Paul Robert H, Shikuma Cecilia M, Chau Nguyen Van Vinh, Ndhlovu Lishomwa C, Thanh Nguyen Tat, Belden Andrew C, Chow Dominic C, Chew Glen M, Premeaux Thomas A, Ly Vo Trieu, McBride Joseph A D, Bolzenius Jacob D, Le Thuy
University of Missouri-St. Louis, St. Louis, MO, United States.
Hawai'i Center for AIDS, University of Hawai'i at Manoa, Honolulu, HI, United States.
Front Neurol. 2021 Mar 12;12:602263. doi: 10.3389/fneur.2021.602263. eCollection 2021.
Long-term neurocognitive outcomes following first-line suppressive anti-retroviral therapy (ART) remain uncertain for individuals with HIV and hepatitis C (HCV) co-infection. The study examined neurocognitive performance before and after 72 weeks of ART using repeated multivariate analyses and latent trajectory models. One hundred and sixty adults with chronic, untreated HIV infection ( = 80 with HCV co-infection and = 80 HIV mono-infected) and 80 demographically similar healthy controls were recruited from the Hospital for Tropical Diseases in Ho Chi Minh City and the surrounding community, respectively. Neurocognitive measures (adapted for use in Vietnam) and liver enzyme tests were compared across groups at baseline. Repeated multivariate and group-based trajectory analyses (GBTA) examined neurocognitive subgroup profiles of the co-infected individuals after 72 weeks of efavirenz- ( = 41) or raltegravir-based ( = 39) ART. Baseline analyses revealed worse motor function in HIV-HCV co-infected individuals compared to both comparison groups. Longitudinal analyses revealed improved neurocognitive performance by week 48 for most participants regardless of treatment arm. GBTA identified a subgroup (35% of HIV-HCV sample) with persistent motor impairment despite otherwise successful ART. Higher HIV viral load and lower CD4 T cell count at baseline predicted persistent motor dysfunction. Liver indices and ART regimen did not predict neurocognitive outcomes in HIV-HCV co-infected individuals. Most HIV-HCV co-infected individuals achieve normative neurocognitive performance after 48 weeks of de novo suppressive ART. However, individuals with more severe HIV disease prior to ART exhibited motor impairment at baseline and 72 weeks after otherwise successful treatment. Interventions aimed at improving motor symptoms at the time of HIV treatment onset may improve long-term clinical outcomes in HIV-HCV co-infected adults.
对于合并感染艾滋病毒（HIV）和丙型肝炎病毒（HCV）的个体，一线抑制性抗逆转录病毒疗法（ART）后的长期神经认知结果仍不明确。该研究使用重复多变量分析和潜在轨迹模型，考察了ART治疗72周前后的神经认知表现。分别从胡志明市热带病医院和周边社区招募了160名慢性未经治疗的HIV感染者（其中80名合并HCV感染，80名单纯HIV感染）以及80名人口统计学特征相似的健康对照者。在基线时，对各组的神经认知测量指标（针对越南情况进行了调整）和肝酶检测结果进行了比较。重复多变量分析和基于组的轨迹分析（GBTA）考察了接受依非韦伦（n = 41）或雷特格韦（n = 39）为基础的ART治疗72周后合并感染个体的神经认知亚组特征。基线分析显示，与两个对照组相比，HIV-HCV合并感染个体的运动功能较差。纵向分析显示，无论治疗方案如何，大多数参与者在第48周时神经认知表现有所改善。GBTA识别出一个亚组（占HIV-HCV样本的35%），尽管ART治疗总体成功，但仍存在持续性运动障碍。基线时较高的HIV病毒载量和较低的CD4 T细胞计数可预测持续性运动功能障碍。肝指标和ART治疗方案并不能预测HIV-HCV合并感染个体的神经认知结果。大多数HIV-HCV合并感染个体在接受初始抑制性ART治疗48周后可达到正常的神经认知表现。然而，在ART治疗前HIV病情较严重的个体在基线时以及在治疗总体成功后的72周时均表现出运动障碍。在开始HIV治疗时旨在改善运动症状的干预措施可能会改善HIV-HCV合并感染成年人的长期临床结局。
