Dreyer Anna Jane, Le Roux Celine, Thomas Kevin G F, Sabin Caroline A, Winston Alan, Khoo Saye, Joska John A, Nightingale Sam
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town.
AIDS. 2025 Mar 15;39(4):393-402. doi: 10.1097/QAD.0000000000004080. Epub 2024 Dec 19.
To investigate whether psychosocial factors account for a proportion of the difference in cognitive performance between persons with and without HIV.
Cross-sectional study of 273 participants (178 persons with HIV) from a low income area of Cape Town, South Africa.
Participants completed comprehensive cognitive testing (7 domains) and 12 psychosocial measures (5 current: income, occupation, assets, accommodation, depressive symptoms, 7 from childhood: assets, quality of education, exposure to childhood trauma and violence, primary caregiver occupation and highest level of education), as well as demographic measures standard in cognition studies (age, sex, years of education). We investigated the HIV association with global cognitive performance after adjustment for standard demographic variables, exploratory psychosocial variables, and balancing characteristics of those with and without HIV using propensity score modelling.
Persons with HIV had significantly lower scores than persons without HIV in 8/12 psychosocial variables. Of these, 7/12 significantly predicted global T-score. In unadjusted regression, HIV status was associated with a reduction in global T-score of 3.72 units. Adjustment for standard variables, reduced the effect of HIV on global T score by 26.9% to 2.72, additional adjustment for psychosocial variables reduced by 40.3% to 2.22, and adjustment for propensity scores by 42.7% to 2.13.
Persons with HIV in this setting have lower psychosocial indices, both current and in childhood, which are associated with lower cognitive test performance as an adult. This is incompletely mitigated by adjustments for standard demographic variables which risks overestimation of cognitive impairment on a population level.
调查社会心理因素是否在感染人类免疫缺陷病毒（HIV）者与未感染者认知表现差异中占一定比例。
对来自南非开普敦低收入地区的273名参与者（178名HIV感染者）进行横断面研究。
参与者完成了全面的认知测试（7个领域）和12项社会心理测量指标（5项当前指标：收入、职业、资产、住所、抑郁症状，7项童年指标：资产、教育质量、童年期受创伤和暴力情况、主要照顾者职业及最高教育水平），以及认知研究中的标准人口统计学测量指标（年龄、性别、受教育年限）。我们使用倾向得分模型，在对标准人口统计学变量、探索性社会心理变量以及HIV感染者和未感染者的平衡特征进行调整后，研究HIV与整体认知表现之间的关联。
在12项社会心理变量中的8项上，HIV感染者的得分显著低于未感染者。其中，12项中有7项显著预测了整体T分数。在未调整的回归分析中，HIV感染状况与整体T分数降低3.72分相关。对标准变量进行调整后，HIV对整体T分数的影响降低了26.9%，至2.72分；对社会心理变量进行额外调整后，降低了40.3%，至2.22分；对倾向得分进行调整后，降低了42.7%，至2.13分。
在这种情况下，HIV感染者当前及童年期的社会心理指标较低，这与成年后较低的认知测试表现相关。对标准人口统计学变量进行调整并不能完全缓解这种情况，这可能会导致在人群层面高估认知障碍。
