Sacktor N C, Bacellar H, Hoover D R, Nance-Sproson T E, Selnes O A, Miller E N, Dal Pan G J, Kleeberger C, Brown A, Saah A, McArthur J C
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Neurovirol. 1996 Dec;2(6):404-10. doi: 10.3109/13550289609146906.
The objective of this study was to determine if sustained decline in psychomotor speed tests is associated with an increased risk of progression to dementia, acquired immunodeficiency syndrome (AIDS), or mortality in human immunodeficiency virus (HIV)-1-infected homosexual men in the Baltimore site of the Multicenter AIDS Cohort-Study (MACS). Clinical and neuropsychological data were obtained on 291 HIV+ homosexual men seen semi-annually over a nine year period (1986-1994). A proportional hazards model was used to assess the predictive value of sustained psychomotor slowing (defined as a 2.0 standard deviation (s.d.) decline in performance on either the Symbol Digit Modalities test or Trailmaking test at two consecutive evaluations). Time-dependent co-variates included in the model were sustained psychomotor slowing, number of attended visits, CD4+ lymphocyte count, hemoglobin and antiretroviral medication use. HIV+ participants with and without sustained psychomotor slowing were compared. Outcome variables were the development of dementia, AIDS and death. HIV+ subjects with sustained psychomotor slowing had an increased hazard of dementia (Risk ratio (RR) = 5.0, P = 0.008), AIDS (RR = 2.4, P = 0.02), and death (RR = 2.0, P = 0.04). A similar analysis using sustained cognitive decline in one domain from a more extensive neuropsychological test battery failed to show any predictive value. Sustained decline in psychomotor performance in HIV infection was predictive of dementia, AIDS and death. This brief neuropsychological test battery may be useful for early detection of HIV+ individuals with a poorer prognosis who may benefit from more aggressive treatment to prevent HIV dementia.
本研究的目的是确定在多中心艾滋病队列研究（MACS）巴尔的摩站点中，感染人类免疫缺陷病毒1型（HIV-1）的同性恋男性在精神运动速度测试中的持续下降是否与发展为痴呆、获得性免疫缺陷综合征（AIDS）或死亡的风险增加相关。在1986年至1994年的九年期间，每半年对291名HIV阳性同性恋男性进行一次临床和神经心理学数据采集。使用比例风险模型评估持续精神运动迟缓（定义为在连续两次评估中，符号数字模态测试或连线测试的表现下降2.0个标准差）的预测价值。模型中纳入的时间依存性协变量包括持续精神运动迟缓、就诊次数、CD4 +淋巴细胞计数、血红蛋白和抗逆转录病毒药物使用情况。比较了有和没有持续精神运动迟缓的HIV阳性参与者。结局变量为痴呆、AIDS和死亡的发生情况。有持续精神运动迟缓的HIV阳性受试者患痴呆（风险比（RR）= 5.0，P = 0.008）、AIDS（RR = 2.4，P = 0.02）和死亡（RR = 2.0，P = 0.04）的风险增加。使用来自更广泛神经心理测试组的一个领域的持续认知下降进行的类似分析未显示任何预测价值。HIV感染中精神运动表现的持续下降可预测痴呆、AIDS和死亡。这种简短的神经心理测试组可能有助于早期发现预后较差的HIV阳性个体，这些个体可能受益于更积极的治疗以预防HIV痴呆。
