Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men
Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men
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DOI：
10.1212/wnl.0b013e3181bd10e7
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发表时间：
2009-10-20
期刊：
影响因子：
9.9
通讯作者：
Visscher, B. R.
中科院分区：
文献类型：
--
作者：
Becker, J. T.;Kingsley, L.;Visscher, B. R.
背景：本研究的目的是评估高效抗逆转录病毒治疗时代认知表现、心脑血管疾病 (CVD) 危险因素和 HIV 感染之间的关系。方法：我们评估了参加多中心艾滋病队列研究心血管疾病子研究的男性认知功能，这些男性年龄 > 40 岁，无自我报告病史 心脏病或脑血管疾病。综合神经心理学评估的结果用于构建精神运动速度和记忆表现的综合评分。通过测量冠状动脉钙和颈动脉内膜中层厚度 (IMT) 以及实验室测量值（包括总胆固醇、空腹血糖、糖化血红蛋白、肾小球滤过率（估计）以及标准化血压和心率测量值）来评估亚临床 CVD。 结果：在考虑了教育程度、抑郁症和种族后，颈动脉 IMT 和 肾小球滤过率与精神运动速度显着相关，而 IMT 与记忆测试表现相关。 HIV 血清状态与较差的认知测试表现没有显着相关。然而，在 HIV 感染者中，血浆中可检测到的 HIV RNA 的存在与较低的记忆能力有关。 结论：这些发现表明，在后高度活跃的抗逆转录病毒治疗时代，HIV 感染可能不是老年同性恋和双性恋男性认知能力的最重要预测因素，至少对于那些能够获得医疗护理和适当药物的人来说是这样。与正常衰老相关的医学因素与神经心理学测试的表现显着相关，对艾滋病毒感染者和有感染风险的人来说，对这些因素进行良好的临床管理可能会在短期内产生有益的影响，并可能降低随后认知能力下降的风险。神经病学（R）2009；73：1292-1299
Background: The purpose of this study was to evaluate the relationship between cognitive performance, risk factors for cardiovascular and cerebrovascular disease (CVD), and HIV infection in the era of highly active antiretroviral therapy.Methods: We evaluated the cognitive functions of men enrolled in the cardiovascular disease substudy of the Multicenter AIDS Cohort Study who were aged > 40 years, with no self-reported history of heart disease or cerebrovascular disease. Results from comprehensive neuropsychological evaluations were used to construct composite scores of psychomotor speed and memory performance. Subclinical CVD was assessed by measuring coronary artery calcium and carotid artery intima-media thickness (IMT), as well as laboratory measures, including total cholesterol, fasting glucose, glycosylated hemoglobin, glomerular filtration rate (estimated), and standardized blood pressure and heart rate measures.Results: After accounting for education, depression, and race, carotid IMT and glomerular filtration rate were significantly associated with psychomotor speed, whereas IMT was associated with memory test performance. HIV serostatus was not significantly associated with poorer cognitive test performance. However, among the HIV-infected individuals, the presence of detectable HIV RNA in plasma was linked to lower memory performance.Conclusions: These findings suggest that HIV infection may not be the most important predictor of cognitive performance among older gay and bisexual men in the post-highly active antiretroviral therapy era, at least among those with access to medical care and to appropriate medications. Medical factors associated with normal aging are significantly associated with performance on neuropsychological tests, and good clinical management of these factors both in HIV-infected individuals and those at risk for infection may have beneficial effects in the short term and could reduce the risk of subsequent cognitive decline. Neurology (R) 2009;73:1292-1299