Fitzgerald Kathryn C, Maki Pauline M, Xu Yanxun, Jin Wei, Dastgheyb Raha, Williams Dionna W, Springer Gayle, Anastos Kathryn, Gustafson Deborah, Spence Amanda B, Adimora Adaora A, Waldrop Drenna, Vance David E, Bolivar Hector, Valcour Victor G, Rubin Leah H
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, United States.
Front Psychol. 2020 Oct 15;11:548521. doi: 10.3389/fpsyg.2020.548521. eCollection 2020.
Statistical techniques used to study cognitive function in HIV typically yield normative estimates and can mask the heterogeneity in cognitive trajectories over time. We applied a novel statistical approach to identify clusters of individuals with distinct patterns of change in declarative memory in HIV-seropositive (HIV+) and HIV-seronegative (HIV-) women.
1731 women from the Women's Interagency HIV Study, a multi-center, prospective cohort study, completed the Hopkins Verbal Learning Test-Revised (HLVT-R) at >2 visits. To derive subgroups with similar patterns of decline by HIV-serostatus, we used a mixed-effects framework that modeled the trajectory of multiple declarative memory outcomes over time, while simultaneously clustering individuals.
Of the 1731 participants, 1149 were HIV+ (70% Black/African American [AA]; 30% White/Other [W/O]) and 582 were HIV- (68% AA; 32% W/O). Race stratification was necessary to optimize clustering. Among HIV+AA's, four subgroups emerged: a subgroup with minimal decline, two with accelerated decline, and one with stable but low performance. In HIV- AA, three subgroups emerged: one with minimal decline and two with accelerated decline. In multivariable-adjusted models among HIV+, individuals with accelerated decline were less educated ( < 0.001) and more likely to have a history of depression ( < 0.001) versus those with minimal decline. Similar subgroups were identified in W/O HIV+ and W/O HIV- participants.
We identified clinically meaningful subgroups of women with distinct phenotypes of declarative memory decline, which depend on race and HIV-serostatus using a data driven approach. Identification of underlying mechanisms and risk factors contributing to the observed differences are warranted. More broadly our modeling approach could be other populations to identify risk factors for accelerated cognitive decline and to personalize interventions.
用于研究HIV患者认知功能的统计技术通常会得出规范性估计，可能掩盖认知轨迹随时间变化的异质性。我们应用一种新的统计方法来识别HIV血清阳性（HIV+）和HIV血清阴性（HIV-）女性中具有不同陈述性记忆变化模式的个体集群。
来自多中心前瞻性队列研究“女性机构间HIV研究”的1731名女性在超过2次访视时完成了霍普金斯词语学习测验修订版（HLVT-R）。为了按HIV血清学状态得出具有相似下降模式的亚组，我们使用了一个混合效应框架，该框架对多个陈述性记忆结果随时间的轨迹进行建模，同时对个体进行聚类。
在1731名参与者中，1149名是HIV+（70%为黑人/非裔美国人[AA]；30%为白人/其他[W/O]），582名是HIV-（68%为AA；32%为W/O）。种族分层对于优化聚类是必要的。在HIV+AA中，出现了四个亚组：一个下降最小的亚组，两个下降加速的亚组，以及一个表现稳定但较低的亚组。在HIV-AA中，出现了三个亚组：一个下降最小的亚组和两个下降加速的亚组。在HIV+个体的多变量调整模型中，与下降最小的个体相比，下降加速的个体受教育程度较低（<0.001），且更有可能有抑郁症病史（<0.001）。在W/O HIV+和W/O HIV-参与者中也识别出了类似的亚组。
我们使用数据驱动方法识别出了具有不同陈述性记忆下降表型的临床上有意义的女性亚组，这些亚组取决于种族和HIV血清学状态。有必要确定导致观察到差异潜在机制和风险因素。更广泛地说，我们的建模方法可用于其他人群，以识别加速认知下降的风险因素并使干预措施个性化。
