Patterns of HIV-associated Neurocognitive Impairment among Clade B and Clade E HIV-infected Individuals in Hong Kong.

摘要

BACKGROUND: The human immunodeficiency virus (HIV) epidemic has been growing in China over the past few years. Extensive investigations on the neurocognitive impact of HIV have been carried out in the West, where clade B is the predominant HIV subtype. There are only a few studies on the neurocognitive pattern of Chinese in Hong Kong, where clade E and clade B HIV was equally distributed in the population. The objective of the present study was to examine the prevalence and the patterns of neurocognitive impairment of Hong Kong Chinese.;METHOD: Participants include 119 HIV+ Chinese patients between the age of 18 to 50 recruited from a major tertiary specialist centre offering and territory-wide comprehensive treatment. For the comparison group, 153 age and years of education matched HIV- controls were recruited from the Hong Kong Red Cross Blood Transfusion Service. A neuropsychological test battery consisted of 12 test measures agreed to be sensitive in detecting the effects of HIV on the brain was administered to the participants.;RESULTS: Factor analysis was used to evaluate the factorial validity of the test battery and 6 neurocognitive domains were identified. A total of 24% of HIV+ participants were classified to suffer from global neurocognitive deficits. No clade-specific difference was observed in terms of prevalence of neurocognitive impairment and pattern of neurocognitive performance. Two-stage cluster analysis identified 5 clusters in both HIV+ and HIV- groups respectively. There was an overall taxonomy of 3 groupings, which are HIV+ patients who are globally impaired, who are neurocognitively intact, and who are subclinical. Neurocognitive impairment was found to have no association with depressed mood and medical indices of CD4 cell count and plasma viral load. Nevertheless, the group of globally impaired group was significantly older than the neurocognitively intact group.;CONCLUSIONS: Among HIV+ Hong Kong Chinese, there is a pattern of subtle and variable neurocognitive deficits. The present findings has highlighted its compatibility with research on the neurocognitive profiles in clade B HIV+ individuals in the West and the impact of cART on the presentations of HAND.