HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors.
HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors.
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DOI：
10.1007/s13365-010-0006-1
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发表时间：
2011-02
影响因子：
3.2
通讯作者：
Grant, Igor
中科院分区：
文献类型：
--
作者：
Heaton, Robert K.;Franklin, Donald R.;Ellis, Ronald J.;McCutchan, J. Allen;Letendre, Scott L.;LeBlanc, Shannon;Corkran, Stephanie H.;Duarte, Nichole A.;Clifford, David B.;Woods, Steven P.;Collier, Ann C.;Marra, Christina M.;Morgello, Susan;Mindt, Monica Rivera;Taylor, Michael J.;Marcotte, Thomas D.;Atkinson, J. Hampton;Wolfson, Tanya;Gelman, Benjamin B.;McArthur, Justin C.;Simpson, David M.;Abramson, Ian;Gamst, Anthony;Fennema-Notestine, Christine;Jernigan, Terry L.;Wong, Joseph;Grant, Igor
联合抗逆转录病毒疗法（CART）极大地降低了艾滋病病毒（HIV）感染的发病率和死亡率，但仍有较高比例的HIV相关神经认知障碍（HAND）被不断报道。由于在CART疗法之前和CART时代没有使用相似方法对大量HIV感染者（HIV +）和未感染者（HIV -）群体进行研究，所以尚不清楚CART是否改变了HAND的患病率、性质以及临床相关性。我们使用可比的受试者筛选和评估方法，对CART疗法之前时代（1988 - 1995年；N = 857）和CART时代（2000 - 2007年；N = 937）的大量HIV +和HIV -参与者的神经认知损害（NCI）进行分类。在两个时代，损害率都随着疾病阶段（美国疾病控制与预防中心分期A、B和C）的进展而增加：在CART疗法之前时代分别为25%、42%和52%，在CART时代分别为36%、40%和45%。在医学上无症状阶段（美国疾病控制与预防中心 - A期），NCI在CART时代明显更为常见。最低值CD4细胞计数低在两个时代都预示着NCI，而当前免疫抑制程度、估计的感染持续时间以及脑脊液中的病毒抑制情况（在接受治疗时）仅在CART疗法之前与损害相关。NCI的模式也有所不同：CART疗法之前在运动技能、认知速度和语言流畅性方面损害更多，而CART时代则更多涉及记忆（学习）和执行功能损害。尽管CART疗法改善了病毒抑制和免疫重建，但在HIV感染的所有阶段，轻度NCI的高发生率仍然存在。不同时代NCI与最低值CD4细胞计数的一致性关联表明，更早进行治疗以防止严重免疫抑制可能也有助于预防HAND。针对HAND预防的临床试验应特别检验抗逆转录病毒治疗启动的时机。
Combination antiretroviral therapy (CART) has greatly reduced medical morbidity and mortality with HIV infection, but high rates of HIV-associated neurocognitive disorders (HAND) continue to be reported. Because large HIV-infected (HIV+) and uninfected (HIV−) groups have not been studied with similar methods in the pre-CART and CART eras, it is unclear whether CART has changed the prevalence, nature, and clinical correlates of HAND. We used comparable methods of subject screening and assessments to classify neurocognitive impairment (NCI) in large groups of HIV + and HIV − participants from the pre-CART era (1988–1995; N = 857) and CART era (2000–2007; N = 937). Impairment rate increased with successive disease stages (CDC stages A, B, and C) in both eras: 25%, 42%, and 52% in pre-CART era and 36%, 40%, and 45% in CART era. In the medically asymptomatic stage (CDC-A), NCI was significantly more common in the CART era. Low nadir CD4 predicted NCI in both eras, whereas degree of current immunosuppression, estimated duration of infection, and viral suppression in CSF (on treatment) were related to impairment only pre-CART. Pattern of NCI also differed: pre-CART had more impairment in motor skills, cognitive speed, and verbal fluency, whereas CART era involved more memory (learning) and executive function impairment. High rates of mild NCI persist at all stages of HIV infection, despite improved viral suppression and immune reconstitution with CART. The consistent association of NCI with nadir CD4 across eras suggests that earlier treatment to prevent severe immunosuppression may also help prevent HAND. Clinical trials targeting HAND prevention should specifically examine timing of ART initiation.
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影响因子：
9.9
作者：
Childs, EA;Lyles, RH;McArthur, JC
通讯作者：
McArthur, JC
影响因子：
11.2
作者：
Ellis, RJ;Hsia, K;Dupont, R
通讯作者：
Dupont, R
DOI：
10.1017/s1355617704102130
发表时间：
2004-05-01
影响因子：
2.6
作者：
Heaton, RK;Marcotte, TD;Grant, I
通讯作者：
Grant, I
影响因子：
9.9
作者：
Cysique, L. A.;Vaida, F.;Ellis, R. J.
通讯作者：
Ellis, R. J.
影响因子：
--
作者：
BECK, AT;ERBAUGH, J;MENDELSOHN, M
通讯作者：
MENDELSOHN, M