 岁的患者占 31%。75%为男性。总体而言，ART 降低了发生任何 NCI（风险比 0.41，95%CI：0.37-0.45）、HAND（风险比 0.57，95%CI：0.48-0.69）、阿尔茨海默病（风险比 0.36，95%CI：0.24-0.54）、帕金森病（风险比 0.36，95%CI：0.25-0.51）、多发性硬化症（风险比 0.26，95%CI：0.18-0.37）和其他痴呆（风险比 0.50，95%CI：0.45-0.55）的风险。与此同时，与无这些合并症的患者相比，患有心律失常、瘫痪、其他神经系统疾病、复杂糖尿病、甲状腺功能减退症、肾衰竭、淋巴瘤、类风湿关节炎、体重减轻和抑郁症等各种合并症的患者发生任何 NCI 的风险显著增加。
ART 可能降低一般 HIV 感染患者发生 NCI 的风险。进一步研究特定抗逆转录病毒方案和合并症对 NCI 的影响，可能为这些患者的长期临床护理提供思路。
