HIV 感染者的病毒载量、神经影像学与 NP 之间的关系。
Relationships Between Viral Load, Neuroimaging, and NP in Persons Living With HIV.
机构信息
Department of Neurology, Washington University in Saint Louis, Saint Louis, MO.
Department of Psychology, University of Missouri, Saint Louis, Saint Louis, MO.
出版信息
J Acquir Immune Defic Syndr. 2021 Jul 1;87(3):985-992. doi: 10.1097/QAI.0000000000002677.
BACKGROUND
This study examined whether recommended viral load (VL) classifications by the Department of Health and Human Services map onto changes in brain integrity observed in people living with HIV (PLWH).
METHODS
Three hundred forty-nine PLWH on combination antiretroviral therapy meeting criteria for virologic suppression (VS) (VL ≤ 20 copies/mL; n = 206), "low-level viremia" (20-200 copies/mL; n = 63), or virologic failure (VF) (>200 copies/mL; n = 80) and 195 demographically similar HIV-negative controls were compared for cognition and brain volumes from 10 regions of interest that are sensitive to HIV. Changes in cognition and brain volumes were examined in a subset of PLWH (n = 132) who completed a follow-up evaluation (mean interval = 28 months) and had no change in treatment regimen.
RESULTS
Significant differences in cognition and brain volumes were observed between the HIV-negative control and VS groups compared with those in the VF groups, with few differences observed between the 3 PLWH subgroups. Longitudinally, PLWH who continued to have VF exhibited a greater decline in cognition and brain volumes compared with PLWH who remained with VS. Observed longitudinal changes in cognition correlated with brain volume changes.
CONCLUSION
PLWH with continued VF (consecutive VL measurements of >200 copies/mL) represent a cause for clinical concern and may benefit from change in treatment in addition to consideration of other potential etiologies of VF to reduce loss of brain integrity.
背景
本研究旨在探讨美国卫生与公众服务部推荐的病毒载量（VL）分类是否与人类免疫缺陷病毒（HIV）感染者（PLWH）大脑完整性变化相关。
方法
符合病毒学抑制标准（VL≤20 拷贝/mL；n=206）、“低水平病毒血症”（20-200 拷贝/mL；n=63）或病毒学失败（VL>200 拷贝/mL；n=80）的 349 名接受联合抗逆转录病毒治疗的 PLWH 和 195 名在人口统计学上与 HIV 阴性对照组相似的 HIV 阴性对照者，比较了对 10 个脑区体积敏感的认知功能和脑区体积。对完成随访评估（平均间隔 28 个月）且治疗方案无变化的亚组 PLWH（n=132）进行认知和脑体积变化的研究。
结果
与 VF 组相比，HIV 阴性对照组和 VS 组的认知和脑体积存在显著差异，而 3 组 PLWH 亚组之间差异较小。纵向研究中，继续发生 VF 的 PLWH 的认知和脑体积下降较持续保持 VS 的 PLWH 更为显著。观察到的认知纵向变化与脑体积变化相关。
结论
持续发生 VF（连续 VL 测量值>200 拷贝/mL）的 PLWH 应引起临床关注，除了考虑 VF 的其他潜在病因外，改变治疗方案可能有助于减少脑完整性的丧失。
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