Persistence of neuropsychologic deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment prevalence and risk factors - Prevalence and risk factors
Persistence of neuropsychologic deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment prevalence and risk factors - Prevalence and risk factors
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DOI：
10.1097/qai.0b013e318042e1ee
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发表时间：
2007-06-01
影响因子：
3.6
通讯作者：
Narciso, Pasquale
中科院分区：
文献类型：
--
作者：
Tozzi, Valerio;Balestra, Pietro;Narciso, Pasquale
目的：虽然高效抗逆转录病毒治疗（HAART）可以逆转 HIV 相关的神经认知障碍（NCI），但尽管接受抗逆转录病毒治疗，相当一部分患者仍可能持续存在神经心理（NP）缺陷。我们评估了 HIV 相关 NCI 患者中尽管长期接受 HAART，但持续 NP 缺陷的患病率和预测因素。方法：对 94 名 HIV 相关 NCI 患者进行了 2 至 7 次连续 NP 治疗、神经系统检查和脑成像研究。患者接受HAART平均63个月（范围：6-127）个月。根据NP评估结果，患者被认为具有可逆性或持续性NP缺陷。 Kaplan-Meier 分析和 Cox 比例风险模型用于分析 NP 缺陷逆转的首次证据的时间。结果：在 59 名 (62.8%) 患者中观察到持续的 NP 缺陷。年龄、性别、疾病控制和预防中心分期、风险类别、CD4(+)细胞计数、血浆病毒载量和中枢神经系统渗透药物的使用与持续性NP缺陷无关。相比之下，持续性 NP 缺陷的患者受教育程度较低，并且在探索心理处理的注意力和速度、记忆力和心理灵活性的 NP 测量中表现出较差的基线表现。在多变量分析中，只有 NCI 的基线严重程度（通过综合 NPZ8 总体评分衡量）（比值比 = 3.07，95% 置信区间：1.54 至 6.08；P = 0.001）仍然与持续性 NP 缺陷显着相关。结论：尽管长期进行了 HAART，但开始 HAART 时 NCI 的严重程度似乎是持续性 NP 缺陷的最强预测因子。我们的数据表明，一旦诊断出 NCI，就应立即开始 HAART，以避免潜在的不可逆的神经损伤。
Objective: Although highly active antiretroviral therapy (HAART) can reverse HIV-related neurocognitive impairment (NCI), neuropsychologic (NP) deficits may persist in a substantial proportion of patients despite antiretroviral treatment. We assessed the prevalence and predictors of persistent NP deficits despite long-term HAART in patients with HIV-related NCI.Methods: A group of 94 patients with HIV-related NCI underwent 2 to 7 serial NP batteries, neurologic examination, and brain imaging studies. Patients received HAART for a mean of 63 (range: 6-127) months. According to NP assessment results, patients were considered to have reversible or persistent NP deficits. Kaplan-Meier analyses and Cox proportional hazards models were used to analyze time to first evidence of NP deficit reversion.Results: Persistent NP deficits were observed in 59 (62.8%) patients. Age, gender, Centers for Disease Control and Prevention stage, risk category, CD4(+) cell count, plasma viral load, and use of central nervous system penetrating drugs were not associated with persistent NP deficits. By contrast, patients with persistent NP deficits were less educated and showed poorer baseline performances in NP measures exploring concentration and speed of mental processing, memory, and mental flexibility. In multivariable analyses, only the baseline severity of NCI, as measured by the composite NPZ8 global score (odds ratio = 3.07, 95% confidence interval: 1.54 to 6.08; P = 0.001) remained significantly associated with persistent NP deficits.Conclusions: The severity of NCI at HAART initiation seems to be the strongest predictor of persistent NP deficits despite long-term HAART. Our data indicate that HAART should be initiated as soon as NCI is diagnosed to avoid potentially irreversible neurologic damage.