Ellis Ronald J, Tang Bin, Heaton Robert K, Patel Payal, Gonzalez Jairo, Riggs Patricia K, Iudicello Jennifer, Letendre Scott L
Department of Neuroscience, University of California San Diego School of Medicine.
Department of Psychiatry, University of California San Diego School of Medicine.
Res Sq. 2025 Mar 27:rs.3.rs-5618870. doi: 10.21203/rs.3.rs-5618870/v1.
We aimed to identify complex, multidimensional, longitudinal biopsychosocial phenotypes (MLBPSPs) in people with HIV (PWH) and evaluate their associations with baseline clinical characteristics. We included 506 PWH in the multi-site CHARTER study who underwent assessments at four visits, six months apart. Using machine learning, we identified four MLBPSP clusters based on means and nonlinear trajectories of biopsychosocial characteristics. These characteristics included neurocognition, depressed mood, self-reported cognitive symptoms, and activities of daily living at each visit. The largest MLBPSP cluster (C1, N = 231) had the best average scores across all domains and remained stable over 18 months of follow-up. Other clusters showed varying degrees of cognitive impairment, depressed mood, and functional disability. In multivariable analyses, several baseline clinical characteristics, including chronic pulmonary disease, distal neuropathic pain, polypharmacy, and creatinine levels, significantly predicted one or more adverse MLBPSP trajectories. These findings have implications for HIV care by identifying PWH at risk for future adverse trajectories. The results may lead to insights informing future personalized interventions targeted to vulnerable subpopulations of PWH.
我们旨在识别艾滋病毒感染者（PWH）的复杂、多维度、纵向生物心理社会表型（MLBPSP），并评估它们与基线临床特征的关联。我们纳入了多中心CHARTER研究中的506名PWH，他们在相隔6个月的四次访视中接受了评估。我们使用机器学习，根据生物心理社会特征的均值和非线性轨迹，确定了四个MLBPSP集群。这些特征包括每次访视时的神经认知、情绪低落、自我报告的认知症状和日常生活活动能力。最大的MLBPSP集群（C1，N = 231）在所有领域的平均得分最高，并且在18个月的随访中保持稳定。其他集群表现出不同程度的认知障碍、情绪低落和功能残疾。在多变量分析中，包括慢性肺病、远端神经性疼痛、多种药物治疗和肌酐水平在内的几个基线临床特征，显著预测了一条或多条不良的MLBPSP轨迹。这些发现通过识别未来有不良轨迹风险的PWH，对艾滋病毒护理具有重要意义。结果可能会为针对PWH脆弱亚群的未来个性化干预提供见解。
