乌干达接受基于蛋白酶抑制剂与非蛋白酶抑制剂的抗逆转录病毒治疗的 HIV 感染儿童的神经认知功能：一项初步研究。

Neurocognitive function among HIV-infected children on protease inhibitor -based versus non-protease inhibitor based antiretroviral therapy in Uganda: a pilot study.

机构信息

Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.

Makerere University Lung Institute, P. O. Box 7749, Kampala, Uganda.

出版信息

BMC Pediatr. 2021 Apr 26;21(1):198. doi: 10.1186/s12887-021-02676-2.

DOI:10.1186/s12887-021-02676-2

PMID:33902506

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8073947/

Abstract

BACKGROUND

HIV infection is associated with significant neurocognitive deficits making maximization of cognitive function among children receiving antiretroviral therapy (ART) a public health imperative. Non-protease inhibitors (non-PIs) achieve higher drug levels in the cerebral spinal fluid (CSF) compared to PIs, potentially leading to better neurocognitive function by reducing CSF viral load and inflammation. ART that maximises children's neurodevelopment and school achievement could result in improved quality of life and productivity as adults, but little research to date has examined whether non-PI ART is associated with better neurocognitive outcomes. We compared the neurocognitive function between children living with HIV receiving PI-based and non PI-based ART.

METHODS

We recruited a consecutive sample of clinically stable Ugandan children living with HIV aged 5-12 years who received PI-based or non PI-based ART for ≥ 1 year (viral load < 1000 copies). Neurocognitive function was assessed using the Kaufman Assessment Battery for Children, the Test of Variables of Attention, and Bruininks-Oseretsky Test of Motor Proficiency. Age-adjusted neurocognitive z-scores for the two groups were compared using linear regression models in STATA version 13. The Hommel's method was used to adjust for multiple testing.

RESULTS

We enrolled 76 children living with HIV; 34 on PI ART and 42 on non-PI ART. Mean (±SD) age was greater in the non-PI vs. PI group (9.5 ± 1.9 vs. 8.5 ± 2.0) years (p = 0.03). Children in the non-PI group had lower socioeconomic scores (5.7 ± 3.3 vs. 7.4 ± 2.8, p = 0.02). There was no difference in neurocognitive function between the groups (adjusted p > 0.05) for KABC and TOVA. Children in the PI group had better total BOT scores than their counterparts (46.07 ± 1.40) vs. 40.51 (1.24), p = 0.03).

CONCLUSIONS

We detected no difference in neurocognitive function among children on PI and non PI-based ART therapy based on KABC and TOVA tests. Children on PI based ART had better motor function than their counterparts. We recommend a prospective study with a larger sample size.

摘要

背景

HIV 感染与显著的神经认知缺陷有关，因此最大限度地提高接受抗逆转录病毒治疗（ART）的儿童的认知功能是公共卫生的当务之急。与蛋白酶抑制剂（PI）相比，非蛋白酶抑制剂（non-PI）在脑脊液（CSF）中的药物水平更高，通过降低 CSF 病毒载量和炎症，可能会导致更好的神经认知功能。最大限度地提高儿童神经发育和学业成绩的 ART 可能会提高他们成年后的生活质量和生产力，但迄今为止，几乎没有研究检查过非 PI ART 是否与更好的神经认知结果相关。我们比较了接受基于 PI 和非 PI 的 ART 的 HIV 感染者儿童的神经认知功能。

方法

我们招募了一组连续的、临床稳定的乌干达 HIV 感染者儿童，年龄在 5-12 岁之间，他们接受 PI 或非 PI 为基础的 ART 治疗至少 1 年（病毒载量 < 1000 拷贝）。使用 Kaufman 儿童评估量表、变量注意力测试和 Bruininks-Oseretsky 运动能力测试来评估神经认知功能。使用 STATA 版本 13 中的线性回归模型比较两组的年龄调整神经认知 z 分数。使用 Hommel 方法进行多次测试调整。

结果

我们共纳入 76 名 HIV 感染者儿童；34 名接受 PI ART，42 名接受非 PI ART。与 PI 组相比，非 PI 组儿童的年龄较大（9.5 ± 1.9 岁 vs. 8.5 ± 2.0 岁）（p = 0.03）。非 PI 组儿童的社会经济评分较低（5.7 ± 3.3 分 vs. 7.4 ± 2.8 分，p = 0.02）。两组在 KABC 和 TOVA 上的神经认知功能无差异（调整后的 p > 0.05）。PI 组儿童的总 BOT 评分高于对照组（46.07 ± 1.40 分 vs. 40.51 ± 1.24 分，p = 0.03）。