Differences in Neurocognitive Impairment Among HIV-Infected Latinos in the United States.
Differences in Neurocognitive Impairment Among HIV-Infected Latinos in the United States.
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在美国，艾滋病毒感染的拉丁美洲人的神经认知障碍差异。
DOI：
10.1017/s1355617717000832
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发表时间：
2018-03
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影响因子：
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通讯作者：
Heaton RK
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作者：
Marquine MJ;Heaton A;Johnson N;Rivera-Mindt M;Cherner M;Bloss C;Hulgan T;Umlauf A;Moore DJ;Fazeli P;Morgello S;Franklin D;Letendre S;Ellis R;Collier AC;Marra CM;Clifford DB;Gelman BB;Sacktor N;Simpson D;McCutchan JA;Grant I;Heaton RK
艾滋病毒不成比例地影响美国的西班牙裔/拉丁裔，然而，对这一人群的神经认知障碍（NCI）知之甚少。我们比较了艾滋病毒感染（艾滋病毒+）的拉丁美洲人和（非拉丁美洲人）白人的大样本中的NCI率，并检查了拉丁美洲人亚组中艾滋病毒相关的NCI。参与者包括在美国六个医疗中心评估的讲英语的HIV+成人（194名拉丁美洲人，600名白人）。对于整个组，年龄：M=42.65，SD=8.93; 86%为男性;教育：M=13.17，SD=2.73; 54%患有艾滋病。NCI的评估与一个全面的测试电池与年龄，教育和性别的规范性校正。检查的协变量包括HIV疾病特征、合并症和遗传祖先。与白人相比，拉丁美洲人在执行功能、学习、回忆、工作记忆和处理速度方面的整体NCI（42%对54%）和领域NCI的比率更高。拉丁美洲人在当前和历史HIV疾病特征上的表现也比白人差，CD 4最低点部分介导了NCI的种族差异。然而，在调整了显著的协变量后，拉丁美洲人继续拥有更多的全球NCI（OR=1.59，95%CI=1.13-2.23，p<0.01）。观察到波多黎各人（n=60; 71%）与墨西哥人（n=79，44%）的全球NCI发生率更高;在调整显著协变量的模型中，这种差异持续存在（OR=2.40，CI=1.11-5.29，p= 0.03）。艾滋病毒阳性的拉丁美洲人，特别是波多黎各（与墨西哥）血统/血统的NCI率增加相比，白人。NCI发生率的差异不能完全用更差的HIV疾病特征、神经认知共病或遗传血统来解释。未来的研究应探讨文化相关的心理社会，生物医学和遗传因素，可能会解释这些差异，并告知有针对性的干预措施的发展。
HIV disproportionately affects Hispanics/Latinos in the U.S., yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, Age: M=42.65, SD=8.93; 86% Male; Education: M=13.17, SD=2.73; 54% had AIDS. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. Compared to Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI (OR=1.59, 95%CI=1.13–2.23, p<.01) after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) vs. Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40, CI=1.11–5.29, p=.03). HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared to Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally-relevant psychosocial, biomedical and genetic factors that might explain these disparities and inform the development of targeted interventions.