Department of Psychiatry, University of California San Diego, San Diego, CA.
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA; and.
J Acquir Immune Defic Syndr. 2020 Aug 15;84(5):522-526. doi: 10.1097/QAI.0000000000002391.
Frailty disproportionally affects people with HIV (PWH) and increased frailty in this already vulnerable population is associated with worse neurocognitive functioning. Whether frailty interacts with current and modifiable markers of HIV disease severity to synergistically increase risk for HIV-associated neurocognitive disorders (HAND), however, is unknown and important for informing the clinical care of aging PWH.
UC San Diego's HIV Neurobehavioral Research Program.
Participants were 178 PWH evaluated between 2014 and 2019. HIV disease severity was measured by current CD4 count and plasma HIV RNA. HAND diagnoses were made according to the Frascati criteria using a 7-domain neuropsychological battery, and the Fried phenotype criteria were used to assess frailty syndrome (0-5 symptoms). The independent and interactive effects of frailty and current HIV disease severity (ie, CD4 count and plasma HIV RNA) on HAND were examined using multiple logistic regressions.
There was an interaction between CD4 count and frailty on HAND. Simple slopes showed that CD4 count and the likelihood of HAND were negatively associated at >1.25 symptoms of frailty, and conversely, frailty and HAND were negatively associated at 642 or less cells/mm. There were no significant independent or interactive effects of plasma HIV RNA and frailty on the likelihood of HAND.
In addition to monitoring CD4 count, assessing for frailty may be critical in older adults with HIV to potentially mitigate poor neurobehavioral outcomes. Longitudinal follow-up studies are needed to determine the directionality of these findings.
衰弱在 HIV 感染者（PWH）中不成比例地发生，在这个已经脆弱的人群中，衰弱程度的增加与更差的神经认知功能有关。然而，衰弱是否与当前和可改变的 HIV 疾病严重程度标志物相互作用，协同增加 HIV 相关神经认知障碍（HAND）的风险尚不清楚，这对于为老龄化的 PWH 提供临床护理非常重要。
加州大学圣地亚哥分校的 HIV 神经行为研究计划。
参与者为 178 名于 2014 年至 2019 年期间接受评估的 PWH。HIV 疾病严重程度通过当前的 CD4 计数和血浆 HIV RNA 进行衡量。HAND 诊断根据 Frascati 标准，使用 7 个领域的神经心理学测试套件进行，采用 Fried 表型标准评估衰弱综合征（0-5 个症状）。使用多因素逻辑回归检查衰弱和当前 HIV 疾病严重程度（即 CD4 计数和血浆 HIV RNA）对 HAND 的独立和交互作用。
CD4 计数和衰弱对 HAND 存在交互作用。简单斜率显示，在存在 1.25 个或更多衰弱症状时，CD4 计数与 HAND 的可能性呈负相关，相反，在 CD4 计数为 642 个或更少时，衰弱与 HAND 呈负相关。血浆 HIV RNA 和衰弱对 HAND 可能性无显著独立或交互作用。
除了监测 CD4 计数外，评估衰弱可能对 HIV 老年患者至关重要，以潜在改善不良神经行为结局。需要进行纵向随访研究以确定这些发现的方向。
