围生期感染人类免疫缺陷病毒的青少年及其同龄人的神经认知和生活质量研究。NeuroCoRISpeS 研究。
Neurocognitive and quality of life study in perinatally HIV-infected young people and their peers. NeuroCoRISpeS study.
机构信息
Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain.
Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Madrid, Spain.
出版信息
Enferm Infecc Microbiol Clin (Engl Ed). 2020 Nov;38(9):417-424. doi: 10.1016/j.eimc.2020.01.004. Epub 2020 Feb 26.
BACKGROUND
Assessing the role of HIV and non-HIV related factors is essential for a better understanding of the neurocognitive outcomes in perinatally HIV-infected (PHIV+) young people. The aim of our study was to assess cognition and quality of life (QoL) of a PHIV+ cohort of young people and to compare it with a control group.
METHODS
Thirty PHIV+ and 30 HIV(-) healthy young adults matched by age, sex and socioeconomic status completed a protocol that included neurocognitive tests, a psychosocial semi-structured interview and a QoL questionnaire (PedsQL). Neurocognitive domain-specific and domain-general (NPZ-5) Z-scores were calculated. CDC AIDS-defining category C or not C (PHIV+/C, PHIV+/noC) was considered to evaluate differences within the PHIV+ group. Univariate and multivariate analysis were performed.
RESULTS
Sixty patients were included; 67% were female; median age (IQR) 19 years (18-21). Regarding PHIV+ young people, 27% showed CDC C category (none encephalopathy), 93% were on ART and 77% had undetectable viral load. No differences regarding occupation were found, although the HIV(-) group repeated less grades (p=0.028) and had a higher education level (p=0.021). No differences were found between PHIV+/noC and HIV(-) participants. However, the PHIV+/C group showed poorer performance than PHIV+/noC (NPZ-5, p=0.037) and HIV(-) subjects (crystallised intelligence, p=0.025; intelligence quotient, p=0.016). Higher nadir CD4+ T-cell count was related to better Z-score in memory (p=0.007) and NPZ-5 (p=0.025). Earlier and longer exposure to ART resulted in better performance in memory (p=0.004) and executive functions (p=0.015), respectively.
CONCLUSIONS
No significant differences were found in the neurocognitive profile nor QoL between PHIV+/noC and HIV(-) adolescents; however, PHIV+/C participants obtained lower scores. The use of longer and earlier ART seems to have a beneficial effect.
背景
评估 HIV 和非 HIV 相关因素的作用对于更好地了解围产期感染 HIV 的年轻人（PHIV+）的神经认知结果至关重要。我们研究的目的是评估 PHIV+年轻人的认知和生活质量（QoL），并将其与对照组进行比较。
方法
30 名 PHIV+和 30 名 HIV（-）健康的年轻成年人按年龄、性别和社会经济地位进行匹配，完成了包括神经认知测试、心理社会半结构化访谈和生活质量问卷（PedsQL）在内的方案。计算了神经认知领域特异性和领域一般性（NPZ-5）Z 分数。考虑到 PHIV+ 组内的差异，评估了符合或不符合美国疾病控制与预防中心（CDC）艾滋病定义标准 C 类（PHIV+/C、PHIV+/noC）的情况。进行了单变量和多变量分析。
结果
共纳入 60 例患者；其中 67%为女性；中位年龄（IQR）为 19 岁（18-21 岁）。关于 PHIV+年轻人，27%的人符合 CDC C 类标准（无脑病），93%的人正在接受抗逆转录病毒治疗（ART），77%的人的病毒载量无法检测到。尽管 HIV（-）组重复的年级较少（p=0.028），教育水平较高（p=0.021），但在职业方面没有发现差异。PHIV+/noC 和 HIV（-）参与者之间没有发现差异。然而，PHIV+/C 组的表现不如 PHIV+/noC（NPZ-5，p=0.037）和 HIV（-）受试者（晶体智力，p=0.025；智商，p=0.016）。更低的 CD4+T 细胞计数最低点与记忆（p=0.007）和 NPZ-5（p=0.025）的 Z 分数更高相关。更早和更长时间接受抗逆转录病毒治疗（ART）分别导致记忆（p=0.004）和执行功能（p=0.015）表现更好。
结论
PHIV+/noC 和 HIV（-）青少年的神经认知特征和生活质量没有显著差异；然而，PHIV+/C 组的得分较低。使用更长和更早的 ART 似乎有有益的效果。
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