Influencing factors for HIV-associated neurocognitive disorders among HIV/AIDS patients
JIA Xiaofeng1, WANG Huiqun2, SHI Min2, TANG Jie2, REN Jingxia2
1. School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210003, China; 2. Nanjing Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210037, China
Abstract:Objective To explore the factors affecting the prevalence of HIV-associated neurocognitive disorders (HAND) among HIV/AIDS patients, so as to provide insights into developing HAND prevention measures. Methods HIV/AIDS patients aged 18 years and above in the Infection Department of Nanjing Second Hospital were selected.Demographic data, treatment regimen and blood biochemical indicators were collected. Depression was evaluated using Patient Health Questionnaire Depression Scale, frailty was evaluated using Chinese version of Tilburg Frailty Indicator, and HAND was evaluated by Montreal Cognitive Assessment Scale. Factors affecting HAND were analyzed using a multivariable logistic regression model. Results Totally 440 questionnaires were allocated and 426 valid questionnaires were recovered, with an effective rate of 96.82%. The median age of patients investigated was 33.00 (interquartile range, 10.00) year. There were 407 males, accounting for 95.54%; 232 patients with bachelor degree or above, accounting for 54.46%; 171 patients with HAND, accounting for 40.14%. Multivariable logistic regression analysis showed that educational level (bachelor degree or above, OR=0.291, 95%CI: 0.157-0.541), depression (OR=2.499, 95%CI: 1.530-4.083), frailty (OR=2.121, 95%CI: 1.307-3.441) and treatment regimen including efavirenz (OR=2.223, 95%CI: 1.367-3.615) were the influencing factors for HAND among HIV/AIDS patients. Conclusion Educational level, depression, frailty and use of efavirenz may be associated with HAND risk.
[1] IROLLO E,LUCHETTA J,HO C,et al.Mechanisms of neuronal dysfunction in HIV-associated neurocognitive disorders[J].Cell Mol Life Sci,2021,78(9):4283-4303. [2] ZENEBE Y,NECHO M,YIMAM W,et al.Worldwide occurrence of HIV-associated neurocognitive disorders and its associated factors:a systematic review and meta-analysis[J/OL].Front Psychiatry,2022,13[2024-05-01].https://doi.org/0.3389/fpsyt.2022.814362. [3] CHENEY L,GUZIK H,MACALUSO F P,et al.HIV Nef and antiretroviral therapy have an inhibitory effect on autophagy in human astrocytes that may contribute to HIV-associated neurocognitive disorders[J/OL].Cells,2020,9(6)[2024-05-01].https://doi.org/10.3390/cells9061426. [4] ZENEBE Y,AKELE B,W/SELASSIE M,et al.A systematic review and meta-analysis of HIV associated neurocognitive disorders(HAND)among people with HIV in Ethiopia[J/OL].AIDS Res Ther,2021,18(1)[2024-05-01].https://doi.org/10.1186/s12981-021-00424-1. [5] MOHAMED A A,ODUOR C,KINYANJUI D.HIV-associated neurocognitive disorders at Moi teaching and referral hospital,Eldoret,Kenya[J/OL].BMC Neurol,2020,20(1)[2024-05-01].https://doi.org/10.1186/s12883-020-01857-3. [6] 于相芬,孙宇新,孙振晓.患者健康问卷抑郁量表在颈椎病患者中的信度和效度研究[J].中华临床医师杂志(电子版),2017,11(6):905-908. [7] 司华新,金雅茹,乔晓霞,等. 中文版Tilburg衰弱量表在养老机构老年人中的信效度检验[J].中国老年学杂志,2018,38(16):4046-4049. [8] 夏安琪,李军,岳玲,等.蒙特利尔认知评估量表在中国社区老人中的应用[J].上海交通大学学报(医学版),2021,41(12):1662-1667,1661. [9] 熊文琴,刘芳,李梅,等.HIV相关神经认知障碍及影响因素调查[J].中国艾滋病性病,2022,28(3):311-315. [10] NYUNDO A A.Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region,central Tanzania:a cross-sectional study[J/OL].PLoS One,2023,18(5)[2024-05-01].https://doi.org/10.1371/journal.pone.0285761. [11] KABUBA N,MENON J A,FRANKLIN D R,et al.Effect of age and level of education on neurocognitive impairment in HIV positive Zambian adults[J].Neuropsychology,2018,32(50):519-528. [12] PAOLILLO E W,PASIPANODYA E C,MOORE R C,et al.Cumulative burden of depression and neurocognitive decline among persons with HIV:a longitudinal study[J].J Acquir Immune Defic Syndr,2020,84(30):304-312. [13] TYMCHUK S,GOMEZ D,KOENIG N,et al.Associations between depressive symptomatology and neurocognitive impairment in HIV/AIDS[J].Can J Psychiatry,2018,63(5):329-336. [14] NYUNDO A A,ISMAIL A.The influence of major depressive disorders on neurocognitive function among adults living with HIV/AIDS in a regional referral hospital in Dodoma,Tanzania[J].Trop Med Int Health,2022,27(1):58-67. [15] 王晓薇,许艳岚.老年2型糖尿病患者认知衰弱风险预测研究[J].预防医学,2023,35(12):1037-1042. [16] 程韬,应翔,张俊英,等.晚发抑郁症患者抑郁程度与神经认知功能的相关性研究[J].预防医学,2019,31(1):42-45,50. [17] ZAMUDIO-RODRIGUEZ A,BELAUNZARAN-ZAMUDIO P F,SIERRA-MADERO J G,et al.Association between frailty and HIV-associated neurodegenerative disorders among older adults living with HIV[J].AIDS Res Hum Retroviruses,2018,34(5):449-455. [18] SUN-SUSLOW N,PAOLILLO E W,MORGAN E E,et al.Brief report:frailty and HIV disease severity synergistically increase risk of HIV-associated neurocognitive disorders[J].J Acquir Immune Defic Syndr,2020,84(5):522-526. [19] MUGENDI A G,KUBO M N,NYAMU D G,et al.Prevalence and correlates of neurocognitive disorders among HIV patients on antiretroviral therapy at a Kenyan hospital[J/OL].Neurol Res Int,2019[2024-05-01].https://doi.org/10.1155/2019/5173289. [20] DECLOEDT E H,SINXADI P Z,VAN ZYL G U,et al.Pharmacogenetics and pharmacokinetics of CNS penetration of efavirenz and its metabolites[J].J Antimicrob Chemother,2019,74(30):699-709. [21] NWOGU J N,GANDHI M,OWEN A,et al.Associations between efavirenz concentrations,pharmacogenetics and neurocognitive performance in people living with HIV in Nigeria[J].AIDS,2021,35(12):1919-1927. [22] HALKERS C S,HERMANS A M,VAN MAARSEVEEN E M,et al.High efavirenz levels but not neurofilament light plasma levels are associated with poor neurocognitive functioning in asymptomatic HIV patients[J].J Neurovirol,2020,26(4):572-580.