Department of Psychology, Rhodes University, Grahamstown, Eastern Cape, South Africa.
Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Braamfontein, Johannesburg, Gauteng, South Africa.
F1000Res. 2023 Sep 11;12:1133. doi: 10.12688/f1000research.132166.1. eCollection 2023.
Despite medical advances in Highly Active Antiretroviral Therapy (HAART), patients living with HIV continue to be at risk for developing HIV-associated neurocognitive disorders (HAND). The optimization of non-HAART interventions, including cognitive rehabilitation therapy (CRT), shows promise in reversing the impact of HAND. No data exist indicating the efficacy of CRT in remediating attention skills following neuroHIV. This paper presents a meta-analysis of randomised and non-randomised controlled trials (RCTs) to remediate attention skills following HIV CRT. The database search included literature from Google Scholar, ERIC, Cochrane Library, ISI Web of Knowledge, PubMed, PsycINFO, and grey literature published between 2013 and 2022. Inclusion criteria included studies with participants living with HIV who had undergone CRT intervention to remediate attention skills following neuroHIV. Exclusion criteria included case studies, non-human studies, and literature reviews. To assess study quality, including, randomisation, allocation concealment, participant and personnel blinding, the Cochrane Collaboration ratings system was applied. A total of 14 studies met the inclusion criteria (n = 532). There were significant pre- to post-intervention between-group benefits due to CRT in the experimental group relative to control conditions for the remediation of attention skills following HIV acquisition (Hedges g = 0.251, 95% CI = 0.005 to 0.497; p < 0.05). No significant effects (p > 0.05) were demonstrated for subgroup analysis. To the author's knowledge, this is the first meta-analysis that exclusively analyses the remediation of attention skills in the era of HAART and neuroHIV, where all studies included participants diagnosed with HIV. The overall meta-analysis effect indicates the efficacy of CRT in remediating attention skills in HIV and HAND. It is recommended that future cognitive rehabilitation protocols to remediate attention skills should be context and population-specific and that they be supplemented by objective biomarkers indicating the efficacy of the CRT. Protocols.io (01/03/2023).
尽管高效抗逆转录病毒疗法 (HAART) 在医学上取得了进展，但 HIV 感染者仍面临发生与 HIV 相关的神经认知障碍 (HAND) 的风险。非 HAART 干预措施（包括认知康复治疗 (CRT)）的优化显示出逆转 HAND 影响的潜力。目前尚无数据表明 CRT 可改善神经 HIV 后的注意力技能。本文对随机和非随机对照试验 (RCT) 进行了荟萃分析，以改善 HIV 后 CRT 的注意力技能。数据库检索包括 Google Scholar、ERIC、Cochrane 图书馆、ISI Web of Knowledge、PubMed、PsycINFO 和 2013 年至 2022 年期间发表的灰色文献。纳入标准包括参与者为 HIV 感染者，接受 CRT 干预以改善神经 HIV 后的注意力技能的研究。排除标准包括案例研究、非人类研究和文献综述。为了评估研究质量，包括随机化、分配隐藏、参与者和人员盲法，应用了 Cochrane 协作评级系统。共有 14 项研究符合纳入标准（n = 532）。由于 CRT，实验组相对于对照组在 HIV 获得后的注意力技能矫正方面具有显著的干预前后组间益处（Hedges g = 0.251，95%CI = 0.005 至 0.497；p < 0.05）。亚组分析未显示出显著效果（p > 0.05）。据作者所知，这是第一项专门分析在 HAART 和神经 HIV 时代注意力技能矫正的荟萃分析，所有研究都纳入了诊断为 HIV 的参与者。总体荟萃分析效应表明 CRT 对改善 HIV 和 HAND 注意力技能的疗效。建议未来的认知康复协议应针对特定的注意力技能矫正，并补充客观的生物标志物，以表明 CRT 的疗效。 Protocols.io (01/03/2023)。
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