与未感染 HIV 的老年人相比，低风险饮酒对感染 HIV 的老年人的神经认知的影响。
The Effects of Low-Risk Drinking on Neurocognition Among Older Persons Living With HIV as Compared to Those Without HIV.
机构信息
From the, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, (MK, EWP, RS), San Diego State University/University of California, San Diego, San Diego, California.
HIV Neurobehavioral Research Program, (MK, EWP, RS, AU, RE, DJM), Department of Psychiatry, University of California, San Diego, San Diego, California.
出版信息
Alcohol Clin Exp Res. 2020 Jul;44(7):1389-1399. doi: 10.1111/acer.14379. Epub 2020 Jun 18.
BACKGROUND
Heavy alcohol use negatively impacts neurocognition, but some studies report neurocognitive benefits associated with light drinking among HIV-seronegative (HIV-) older persons, suggesting a nonlinear or an inverted "J-shaped" association of alcohol consumption on neurocognition. Alcohol use is common among people with HIV (PWH); however, the association between recent "low-risk" alcohol consumption and neurocognition among PWH is poorly understood.
METHODS
Participants included 310 PWH and 89 HIV- older (≥50 years) adults who reported alcohol abstinence or "low-risk" drinking, defined per the National Institute on Alcohol Abuse and Alcoholism criteria (i.e., ≥15 drinks/wk or ≥5 drinks/d for men; ≥8 drinks/wk or ≥4 drinks/d for women). Neurocognition was measured using global and domain-specific demographically corrected T-scores. Multiple linear regressions examined the interaction between total drinks in the last 30 days (linear and quadratic terms) and HIV serostatus on neurocognition, covarying for age, sex, lifetime major depressive disorder, lifetime nonalcohol substance use disorders, and lifetime alcohol use disorder.
RESULTS
Total drinks consumed in the last 30 days did not differ by HIV serostatus (p = 0.202). Among HIV- older adults, quadratic effects of total drinks on neurocognition occurred such that optimal neurocognition (i.e., global function, executive function, learning, delayed recall, and motor skills) was detected at intermediate levels of "low-risk" drinking (~20 to 40 drinks), with poorer performance at the lower and higher ranges of "low-risk" consumption. In PWH, total drinks did not exhibit linear or quadratic associations with neurocognition.
CONCLUSIONS
In HIV- "low-risk" drinkers, intermediate levels of recent alcohol use were associated with better neurocognition, consistent with the inverted J-shaped association. The same nonlinear effect of recent alcohol consumption on neurocognition was absent in PWH, indicating there may be no beneficial or deleterious effects of low-risk alcohol consumption on neurocognition among PWH. Future research is warranted to examine associations between alcohol consumption and HIV-related biopsychosocial disadvantages that may supersede the neurocognitive benefits of alcohol.
背景
大量饮酒会对认知功能产生负面影响，但一些研究报告称，在 HIV 阴性（HIV-）的老年人中，轻度饮酒与认知功能相关，这表明饮酒与认知功能之间存在非线性或倒置的“J 形”关联。HIV 感染者（PWH）中饮酒较为常见；然而，PWH 中近期“低风险”饮酒与认知功能之间的关联尚不清楚。
方法
参与者包括 310 名 PWH 和 89 名 HIV-老年人（≥50 岁），他们报告了酒精禁欲或“低风险”饮酒，这是根据国家酒精滥用和酒精中毒研究所的标准定义的（即，男性每周≥15 杯或每天≥5 杯；女性每周≥8 杯或每天≥4 杯）。使用全球和特定领域的人口统计学校正 T 评分来衡量认知功能。多元线性回归检验了过去 30 天内总饮酒量（线性和二次项）与 HIV 血清状态对认知功能的交互作用，同时对年龄、性别、终生重度抑郁症、终生非酒精物质使用障碍和终生酒精使用障碍进行了协方差分析。
结果
过去 30 天内的总饮酒量不因 HIV 血清状态而异（p=0.202）。在 HIV-老年人中，总饮酒量对认知功能的二次效应表明，在“低风险”饮酒的中等水平（约 20-40 杯）时，最佳认知功能（即整体功能、执行功能、学习、延迟回忆和运动技能）得以检测，而在较低和较高“低风险”饮酒量时，表现较差。在 PWH 中，总饮酒量与认知功能无线性或二次关联。
结论
在 HIV-“低风险”饮酒者中，近期饮酒量的中等水平与认知功能更好相关，与倒置的 J 形关联一致。在 PWH 中，近期饮酒对认知功能的非线性效应并不存在，这表明 PWH 中低风险饮酒对认知功能可能没有有益或有害的影响。需要进一步研究来检验饮酒与可能超越酒精对认知功能的益处的 HIV 相关生物心理社会劣势之间的关联。
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