Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4395, USA.
Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Sci Rep. 2021 Feb 12;11(1):3738. doi: 10.1038/s41598-021-83131-1.
HIV-related neurocognitive impairment (NCI) may increase the risk of death. However, a survival disadvantage for patients with NCI has not been well studied in the post-combination antiretroviral therapy (cART) era. Specifically, limited research has been conducted considering the reversible nature and variable progression of the impairment and this area demands further evaluation. We performed multivariable Cox proportional hazards modeling to assess the association between baseline NCI (global T scores) and mortality. A joint modeling approach was then used to model the trajectory of global neurocognitive functioning over time and the association between neurocognitive trajectory and mortality. Among the National NeuroAIDS Tissue Consortium's (NNTC) HIV-infected participants, we found a strong negative association between NCI and mortality in the older age groups (e.g., at age = 55, HR = 0.79; 95% CI 0.64-0.99). Three neurocognitive sub-domains (abstraction and executive functioning, speed of information processing, and motor) had the strongest negative association with mortality. Joint modelling indicated a 33% lower hazard for every 10-unit increase in global T scores (HR = 0.67; 95% CI 0.56-0.80). The study identified older HIV-infected individuals with NCI as a group needing special attention for the longevity of life. The study has considerable prognostic utility by not only predicting mortality hazard, but also future cognitive status.
艾滋病毒相关的神经认知障碍（NCI）可能会增加死亡风险。然而，在联合抗逆转录病毒治疗（cART）时代，尚未很好地研究 NCI 患者的生存劣势。具体来说，考虑到损伤的可逆性和可变性，针对该领域的研究有限，需要进一步评估。我们进行了多变量 Cox 比例风险模型分析，以评估基线 NCI（全球 T 评分）与死亡率之间的关联。然后使用联合建模方法来模拟全球神经认知功能随时间的轨迹以及神经认知轨迹与死亡率之间的关联。在国家神经艾滋病组织联盟（NNTC）的艾滋病毒感染者参与者中，我们发现 NCI 与年龄较大的组（例如，年龄为 55 岁）的死亡率之间存在很强的负相关（HR=0.79；95%CI 0.64-0.99）。三个神经认知子领域（抽象和执行功能、信息处理速度和运动）与死亡率的负相关最强。联合建模表明，全球 T 评分每增加 10 个单位，死亡风险就会降低 33%（HR=0.67；95%CI 0.56-0.80）。该研究确定了 NCI 年龄较大的艾滋病毒感染者是一个需要特别关注的群体，以延长其寿命。该研究具有相当大的预后效用，不仅可以预测死亡风险，还可以预测未来的认知状况。
