No Evidence for Accelerated Aging-Related Brain Pathology in Treated Human Immunodeficiency Virus: Longitudinal Neuroimaging Results From the Comorbidity in Relation to AIDS (COBRA) Project
No Evidence for Accelerated Aging-Related Brain Pathology in Treated Human Immunodeficiency Virus: Longitudinal Neuroimaging Results From the Comorbidity in Relation to AIDS (COBRA) Project
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DOI：
10.1093/cid/cix1124
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发表时间：
2018-06-15
影响因子：
11.8
通讯作者：
Sharp, David J.
中科院分区：
文献类型：
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作者：
Cole, James H.;Caan, Matthan W. A.;Sharp, David J.
背景尽管成功的抗逆转录病毒治疗，但人类免疫缺陷病毒（PLWH）感染者的年龄相关发病率较高，包括脑结构异常，脑功能和认知障碍。这引起了人们的关注，PLWH可能会经历加速老化相关的脑病理学。我们对134例病毒学抑制的PLWH（中位年龄56.0岁）和79例人口统计学相似的人类免疫缺陷病毒（HIV）阴性对照（中位年龄57.2岁）进行了一项多中心纵向研究。为了测量认知能力和大脑病理学，我们在基线和2年时进行了详细的神经心理学评估和多模态神经成像（T1加权，T2加权，弥散磁共振成像[MRI]，静息状态功能MRI，光谱学，动脉自旋标记）。使用线性混合效应模型评估变化率的组间差异。123名PLWH和78名HIV阴性对照完成了纵向评估（中位间隔，1.97年）。PLWH和HIV阴性对照组在年龄、性别、受教育年限、吸烟或饮酒方面没有差异。基线时，PLWH的整体认知能力较差（P <0.01），灰质体积较低（P = 0.04），白色高强度负荷较高（P = 0.02），白色微结构异常（P <0.005），脑预测年龄差异较大（P = 0.01）。纵向上，PLWH和HIV阴性对照组之间任何神经影像学指标的变化率均无显著差异（P > 0.1）。两组患者的认知能力纵向稳定。我们没有发现任何证据表明中年PLWH在接受成功治疗时，在2年内加速老化相关的大脑变化或认知能力下降的风险增加。
Background. Despite successful antiretroviral therapy, people living with human immunodeficiency virus (PLWH) experience higher rates of age-related morbidity, including abnormal brain structure, brain function, and cognitive impairment. This has raised concerns that PLWH may experience accelerated aging-related brain pathology.Methods. We performed a multicenter longitudinal study of 134 virologically suppressed PLWH (median age, 56.0 years) and 79 demographically similar human immunodeficiency virus (HIV)-negative controls (median age, 57.2 years). To measure cognitive performance and brain pathology, we conducted detailed neuropsychological assessments and multimodality neuroimaging (T1-weighted, T2-weighted, diffusion magnetic resonance imaging [MRI], resting-state functional MRI, spectroscopy, arterial spin labeling) at baseline and at 2 years. Group differences in rates of change were assessed using linear mixed effects models.Results. One hundred twenty-three PLWH and 78 HIV-negative controls completed longitudinal assessments (median interval, 1.97 years). There were no differences between PLWH and HIV-negative controls in age, sex, years of education, smoking or alcohol use. At baseline, PLWH had poorer global cognitive performance (P < .01), lower gray matter volume (P = .04), higher white matter hyperintensity load (P = .02), abnormal white matter microstructure (P < .005), and greater brain-predicted age difference (P = .01). Longitudinally, there were no significant differences in rates of change in any neuroimaging measure between PLWH and HIV-negative controls (P > .1). Cognitive performance was longitudinally stable in both groups.Conclusions. We found no evidence that middle-aged PLWH, when receiving successful treatment, are at increased risk of accelerated aging-related brain changes or cognitive decline over 2 years.