Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Laboratory of Neuroimmunology, Research Centre of Clinical Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
HIV Med. 2023 Jun;24(6):738-748. doi: 10.1111/hiv.13472. Epub 2023 Mar 8.
With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time-consuming and logistically demanding. We developed a neuro-HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach.
People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt-out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced.
Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV-associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non-HIV-associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV-1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV-RNA was detectable in 18.4% out of 185 participants.
Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non-HIV causes of NCI. A 1-day evaluation system is beneficial for both participants and referring physicians.
随着年龄的增长，艾滋病毒感染者（PLWH）中出现了神经认知障碍等合并症。然而，解决其多因素性质既费时又费力。我们开发了一个神经艾滋病诊所，能够通过多学科方法在 8 小时内评估这些投诉。
有神经认知障碍投诉的艾滋病毒感染者从门诊诊所转介到洛桑大学医院。在 8 小时内，参与者接受了正式的传染病、神经、神经心理学和精神病学评估，并选择进行磁共振成像（MRI）和腰椎穿刺。随后进行了多学科小组讨论，并生成了一份综合所有发现的最终报告。
在 2011 年至 2019 年间，共评估了 185 名 PLWH（中位年龄 54 岁）。其中，37 人（27%）有与艾滋病毒相关的神经认知障碍，但主要是无症状的（24/37，64.9%）。大多数参与者有非艾滋病毒相关的神经认知障碍（NHNCI），并且所有参与者中都普遍存在抑郁（185/185，79.5%）。执行功能是两组参与者中受影响的主要神经认知领域（分别有 75.5%和 83.8%的参与者受损）。29 名参与者（15.7%）患有多发性神经病。在 167 名参与者中发现了 45 名（26.9%）MRI 异常，在 NHNCI 中更常见（35 名，77.8%），在 142 名参与者中检测到 16 名（11.2%）HIV-1 RNA 病毒逃逸。在 185 名参与者中，有 18.4%可检测到血浆 HIV-RNA。
认知投诉仍然是 PLWH 的一个重要问题。全科医生或艾滋病毒专家的单独评估是不够的。我们的观察结果显示了 HIV 管理的许多层面，并表明多学科方法有助于确定非 HIV 引起的 NCI 的原因。为期一天的评估系统对参与者和转介医生都有益。
