Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort
Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort
复制标题
DOI：
10.1212/wnl.0b013e3181d9ed09
复制
发表时间：
2010-04-20
期刊：
影响因子：
9.9
通讯作者：
Skiest, D. J.
中科院分区：
文献类型：
--
作者：
Robertson, K. R.;Su, Z.;Skiest, D. J.
目的：先前的研究表明，艾滋病毒抗逆转录病毒治疗（ART）的开始改善了神经认知。我们假设停止ART与较差的神经认知功能有关。方法：作为ACTG 5170的一部分，对神经认知功能进行了评估，ACTG 5170是一项针对选择停止ART的HIV感染受试者的多中心、前瞻性观察性研究。符合条件的受试者的CD 4计数>350个细胞/mm（3），HIV RNA病毒载量= 2个药物）>= 6个月。受试者在进入研究时停止ART，并随访96周，进行神经认知检查。共有167名受试者入组，中位CD 4最低值为436个细胞/mm（3），中位ART治疗时间为4.5年。和96（均P < 0.001）。在46名受试者谁重新开始ART前96周，没有显着的变化，神经认知功能observed.Conclusion：保留免疫功能的受试者发现，神经认知显着改善后，抗逆转录病毒治疗（ART）中止。未经治疗的HIV病毒血症的神经认知成本和ART可能的毒性之间的平衡需要考虑。证据分类：这项研究提供了III级证据，证明停止ART与2项神经心理学测试（线索制作测试A和B以及韦氏成人智力量表修订的数字符号子测试）的改善相关，持续时间长达96周。恢复抗逆转录病毒疗法与这些评分下降不相关，持续45周。神经病学（R）2010;74：1260-1266
Objective: Prior studies have shown improved neurocognition with initiation of antiretroviral treatment (ART) in HIV. We hypothesized that stopping ART would be associated with poorer neurocognitive function.Methods: Neurocognitive function was assessed as part of ACTG 5170, a multicenter, prospective observational study of HIV-infected subjects who elected to discontinue ART. Eligible subjects had CD4 count >350 cells/mm(3), had HIV RNA viral load = 2 drugs) for >= 6 months. Subjects stopped ART at study entry and were followed for 96 weeks with a neurocognitive examination.Results: A total of 167 subjects enrolled with a median nadir CD4 of 436 cells/mm(3) and 4.5 median years on ART. Significant improvements in mean neuropsychological scores of 0.22, 0.39, 0.53, and 0.74 were found at weeks 24, 48, 72, and 96 (all p < 0.001). In the 46 subjects who restarted ART prior to week 96, no significant changes in neurocognitive function were observed.Conclusion: Subjects with preserved immune function found that neurocognition improved significantly following antiretroviral treatment (ART) discontinuation. The balance between the neurocognitive cost of untreated HIV viremia and the possible toxicities of ART require consideration. Classification of evidence: This study provides Class III evidence that discontinuing ART is associated with an improvement in 2 neuropsychological tests (Trail-Making Test A & B and the Wechsler Adult Intelligence Scale-Revised Digit Symbol subtest) for up to 96 weeks. Resuming ART was not associated with a decline in these scores for up to 45 weeks. Neurology (R) 2010;74:1260-1266