Selnes O A, Galai N, McArthur J C, Cohn S, Royal W, Esposito D, Vlahov D
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Neurology. 1997 Jan;48(1):223-30. doi: 10.1212/wnl.48.1.223.
A cohort of 185 HIV-infected injection drug users (IDUs) and seronegative controls was followed with semiannual neuropsychological assessments for up to 4.5 years. Changes in cognitive performance over time were evaluated, and results of seronegative controls were used to adjust for level of education and practice effects. The effects of duration of follow-up, decline in CD4+ count, development of clinical symptoms, antiretroviral use, and diagnosis of AIDS on changes in neuropsychological performance over time were assessed with regression models using the generalized estimating equation approach. Improvement in performance over time, consistent with practice effects, was observed for all measures. The only subtest for which the magnitude of the practice effects was mildly attenuated relative to the seronegative controls was Grooved Pegboard, dominant hand. After adjusting for disease progression and antiretroviral therapy use, none of the time trends for the neuropsychological test scores were significant, suggesting no decline in performance of the seropositive patients relative to the seronegative controls. With development of clinical symptoms, there was a trend in the direction of declining performance. For subjects reporting two or more symptoms but not using antiretroviral therapy, the trend was not significant, whereas having two or more symptoms and using antiretroviral therapy was associated with significantly worse performance on tests of psychomotor speed and memory. With development of AIDS, a significant decline in performance was observed on measures of motor and psychomotor speed as well as memory. There is thus no evidence to suggest that HIV infection in the context of chronic drug and alcohol use significantly alters the frequency or rate of progression of cognitive symptoms. These findings suggest that the natural history of cognitive changes secondary to HIV infection is similar among HIV-infected IDUs and other risk groups such as homosexual/bisexual men.
对185名感染HIV的注射吸毒者（IDU）和血清学阴性对照者进行了队列研究，每半年进行一次神经心理学评估，随访时间长达4.5年。评估了认知表现随时间的变化，并使用血清学阴性对照者的结果来校正教育水平和练习效应。使用广义估计方程方法的回归模型评估了随访时间、CD4 +细胞计数下降、临床症状的出现、抗逆转录病毒药物的使用以及艾滋病诊断对神经心理学表现随时间变化的影响。所有测量指标均观察到与练习效应一致的随时间表现改善。相对于血清学阴性对照者，练习效应大小仅在优势手沟槽插板测验这一亚测验中略有减弱。在校正疾病进展和抗逆转录病毒治疗的使用后，神经心理学测试分数的时间趋势均无显著性，这表明血清阳性患者相对于血清学阴性对照者的表现没有下降。随着临床症状的出现，表现有下降的趋势。对于报告有两种或更多症状但未使用抗逆转录病毒治疗的受试者，该趋势不显著，而有两种或更多症状且使用抗逆转录病毒治疗与心理运动速度和记忆测试中的显著较差表现相关。随着艾滋病的发展，在运动和心理运动速度以及记忆测量指标上观察到表现显著下降。因此，没有证据表明在慢性药物和酒精使用背景下的HIV感染会显著改变认知症状的发生频率或进展速度。这些发现表明，HIV感染继发的认知变化的自然史在感染HIV的注射吸毒者和其他风险群体（如同性恋/双性恋男性）中相似。
