Changes in neurocognitive performance in a cohort of patients treated with HAART for 3 years
Changes in neurocognitive performance in a cohort of patients treated with HAART for 3 years
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DOI：
10.1097/00042560-200109010-00004
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发表时间：
2001-09-01
期刊：
影响因子：
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通讯作者：
Ippolito, G
中科院分区：
文献类型：
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作者：
Tozzi, V;Balestra, T;Ippolito, G
目的：描述在接受高效抗逆转录病毒疗法（HAART）治疗至少3 years.Methods的患者中HIV相关神经认知功能障碍的变化：自1996年4月以来，对28例连续在我科接受HAART治疗的患者进行前瞻性、观察性研究，包括HAART治疗前和HAART治疗后6、15和45个月的综合神经心理学（NP）测试、神经系统检查和实验室测量。基线时，16例患者神经认知受损，12例无神经认知受损。在16名受损患者中，5名患者在HAART治疗6个月后未达到受损标准，9名患者在HAART治疗15个月和45个月后分别达到受损标准。在探索精神处理的集中度和速度的六项措施中的两项，探索精神灵活性的三项措施中的两项，探索记忆的五项措施中的一项，以及探索精细运动功能的两项措施中，观察到统计学显著改善（p小于或等于.01）。未受损的研究对象表现优于受损的10个17项措施在基线，在8个17 6个月后，在6个17后15个月，在7个17后45个月的HAART。结论：在HAART过程中，患者经历了积极的和持续的改善，他们的神经认知性能。然而，16例患者中有7例（43.7%）存在神经认知功能障碍，并且在HAART治疗3年以上后，受损和未受损患者之间的神经认知功能持续存在统计学显著差异，这表明即使在有效的抗逆转录病毒治疗期间也可能发生持续的HIV相关神经损伤。
Objectives: To describe changes in HIV-associated neurocognitive impairment in patients treated with highly active antiretroviral therapy (HAART) for at least 3 years.Methods: Prospective, observational study of comprehensive neuropsychologic (NP) testing, neurologic examination, and laboratory measures before HAART and after 6, 15 and 45 months of HAART, on 28 consecutive patients seen in our department since April 1996.Results: At baseline, 16 patients were neurocognitively impaired and 12 were not. Among the 16 impaired patients, 5 patients failed to meet the criteria for impairment after 6 months and 9 patients after both 15 and 45 months of HAART, respectively. Statistically significant improvements (p less than or equal to .01) were seen in two of six measures exploring the concentration and speed of mental processing, two of three measures exploring mental flexibility, in one of five measures exploring memory, and in two of two measures exploring fine motor functions. Unimpaired study subjects performed better than impaired ones in 10 of 17 measures at baseline, in eight of 17 after 6 months, in six of 17 after 15 months, and in seven of 17 after 45 months of HAART.Conclusions: During the course of HAART, patients experienced a positive and sustained improvement in their neurocognitive performance. However, the presence of 7 of 16 (43.7%) patients with neurocognitive impairment, and the persistence of statistically significant differences in the neurocognitive performance between impaired and unimpaired patients after more than 3 years of HAART, suggests that ongoing HIV-related neurologic damage can occur even during potent antiretroviral treatment.