Effect of combination therapy with zidovudine and didanosine on neuropsychological functioning in patients with symptomatic HIV disease: A comparison of simultaneous and alternating regimens
Effect of combination therapy with zidovudine and didanosine on neuropsychological functioning in patients with symptomatic HIV disease: A comparison of simultaneous and alternating regimens
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DOI：
10.1097/00002030-199701000-00009
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发表时间：
1997-01-01
期刊：
影响因子：
3.8
通讯作者：
Yarchoan, R
中科院分区：
文献类型：
--
作者：
Brouwers, P;Hendricks, M;Yarchoan, R
目的：评价齐多夫定和地丹诺辛交替和同步治疗对有症状的HIV-1患者神经心理功能的影响。设计：随机、非盲临床试验。地点：政府医学研究中心。患者：38例有症状的HIV-1患者，其中21例有中枢神经系统损害的证据。结果：治疗12周后，两种方案的记忆力(P<；0.01)和注意力集中(P<；0.001)均有显著改善。然而，这些进展在很大程度上仅限于那些在入院时与HIV-1相关的中枢神经系统受损的患者(P<；0.05)。在接受性词汇、阅读、知觉辨别和推理、分散注意力、运动强度以及情绪和情感方面也有改善。后者功能的改善通常是有限的，对于受损和未受损的患者来说，改善的程度是相当的。两种药物方案对中枢神经系统参数的影响总体上没有差异。结论：尤其是对HIV-1相关中枢神经系统损害的患者，治疗相关的改善更明显。与艾滋病痴呆症有关的神经心理功能--记忆和注意力--显示出最大的进步。与之前描述的同时方案在免疫学和病毒学参数方面的优势相反，在中枢神经系统措施方面，两种方案之间没有差异。这支持了这样一种观点，即在艾滋病毒疾病和治疗方面，中枢神经系统是一个相对独立的部门。
Objective: To evaluate the effects of treatment with alternating and simultaneous regimens of zidovudine and didanosine on neuropsychological Function in patients with symptomatic HIV-1 disease, focusing on patients with possible HIV-1-associated central nervous system (CNS) compromise at entry.Design: Randomized non-blinded clinical trial.Setting: Government medical research center.Patients: Thirty-eight patients with symptomatic HIV-1 disease, of whom 21 had evidence of CNS compromise at entry.Results: After 12 weeks of therapy, overall significant improvements in memory (P < 0.01) and focused attention (P < 0.001) were seen on both regimens. These gains, however, were largely limited to those patients with HIV-1-associated CNS compromise at entry (P < 0.05). Improvements were also noted in receptive vocabulary, reading, perceptual discrimination and reasoning, divided attention, motor strength, and in mood and affect. Improvements in those latter functions were generally of limited magnitude and were of comparable size for both compromised and non-compromised patients. There was no overall difference between the two drug regimens in the effects on CNS parameters.Conclusions: Therapy-related improvements were noted particularly for patients with HIV-1-associated CNS compromise. Neuropsychological functions that have been implicated in AIDS dementia - memory and attention - showed the greatest gains. In contrast to the previously described superiority of the simultaneous regimen with regard to immunologic and virologic parameters, there was no difference between the regimens with regard to CNS measures. This supports the contention that the CNS constitutes a relatively independent compartment in terms of HIV disease and treatment.