Enhancing antiretroviral therapy for human immunodeficiency virus cognitive disorders
Enhancing antiretroviral therapy for human immunodeficiency virus cognitive disorders
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DOI：
10.1002/ana.20198
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发表时间：
2004-09-01
影响因子：
11.2
通讯作者：
Ellis, RJ
中科院分区：
文献类型：
--
作者：
Letendre, SL;McCutchan, JA;Ellis, RJ
联合抗逆转录病毒疗法（ART）对艾滋病毒认知障碍的益处在个体之间差异很大。本研究评估了是否脑脊液（CSF）药物渗透和CSF病毒学抑制影响的程度，神经心理学（NP）的改善在ART。整体性能的电池NP测试管理在基线和后续（中位数15周）计算使用全球赤字评分（GDS）的方法在31个认知功能受损，HIV感染者开始新的ART方案。分别评估血浆和CSF的病毒学抑制（随访时通过RT-PCR检测不到病毒载量）。受试者的方案含有更多的CSF穿透药物显示出显着更大的减少CSF病毒载量。达到CSF病毒学抑制的受试者表现出比未达到CSF病毒学抑制的受试者更大的GDS改善（中位GDS变化，0.62 vs 0.23; p = 0.01）。血浆的类似趋势未达到统计学显著性（p = 0.053）。ART初治受试者的NP改善程度高于接受过治疗的受试者。在多变量模型中（总体p = 0.0008），GDS降低的显著独立预测因素为CSF HIV RNA抑制、基线抗逆转录病毒治疗史及其相互作用。在ART方案中加入CSF穿透药物并监测CSF病毒载量可能适用于HIV相关认知障碍患者。
The benefits of combination antiretroviral therapy (ART) for HIV cognitive disorders vary substantially between individuals. This study evaluated whether cerebrospinal fluid (CSF) drug penetration and CSF virological suppression influence the extent of neuropsychological (NP) improvement during ART. Overall performance on a battery of NP tests administered at baseline and follow-up (median 15 weeks) was computed by using the global deficit score (GDS) methods in 31 cognitively impaired, HIV-infected individuals who began new ART regimens. Virological suppression (attaining undetectable viral load by RT-PCR at follow-up) was assessed separately for plasma and CSF. Subjects on regimens containing greater numbers of CSF-penetrating drugs showed significantly greater reduction in CSF viral load. Subjects attaining CSF virological suppression demonstrated greater GDS improvement than those who did not (median GDS change, 0.62 vs 0.23; p = 0.01). A similar trend for plasma did not reach statistical significance (p = 0.053). NP improvement was greater in ART-naive versus treatment-experienced subjects. In a multivariate model (overall p = 0.0008), significant, independent predictors of GDS reduction were CSF HIV RNA suppression, baseline antiretroviral history, and their interaction. Including CSF-penetrating drugs in the ART regimen and monitoring CSF viral load may be indicated for individuals with HIV-associated cognitive impairment.