Independent effects of HIV, aging, and HAART on brain volumetric measures.
Independent effects of HIV, aging, and HAART on brain volumetric measures.
复制标题
DOI：
10.1097/qai.0b013e318249db17
复制
发表时间：
2012-04-15
期刊：
影响因子：
--
通讯作者：
Paul R
中科院分区：
文献类型：
--
作者：
Ances BM;Ortega M;Vaida F;Heaps J;Paul R
神经认知功能障碍仍然普遍存在于艾滋病毒感染（HIV+）的个人，尽管高度活跃的抗逆转录病毒治疗（HAART）。我们使用结构神经成像评估了HIV、HAART和衰老的影响。78名参与者（HIV-（n=26），HIV+稳定HAART（HIV+/HAART+; n=26），HIV+ HAART初治（HIV+/HAART-; n=26））完成了神经影像学和神经心理学测试。一个HIV+受试者亚组（n = 12）在开始HAART之前和之后进行了纵向评估。神经心理学测试评估记忆力、心理速度和执行功能，并根据标准化表现（NPZ-4）计算复合神经心理学评分。评价杏仁核、尾状核、丘脑、海马、壳核、胼胝体、大脑灰质和白色物质的体积。三组单因素方差分析评估神经影像学和神经心理学指标的差异。检查NPZ-4和容量测定法之间的相关性。探索性测试使用断棒回归模型评估自我报告的HIV感染持续时间对大脑结构的影响。与HIV-参与者相比，HIV+个体在选定的皮质下区域（杏仁核，尾状核和胼胝体）的脑容量显著减少。然而，HAART并不影响大脑结构，因为HIV+/HAART−和HIV+/HAART+的区域体积相似。NPZ-4与容量测定之间不存在关联。HIV和衰老与体积减少独立相关。探索性分析表明，尾状核萎缩由于艾滋病毒缓慢发生后，自我报告的血清转换。尽管有HAART，但仍会发生与HIV相关的杏仁核、尾状核和胼胝体体积减少。在自我报告的血清转换后，尾状核体积逐渐下降。艾滋病毒和衰老独立地增加了大脑的脆弱性。需要额外的纵向结构MRI研究，特别是在老年HIV+受试者中。
Neurocognitive impairment remains prevalent in HIV infected (HIV+) individuals despite highly active anti-retroviral therapy (HAART). We assessed the impact of HIV, HAART, and aging using structural neuroimaging. Seventy-eight participants (HIV− (n=26), HIV+ on stable HAART (HIV+/HAART+; n=26), HIV+ naive to HAART (HIV+/HAART−; n=26)) completed neuroimaging and neuropsychological testing. A subset of HIV+ subjects (n = 12) performed longitudinal assessments before and after initiating HAART. Neuropsychological tests evaluated memory, psychomotor speed, and executive function and a composite neuropsychological score was calculated based on normalized performances (NPZ-4). Volumetrics were evaluated for the amygdala, caudate, thalamus, hippocampus, putamen, corpus callosum, cerebral grey and white matter. A three-group one way analysis of variance assessed differences in neuroimaging and neuropsychological indices. Correlations were examined between NPZ-4 and volumetrics. Exploratory testing using a broken stick regression model evaluated self-reported duration of HIV infection on brain structure. HIV+ individuals had significant reductions in brain volumetrics within select subcortical regions (amygdala, caudate, and corpus callosum) compared to HIV− participants. However, HAART did not affect brain structure as regional volumes were similar for HIV+/HAART− and HIV+/HAART+. No association existed between NPZ-4 and volumetrics. HIV and aging were independently associated with volumetric reductions. Exploratory analyses suggest caudate atrophy due to HIV slowly occurs after self-reported seroconversion. HIV associated volumetric reductions within the amygdala, caudate, and corpus callosum occurs despite HAART. A gradual decline in caudate volume occurs after self-reported seroconversion. HIV and aging independently increase brain vulnerability. Additional longitudinal structural MRI studies, especially within older HIV+ participants, are required.