A Study On HIV-Associated Neurocognitive Disorders In HIV/AIDS Patients With Antiviral Therapy

Objective:To understand the occurrence of HIV-Associated Neurocognitive Disorders in AIDS patients with antiviral therapy,and the influencing factors,so as to provide basis for early intervention and care.Methods:A cross-sectional study design was applied.A questionnaire survey was conducted on 400 HIV/AIDS patients receiving antiviral treatment in a provincial specialized hospital in Yunnan Province.Information on HIV infection and treatment was collected through the national free antiviral treatment system and the hospital patient experimental data system.The occurrence of Mild Cognitive Impairment(MCI)and HIV-Associated Dementia(HAD)in patients was assessed using the Mini-mental State Examination(MMSE)and International HIV-associated dementia scale(IHDS).Chi-square test and multivariable logistic regression were performed to explore the determinants of HIV-Associated Neurocognitive Disorders.Results:1.Among the 400 patients,252(63.0%)were male and 148(37.0%)were female,the mean age were(54.8±8.5)years old,103(25.8%)patients were 60 years old or above,The not-illiteracy patients accounted for 59.5%.47.0%of the patients’monthly income was lower than the standard monthly minimum wage(1350 yuan)in the third-grade area of Yunnan Province,and 14.5%of the patients only lived on subsistence allowance.271 patients(68.0%)reported themselves to be sexually transmitted,69 patients(17.3%)to be intravenous drug users,the average years of HIV infection was 8.40±0.17 years,and the average years for HAART was 6.97±3.12 years.The proportion of smoke and drink in men was significantly more than women,and the drug users was also higher than women.Compared with patients aged 40-59 years,patients aged 60 years and over had a lower proportion of current smokers,a higher proportion of quitters and a lower proportion of drug users,but they seemed to exercise more regularly.There were 132 patients with hypertension,12 with coronary heart disease,and 13 with stroke.2.Among the 400 patients receiving anti-virus therapy for AIDS,the MMSE score showed that there were 34 illiteracy patients had MCI,46 not-illiteracy patients had MCI,total of 80(20.0%)patients.99(24.8%)patients had 10 or less score in IHDS..The most common cognitive dysfunction in MCI were five aspects:directionality,memory,attention and calculation,recall ability and language ability.The most common cognitive dysfunction in HAD were poor memory and reduced ability to flip tests.3.The prevalence of MCI in 400 patients in this study showed significant differences in gender,age,educational level,monthly income,smoking,alcohol drinking,latest viral load,and stroke distribution.Female,60 years old and above,illiteracy,monthly income less than 1350,never smoking,not drinking,the last viral load≥50/ml more likely to be MCI.The occurrence of HAD showed significant differences in age,educational level,monthly income,drug use,and the most recent viral load distribution.Age over 60,not-illiteracy,monthly income below 1350,never taking drugs,latest viral load≥50/ml more likely to be HAD.4.Multivariate logistic regression analysis indicated that the risk of MCI was 0.13 times higher in patients not-illiteracy than illiteracy(95%CI:0.07-0.24,p<0.001).The risk of MCI for those with alcohol drinking is 0.44 times as those without alcohol drinking(95%CI:0.25-0.78,p=0.005).The risk of developing MCI in patients with a recent viral load of 50/ml or more was 3.04 times greater than in patients with less than 50/ml(95%CI:1.18-7.78,p=0.005).Patients with stroke were 4.22 times more likely to develop MCI than patients without stroke(95%CI:1.25-14.25,p=0.020).These results suggested that there was an association between educational level,alcoholdrinking,latest viral load,stroke,illiteracy,no alcohol drinking,latest viral load≥50/ml and stroke more likely to be MCI.No Association was found between age,sex,smoking,drug use,and the hyperosmotic drugs in current treatment regimens and MCI.5.Multivariate logistic regression analysis showed that patients aged 60 and over had 1.97 times risk of HAD as 40-59 years old individuals(95%CI:1.15-3.37,p=0.012).The risk of HAD was 0.29 times higher in patients with not-illiteracy than illiteracy(95%CI:0.16-0.51,p<0.001).The risk of HAD in patients with the most recent viral load of≥50/ml or more was 2.96 times as those with less than≥50/ml(95%CI:1.26-6.97,p=0.013).Age,education level,the most recent viral load and the occurrence of HAD were correlated.Aged 60,illiteracy,latest viral load≥50/ml more likely to be HAD.Sex,smoking,alcohol drinking,drug use,years of HAART,and the current treatment regimen contains hyperosmotic drugs were not found to be associated with the occurrence of HAD.Conclusions:1.The MCI prevalence was reported 20.0%among 398 HAART HIV-infected patients.The most common impairments in MCI were orientations,attention and computation,recall,and language.The most common damage of HAD was memory and motor function.Therefore,in the course of antiviral treatment,clinical medical staff should strengthen the neurocognitive protection monitoring of HIV antiviral therapy patients who often show behaviors such as forgetting to take medicine on time.2.This study explored that old age,illiteracy,last viral load≥50/ml,cerebral stroke is more likely to be HAND among HIV/AIDS patients receiving HAART.If the patient fits the profile and often forget to take drugs,we should pay attention to strengthen the number of visits and give them memory training.3.The correlation analysis of high CNS Penetration Effectiveness in antiviral drugs was not statistically significant in this study,but there was controversy about the neurotoxicity of antiretroviral drugs in previous literature,so more relevant studies and analyses are recommended.