Villa G, Solida A, Moro E, Tavolozza M, Antinori A, De Luca A, Murri R, Tamburrini E
Servizio di Neuropsicologia, Istituto di Neurologia, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Roma, Italia.
Eur Neurol. 1996;36(3):125-33. doi: 10.1159/000117228.
Seventy-eight asymptomatic HIV-seropositive (aHIV) subjects were examined by means of an extensive neuropsychological test battery in comparison with 32 HIV-seronegative controls. They were also tested with regard to CD4+ and serum p24 antigen. Fifty-six of them completed a clinical follow-up of 12 up to 36 months and 35 also underwent a second session of neuropsychological, CD4+ and p24 antigen assessments at a 12- to 18-month interval from the first session. Results obtained lead to the following conclusions: (a) even among aHIV subjects there is a significant prevalence (28.2%) of cognitive abnormalities for which no cause other than HIV can be found, and therefore this suggests the possible development of HIV-related brain damage since the earliest stages of infection; (b) most sensitive to early HIV-related cognitive impairment are timed psychomotor tasks and memory tasks which require attention, learning and 'active' monitoring or retrieval of information; (c) during the early asymptomatic stages of HIV infection, there is no clear-cut evidence of a cross-sectional relationship between cognition and immunological/ virological markers (at least in the high ranges of CD4+ cell counts considered here); only in relatively more advanced stages does this relationship become evident in the subgroup of aHIV subjects with cognitive abnormalities; (d) the presence of cognitive abnormalities in early HIV infection is predictive of a further decrease in cognitive functioning and faster progression to AIDS-this latter reflected by a faster rate of decline in the number of CD4+ cells and by an increase in positivity of serum p24 antigen.
78名无症状HIV血清阳性（aHIV）受试者接受了一系列广泛的神经心理学测试，并与32名HIV血清阴性对照者进行了比较。他们还接受了CD4 +和血清p24抗原检测。其中56人完成了12至36个月的临床随访，35人在距第一次评估12至18个月时还接受了第二轮神经心理学、CD4 +和p24抗原评估。所得结果得出以下结论：（a）即使在aHIV受试者中，也有相当比例（28.2%）的认知异常，除了HIV之外找不到其他原因，因此这表明在感染的最早阶段就可能发生与HIV相关的脑损伤；（b）对早期HIV相关认知障碍最敏感的是计时心理运动任务和需要注意力、学习以及“主动”监测或信息检索的记忆任务；（c）在HIV感染的早期无症状阶段，没有明确证据表明认知与免疫/病毒学标志物之间存在横断面关系（至少在这里考虑的高CD4 +细胞计数范围内）；只有在相对更晚期阶段，这种关系才在有认知异常的aHIV受试者亚组中变得明显；（d）早期HIV感染中存在认知异常可预测认知功能进一步下降以及更快发展为艾滋病——后者表现为CD4 +细胞数量下降速度加快以及血清p24抗原阳性率增加。
