Identifying risk factors for HIV-associated neurocognitive disorders using the international HIV dementia scale.
Identifying risk factors for HIV-associated neurocognitive disorders using the international HIV dementia scale.
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使用国际艾滋病毒痴呆量表识别艾滋病毒相关神经认知障碍的危险因素。
DOI：
10.1007/s11481-013-9505-1
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发表时间：
2013-12
期刊：
影响因子：
--
通讯作者：
Ances BM
中科院分区：
文献类型：
--
作者：
Cross S;Önen N;Gase A;Overton ET;Ances BM
尽管联合抗逆转录病毒治疗（cART）取得了巨大进展，但HIV相关神经认知障碍（HAND）仍然存在。诊断认知障碍的黄金标准是由受过训练的神经心理学家进行一系列耗时的神经心理测试，但在艾滋病毒门诊中，这是不可行的。国际艾滋病痴呆量表（IHDS）的开发是为了帮助确定个人在门诊设置认知障碍。IHDS对于检测更多症状形式的HAND具有中等灵敏度，但在轻度损伤中灵敏度较差。尚未在发达国家的大型队列人群中对IHDS进行评价。我们进行了一项前瞻性的横断面研究，只有艾滋病毒阳性的个人在城市诊所和评估的患病率手和相关的危险因素，认知功能障碍使用IHDS。共有507名HIV阳性个体参与了这项研究，其中大多数是男性（65%）和非洲裔美国人（68%）; 41%有认知障碍。在多变量分析中，非裔美国人种族（p=2.21），年龄较大（p=1.03），高中或更低的教育程度（p=2.03）和抑郁症（p=1.05）与认知障碍相关。HAND在该组中的高患病率表明，尽管有cART，但仍存在更严重形式的HAND。已确定的风险因素与艾滋病毒无关，表明环境和社会人口因素对认知功能有重大影响，应给予更多关注。IHDS应在美国的大型队列HIV+和HIV-人群中进一步评估，因为仍然非常需要确定一种有效的认知障碍简短筛查工具。
HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65%) and African American (68%); and 41% had cognitive impairment. On multivariate analysis, African American race (p=2.21), older age (p=1.03), high school education or less (p=2.03) and depression (p=1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV− populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.
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2.8
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