Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
AIDS Patient Care STDS. 2023 May;37(5):243-252. doi: 10.1089/apc.2023.0006. Epub 2023 Apr 20.
HIV-associated neurocognitive disorders (HAND) remain a major challenge for people with HIV in the antiretroviral therapy era. Cocaine use may trigger/exacerbate HAND among African American (AA) adults, especially women. Between 2018 and 2019, 922 adults, predominantly AAs, with/without HIV and with/without cocaine use in Baltimore, Maryland, were enrolled in a study investigating the association of HIV and cocaine use with neurocognitive impairment (NCI). Neurocognitive performance was assessed with the NIH Toolbox Cognition Battery (NIHTB-CB). NCI was considered to be present if the fully adjusted standard score for at least two cognitive domains was 1.0 standard deviation below the mean. Although the overall analysis showed HIV and female sex were associated with NCI, the associations were dependent on cocaine use. Neither HIV [adj prevalence ratio (PR): 1.12, confidence interval (95% CI): 0.77-1.64] nor female sex (adj PR: 1.07, 95% CI: 0.71-1.61) was associated with NCI among cocaine nonusers, while both HIV (adj PR: 1.39, 95% CI: 1.06-1.81) and female sex (adj PR: 1.53, 95% CI: 1.18-1.98) were associated with NCI in cocaine users. HIV was associated with two NIHTB-CB measures overall. In addition, HIV was associated with a lower dimensional change card sort score (an executive function measure) in cocaine users and not in nonusers. Cognitive performance was poorer in female than in male cocaine users. The adverse effect of HIV on cognitive performance predominantly affected cocaine users. However, cocaine use may moderate the impact of HIV and female sex on cognitive performance, highlighting the importance of reducing cocaine use in NCI prevention among the AA population.
艾滋病毒相关神经认知障碍（HAND）仍然是抗逆转录病毒治疗时代艾滋病毒感染者面临的主要挑战。可卡因的使用可能会引发/加重非裔美国人（AA）成年人的 HAND，尤其是女性。在 2018 年至 2019 年期间，马里兰州巴尔的摩市的 922 名成年人（主要为 AA），无论是否患有 HIV，是否使用可卡因，都参与了一项研究，该研究旨在调查 HIV 和可卡因使用与神经认知障碍（NCI）之间的关联。神经认知表现使用 NIH 工具包认知电池（NIHTB-CB）进行评估。如果至少两个认知域的完全调整标准分数低于平均值 1.0 个标准差，则认为存在 NCI。尽管总体分析表明 HIV 和女性性别与 NCI 相关，但这些关联取决于可卡因的使用情况。无论是 HIV [调整后的患病率比（PR）：1.12，置信区间（95%CI）：0.77-1.64]还是女性性别（调整后的 PR：1.07，95%CI：0.71-1.61）都与可卡因非使用者的 NCI 无关，而 HIV（调整后的 PR：1.39，95%CI：1.06-1.81）和女性性别（调整后的 PR：1.53，95%CI：1.18-1.98）都与可卡因使用者的 NCI 相关。HIV 总体上与两项 NIHTB-CB 措施相关。此外，在可卡因使用者中，HIV 与较低的维度变化卡片分类评分（一种执行功能测量）相关，而在非使用者中则没有。在可卡因使用者中，女性的认知表现比男性差。HIV 对认知表现的不良影响主要影响可卡因使用者。然而，可卡因的使用可能会调节 HIV 和女性性别对认知表现的影响，这突出了在非裔美国人人群中预防 NCI 减少可卡因使用的重要性。
