Rodrigues Janine, Lowton Karishma
Department of Psychiatry, Faculty of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
S Afr J Psychiatr. 2023 Sep 28;29:2071. doi: 10.4102/sajpsychiatry.v29i0.2071. eCollection 2023.
Neurocognitive disorders due to human immunodeficiency virus (HIV) remain highly prevalent, specifically mild forms despite effective antiretroviral therapy (ART). Dolutegravir-based regimens are the first line of treatment for adult HIV-positive patients. Controversies exist regarding the neurocognitive effects of dolutegravir. Evidence regarding the neurocognitive effects of dolutegravir is important, in support of its use in patients with HIV-associated neurocognitive disorders (HAND).
This study aimed to describe the change in cognitive function using the International HIV Dementia Scale (IHDS) and Brief Neuropsychological Cognitive Examination (BNCE) in HIV positive, treatment naïve patients before and 3 months after initiation of ART using a dolutegravir-based regimen.
The HIV initiation clinic of Hillbrow Community Health Centre in Johannesburg.
This prospective, quantitative cohort study assessed adult HIV-positive patients who were ART naïve being initiated on a dolutegravir-based regimen, using the BNCE and IHDS at baseline and after 3 months of treatment.
Neurocognitive test results of 26 participants showed significant improvements for IHDS ( = 1.84, = 0.033) and time to complete BNCE ( = 2.47, = 0.007). BNCE total results showed improvements that were not significant ( = 1.44, = 0.075); however, Part 2 of the BNCE reflecting that of executive function showed significant improvements ( = 66.5, = 0.043).
The trend of neurocognitive function is towards improvement in HIV-positive treatment naïve patients who receive 3 months of dolutegravir-based ART.
The findings support the use of dolutegravir-based regimens in the treatment of patients with HIV-associated neurocognitive disorders.
HIV-associated neurocognitive disorders; BNCE; IHDS; dolutegravir; neurocognitive screening; neurocognitive impairment; South Africa.
尽管有有效的抗逆转录病毒疗法（ART），但人类免疫缺陷病毒（HIV）所致的神经认知障碍仍然非常普遍，尤其是轻度形式。基于多替拉韦的治疗方案是成年HIV阳性患者的一线治疗方法。关于多替拉韦的神经认知作用存在争议。多替拉韦神经认知作用的证据对于支持其在HIV相关神经认知障碍（HAND）患者中的应用很重要。
本研究旨在使用国际HIV痴呆量表（IHDS）和简易神经心理学认知检查（BNCE）描述初治的HIV阳性患者在开始基于多替拉韦的ART治疗前及治疗3个月后的认知功能变化。
约翰内斯堡希尔布罗社区健康中心的HIV初治诊所。
这项前瞻性定量队列研究评估了初治的成年HIV阳性患者，这些患者开始接受基于多替拉韦的治疗方案，在基线和治疗3个月后使用BNCE和IHDS进行评估。
26名参与者的神经认知测试结果显示，IHDS有显著改善（t = 1.84，p = 0.033），完成BNCE的时间也有显著改善（t = 2.47，p = 0.007）。BNCE的总结果显示改善不显著（t = 1.44，p = 0.075）；然而，反映执行功能的BNCE第2部分显示有显著改善（t = 66.5，p = 0.043）。
接受3个月基于多替拉韦的ART治疗的初治HIV阳性患者的神经认知功能有改善趋势。
这些发现支持使用基于多替拉韦的治疗方案治疗HIV相关神经认知障碍患者。
HIV相关神经认知障碍；BNCE；IHDS；多替拉韦；神经认知筛查；神经认知损害；南非
