The Effect of Central Nervous System Penetration Effectiveness of Highly Active Antiretroviral Therapy on Neuropsychological Performance and Neuroimaging in HIV Infected Individuals.
The Effect of Central Nervous System Penetration Effectiveness of Highly Active Antiretroviral Therapy on Neuropsychological Performance and Neuroimaging in HIV Infected Individuals.
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DOI：
10.1007/s11481-015-9610-4
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Ances BM
中科院分区：
文献类型：
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作者：
Baker LM;Paul RH;Heaps-Woodruff JM;Chang JY;Ortega M;Margolin Z;Usher C;Basco B;Cooley S;Ances BM
在高效抗逆转录病毒治疗（HAART）时代，HIV相关痴呆的发病率已大大降低；然而，较轻微的认知障碍仍然存在。目前尚不确定具有高度中枢神经系统渗透有效性 (CPE) 的 HAART 方案是否对接受稳定治疗的 HIV 感染者 (HIV+) 产生有益的神经学结果。使用已发布的排名系统对 64 名接受 HAART 的 HIV 感染者进行 CPE 评分，并将其分为高 CPE 组（≥ 7；n=35）和低 CPE 组（< 7；n=29）。除了结构神经影像学检查之外，所有参与者还完成了神经心理学测试。神经心理学测试包括已知对 HIV 敏感的测量值，并根据已发布的规范分数转换为标准化分数 (NPZ-4)。采用半自动方法来评估感兴趣的皮质（灰质和白质）和皮质下（丘脑、尾状核、壳核）区域内的大脑体积。分析评估了具有高 CPE 分数和低 CPE 分数的 HIV+ 个体之间的 NPZ-4 和大脑体积差异。两组之间的大脑完整性没有观察到显着差异。具有高度 CPE 的长期 HAART 方案与 HIV + 成人的神经心理学或神经影像学结果的显着改善无关。结果表明，在 HAART 时代，替代机制可能有助于改善神经系统结果。
The incidence of HIV-associated dementia has been greatly reduced in the era of highly active antiretroviral therapy (HAART); however milder forms of cognitive impairment persist. It remains uncertain whether HAART regimens with a high degree of central nervous system penetration effectiveness (CPE) exert beneficial neurological outcomes in HIV-infected (HIV+) individuals on stable treatment. Sixty-four HIV-infected adults on HAART were assigned a CPE score using a published ranking system and divided into high (≥ 7; n=35) and low (< 7; n=29) CPE groups. All participants completed neuropsychological testing in addition to structural neuroimaging. Neuropsychological tests included measures known to be sensitive to HIV with values converted into standardized scores (NPZ-4) based on published normative scores. A semi-automated methodology was utilized to assess brain volumetrics within cortical (grey and white matter) and subcortical (thalamus, caudate, putamen) regions of interest. Analyses assessed NPZ-4 and brain volumetric differences between HIV+ individuals with high and low CPE scores. No significant differences in brain integrity were observed between the two groups. Long-term HAART regimens with a high degree of CPE were not associated with significantly improved neuropsychological or neuroimaging outcomes in HIV+ adults. Results suggest that alternate mechanisms may potentially contribute to better neurological outcomes in the era of HAART.