Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong Special Administrative Region, China.
JAMA Netw Open. 2022 Mar 1;5(3):e220970. doi: 10.1001/jamanetworkopen.2022.0970.
In the era of antiretroviral therapy (ART), the incidence of HIV-associated neurocognitive disorder (HAND) has not yet been controlled. With the exception of ART, there is no beneficial pharmacologic treatment. However, some studies have reported that computerized cognitive training (CCT) programs may improve cognitive function among people living with HIV.
To examine the association between CCT programs and 8 domains measuring cognitive function (7 domains) and daily function (1 domain) among people living with HIV.
Records from the Cochrane Library, PsycINFO, PubMed, and Web of Science were searched from database inception to December 15, 2020. Supplementary searches to identify missing studies were conducted in Google Scholar using updated search terms from database inception to November 18, 2021.
Studies that compared changes before and after a CCT intervention among people living with HIV were included. Search terms were a combination of words associated with HIV (eg, people living with HIV, HIV, and/or AIDS) and cognitive training (eg, cognitive intervention, nonpharmacology intervention, computer game, video game, computerized training, cognitive exercise, cognitive stimulation, and/or cognitive enhancement). Studies were included if they (1) used CCT as the primary intervention or combined CCT with other types of interventions; (2) used placebo, passive control conditions, traditional cognitive training, or single training tasks as control conditions; (3) reported changes between baseline and posttraining; (4) included participants 18 years or older; and (5) were randomized clinical trials (RCTs). Studies were excluded if they (1) were not associated with HIV, (2) were research protocols or feedback reports, (3) were case reports, or (4) did not report findings for domains of interest.
Two reviewers independently extracted data. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used to quantitatively synthesize the existing data.
Primary outcomes were the meta-synthesized changes in each domain after CCT.
Among 1245 records identified, 1043 were screened after removal of duplicates. Of those, 1019 records were excluded based on titles and abstracts, and 24 full-text articles were assessed for eligibility. After exclusions, 12 eligible RCTs were selected for inclusion in the meta-analysis. These RCTs involved 596 total participants, with 320 individuals in the CCT group (mean age, 47.5-59.7 years; 0%-94% female; 8.3-14.2 years of education) and 276 individuals in the control group (mean age, 44.2-60.0 years; 19%-90% female; 9.0-14.9 years of education). The average HIV inhibition ratio (the proportion of participants who achieved virological suppression) ranged from 30% to 100%, and the CD4+ T-cell count ranged from 471 to 833 cells/μL. The time since training ranged from 3 to 24 weeks. After receipt of CCT, function significantly improved in 6 of the 8 domains: abstraction and executive function (standardized mean difference [SMD], 0.58; 95% CI, 0.26-0.91; P < .001), attention and working memory (SMD, 0.62; 95% CI, 0.33-0.91; P < .001), memory (SMD, 0.59; 95% CI, 0.20-0.97; P = .003), motor skills (SMD, 0.50; 95% CI, 0.24-0.77; P < .001), speed of information processing (SMD, 0.65; 95% CI, 0.37-0.94; P < .001), and daily function (SMD, 0.44; 95% CI, 0.02-0.86; P = .04). Sensory and perceptual skills (SMD, 0.06; 95% CI, -0.36 to 0.48; P = .78) and verbal and language skills (SMD, 0.46; 95% CI, -0.07 to 0.99; P = .09) did not significantly improve after CCT.
This meta-analysis of RCTs found that CCT programs were associated with improvements in cognitive and daily function among people living with HIV. Future studies are needed to design optimal specific training programs and use implementation science to enable the transformation of CCT from a scientific research tool to a real-world clinical intervention.
在抗逆转录病毒疗法（ART）时代，HIV 相关神经认知障碍（HAND）的发病率尚未得到控制。除了 ART 之外，没有有益的药物治疗方法。然而，一些研究报告称，计算机认知训练（CCT）计划可能会改善 HIV 感染者的认知功能。
检查 CCT 计划与测量认知功能（7 个领域）和日常功能（1 个领域）的 8 个领域之间的关联，在 HIV 感染者中。
从 Cochrane 图书馆、PsycINFO、PubMed 和 Web of Science 数据库中检索记录，检索时间从数据库成立到 2020 年 12 月 15 日。在 2021 年 11 月 18 日之前，使用更新的搜索词在 Google Scholar 中进行了补充搜索，以确定缺失的研究。
包括将 HIV 感染者接受 CCT 干预前后的变化进行比较的研究。搜索词是与 HIV 相关的词的组合（例如，HIV 感染者、HIV 和/或 AIDS）和认知训练（例如，认知干预、非药物干预、电脑游戏、视频游戏、电脑训练、认知锻炼、认知刺激和/或认知增强）。如果研究（1）将 CCT 作为主要干预措施或结合 CCT 与其他类型的干预措施；（2）使用安慰剂、被动对照条件、传统认知训练或单一训练任务作为对照条件；（3）报告了基线和训练后之间的变化；（4）包括 18 岁或以上的参与者；（5）是随机临床试验（RCT），则将其纳入研究。如果研究（1）与 HIV 无关；（2）是研究方案或反馈报告；（3）是病例报告；或者（4）未报告感兴趣的领域的发现，则将其排除在外。
两名审查员独立提取数据。本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）报告准则。使用随机效应模型对现有数据进行定量综合。
主要结果是 CCT 后每个领域的meta 综合变化。
在 1245 条记录中，有 1043 条在删除重复项后进行了筛选。其中，1019 条记录根据标题和摘要被排除在外，24 篇全文文章被评估为合格。排除后，选择了 12 项符合纳入荟萃分析标准的 RCT。这些 RCT 共涉及 596 名参与者，320 名参与者在 CCT 组（平均年龄 47.5-59.7 岁；0%-94%女性；教育程度 8.3-14.2 年），276 名参与者在对照组（平均年龄 44.2-60.0 岁；19%-90%女性；教育程度 9.0-14.9 年）。平均 HIV 抑制率（表示参与者实现病毒学抑制的比例）范围从 30%到 100%，CD4+T 细胞计数范围从 471 到 833 个/μL。从训练开始到现在的时间范围从 3 周到 24 周不等。接受 CCT 后，6 个领域的功能显著改善：抽象和执行功能（标准化均数差 [SMD]，0.58；95%置信区间，0.26-0.91；P<0.001）、注意力和工作记忆（SMD，0.62；95%置信区间，0.33-0.91；P<0.001）、记忆（SMD，0.59；95%置信区间，0.20-0.97；P=0.003）、运动技能（SMD，0.50；95%置信区间，0.24-0.77；P<0.001）、信息处理速度（SMD，0.65；95%置信区间，0.37-0.94；P<0.001）和日常功能（SMD，0.44；95%置信区间，0.02-0.86；P=0.04）。感觉和知觉技能（SMD，0.06；95%置信区间，-0.36 至 0.48；P=0.78）和语言技能（SMD，0.46；95%置信区间，-0.07 至 0.99；P=0.09）在 CCT 后没有显著改善。
这项对 RCT 的荟萃分析发现，CCT 计划与 HIV 感染者的认知和日常功能改善有关。未来的研究需要设计最佳的特定培训计划，并利用实施科学将 CCT 从科学研究工具转变为现实世界的临床干预措施。
