Effects of nadir CD4 count and duration of human immunodeficiency virus infection on brain volumes in the highly active antiretroviral therapy era.
Effects of nadir CD4 count and duration of human immunodeficiency virus infection on brain volumes in the highly active antiretroviral therapy era.
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DOI：
10.3109/13550280903552420
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发表时间：
2010-02
影响因子：
3.2
通讯作者：
Navia B
中科院分区：
文献类型：
--
作者：
Cohen RA;Harezlak J;Schifitto G;Hana G;Clark U;Gongvatana A;Paul R;Taylor M;Thompson P;Alger J;Brown M;Zhong J;Campbell T;Singer E;Daar E;McMahon D;Tso Y;Yiannoutsos CT;Navia B
脑萎缩是HIV感染的一种常见并发症，但对其了解甚少。尽管在HAART时代艾滋病毒相关痴呆的患病率降低，但艾滋病毒继续影响慢性感染患者的大脑。在这项研究中，我们研究了艾滋病毒感染的HAART患者的脑容量损失的模式，人口和临床因素促成it.We假设，最低点的CD4+淋巴细胞计数，HIV感染的持续时间和年龄将与皮质体积减少。使用基于体素的形态测量法测量了69名HIV感染的神经无症状（NA）个体和13名至少轻度AIDS痴呆综合征（ADC）个体的皮质和皮质下区域的脑白质。将人口统计学和临床因素（年龄、血浆HIV RNA水平、当前和最低CD4计数、感染持续时间、抗逆转录病毒治疗方案的CNS渗透）及其相互作用沿着输入回归模型选择算法，以确定最佳描述局部脑体积的最终模型。相对于NA，ADC患者的总灰质和顶叶皮质体积减少，总脑室体积增加。最终回归模型显示，总体脑体积，包括灰色和白色物质体积以及顶叶、颞叶、额叶和海马体积，与疾病史因素（最低CD4和感染持续时间）最密切相关。相比之下，基底神经节体积与当前疾病因素的相关性最强，最明显的是血浆HIV RNA。这些研究结果表明，有慢性HIV感染史的个体，如CD4 +淋巴细胞计数最低值降低所反映的，既往免疫功能严重受损，可能是脑萎缩的最大风险。在HAART治疗中大部分无症状的患者中，HIV相关脑功能丧失的模式可能正在从皮质下疾病转变为皮质疾病。
Cerebral atrophy is a well described, but poorly understood complication of HIV infection. Despite reduced prevalence of HIV-associated dementia in the HAART era, HIV continues to affect the brains of patients with chronic infection. In this study we examine patterns of brain volume loss in HIV infected patients on HAART, and demographic and clinical factors contributing to it. We hypothesized that nadir CD4+ lymphocyte count, duration of HIV infection and age would be associated with reduced cortical volumes. Volumes of cortical and subcortical regions in 69 HIV-infected neuroasymptomatic (NA) individuals and 13 with at least mild AIDS dementia complex (ADC) were measured using voxel-based morphometry. Demographic and clinical factors (age, plasma HIV RNA level, current and nadir CD4 count, duration of infection, CNS penetration of antiretroviral regimen) along with their interactions were entered into a regression model selection algorithm to determine the final models that best described regional brain volumes. Relative to NA, individuals with ADC exhibited decreased total gray matter and parietal cortex volumes and increased total ventricular volumes. Final regression models showed overall cerebral volume, including gray and white matter volume and volumes of the parietal, temporal, and frontal lobes and the hippocampus, were most strongly associated with disease history factors (nadir CD4 and duration of infection). In contrast, basal ganglia volumes were related most strongly to current disease factors, most notably plasma HIV RNA. These findings indicate that individuals with a history of chronic HIV infection with previous episodes of severely impaired immune function, as reflected by reduced nadir CD4 + lymphocyte count, may be at greatest risk for cerebral atrophy. The pattern of HIV-associated brain loss may be changing from a subcortical to a cortical disease among patients who are largely asymptomatic on HAART.
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影响因子：
9.9
作者：
Ances, BM;Roc, AC;Detre, JA
通讯作者：
Detre, JA
影响因子：
--
作者：
JERNIGAN, TL;ARCHIBALD, S;GRANT, I
通讯作者：
GRANT, I
DOI：
10.1073/pnas.0502548102
发表时间：
2005-10-25
影响因子：
11.1
作者：
Thompson, PM;Dutton, RA;Becker, JT
通讯作者：
Becker, JT
影响因子：
3.8
作者：
Masliah, E;DeTeresa, RM;Hansen, LA
通讯作者：
Hansen, LA
影响因子：
6.8
作者：
AKAIKE, H
通讯作者：
AKAIKE, H