MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital.
Department of Psychiatry, University of Toronto.
AIDS. 2021 Jan 1;35(1):63-72. doi: 10.1097/QAD.0000000000002709.
To examine whether persons with asymptomatic neurocognitive impairment (ANI) were more likely to show progression to mild neurocognitive disorder or HIV-associated dementia than those who were neuropsychologically normal (NP-N).
Longitudinal observational cohort study.
Study sample included 720 HIV-1 seropositive persons (317 with ANI and 403 NP-N) receiving care in Toronto, Canada [83% were on antiretroviral treatment; 71% had undetectable (<50 copies/ml) plasma HIVRNA]. Neuropsychological assessments were conducted at 12 months intervals for a median follow-up time of 34 months. Neuropsychological data were corrected for age, education, sex, and race/ethnicity, and corrected for practice effect at follow-ups. Progression to mild neurocognitive disorder and HIV-associated dementia at each time point was determined using the Global Deficit Score and presence of cognitive symptoms.
Over the follow-up period, 170 individuals (24%) progressed to symptomatic HIV-associated neurocognitive disorders (HAND). Persons with ANI were more likely to progress to symptomatic HAND than persons with NP-N after adjusting for baseline and time-varying confounders (adjusted hazards ratio: 1.88; 95% confidence interval: 1.37-2.60; P < 0.001). Female sex, depression, and cigarette smoking were associated with higher risk of progression to symptomatic HAND, but traditional HIV markers and antiretroviral treatment were not.
ANI is associated with a two-fold increased risk of progression to symptomatic HAND in a cohort with universal healthcare access. This represents the largest replication of comparable US results. Reproducibility of these findings indicate that routine monitoring of persons with ANI and exploration of clinical interventions to prevent or delay progression to symptomatic HAND are imperative.
HIV, HAND, HIV-associated dementia, cohort study, replicability, reproducibility.
检验无症状性神经认知障碍（ANI）患者是否比神经心理学正常（NP-N）患者更有可能进展为轻度神经认知障碍或 HIV 相关痴呆。
纵向观察队列研究。
研究样本包括 720 名 HIV-1 血清阳性者（317 名 ANI 患者和 403 名 NP-N 患者），他们在加拿大多伦多接受治疗[83%接受抗逆转录病毒治疗；71%的人血浆 HIVRNA 不可检测（<50 拷贝/ml）]。神经心理学评估在 12 个月的时间间隔内进行，中位随访时间为 34 个月。神经心理学数据根据年龄、教育程度、性别和种族/民族进行校正，并在随访时根据练习效果进行校正。在每个时间点，使用全球缺陷评分和认知症状的存在来确定轻度认知障碍和 HIV 相关痴呆的进展。
在随访期间，170 名患者（24%）进展为有症状的 HIV 相关神经认知障碍（HAND）。调整基线和时变混杂因素后，ANI 患者进展为有症状 HAND 的可能性高于 NP-N 患者（调整后的危险比：1.88；95%置信区间：1.37-2.60；P<0.001）。女性、抑郁和吸烟与进展为有症状 HAND 的风险增加相关，但传统的 HIV 标志物和抗逆转录病毒治疗则没有。
在一个普遍获得医疗保健的队列中，ANI 与进展为有症状 HAND 的风险增加两倍相关。这是对类似美国结果的最大复制。这些发现的可重复性表明，对 ANI 患者进行常规监测，并探索预防或延缓进展为有症状 HAND 的临床干预措施至关重要。
HIV，HAND，HIV 相关痴呆，队列研究，可重复性，可再现性。
