Neurologic complications of the human immunodeficiency virus (HIV) are common in treated individuals, and toxicity of certain antiretroviral therapies (ART) may contribute to cognitive impairment. We investigated exposures to specific ART and cognition among women living with HIV (WLWH). Virologically suppressed (viral load <200 copies/mL during at least two semi-annual visits) WLWH and age/race matched HIV-seronegative controls enrolled in the Women's Interagency HIV Study who completed at least two biennial cognitive assessments were included. Analysis of WLWH was restricted to those with exposure to the drug class of interest and a nucleoside reverse transcriptase inhibitor (NRTI) backbone. Generalized estimating equations were used to evaluate repeated measures of cognition over time in association with ART class exposure. Among 1,242 eligible WLWH, 20% (n = 247) had isolated drug exposure to non-nucleoside reverse transcriptase inhibitors (NNRTI), 18% (n = 219) to protease inhibitors (PIs), and 6% (n = 79) to integrase inhibitors with a NRTI backbone. Cognitive assessments were performed at a median of 3 biennial visits {IQR 2–4 visits}. At the index assessment, 21% of WLWH demonstrated global cognitive impairment versus 29% at their last cognitive assessment. In multivariable analyses adjusted for hypertension, depression, diabetes mellitus, history of AIDS-defining illness, alcohol use, number of medications, and time on ART, WLWH exposed to NNRTIs demonstrated verbal learning improvements (mean T-score change 1.3, p = .020) compared to other treated women. Compared to HIV-seronegative women, WLWH exposed to PIs had worse verbal learning (mean T-score difference −2.62, p = .002) and verbal memory performance (mean T-score difference −1.74, p = .032) at baseline. Compared to HIV-seronegative women, WLWH exposed to PIs had improvements in verbal learning (mean T-score slope difference 0.36, p = .025) and verbal memory (mean T-score slope difference 0.32, p = .042). The index T-score and slope of change in the T-score were similar among other treated groups and the HIV-seronegative group. We noted emerging trends in cognition in WLWH exposed to specific drug classes. Ongoing study of this relatively young group is important to characterize long-term cognitive outcomes and effect of antiretrovirals as treatment guidelines evolve.

中文翻译：

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艾滋病毒感染者中基于类别的抗逆转录病毒暴露和认知

人类免疫缺陷病毒 (HIV) 的神经系统并发症在接受治疗的个体中很常见，某些抗逆转录病毒疗法 (ART) 的毒性可能会导致认知障碍。我们调查了女性艾滋病毒感染者 (WLWH) 接受特定抗逆转录病毒治疗的情况和认知情况。病毒学抑制（至少两次半年访视期间病毒载量<200拷贝/mL）WLWH和年龄/种族匹配的HIV血清阴性对照参加了妇女机构间HIV研究，并完成了至少两次两年期认知评估。WLWH 分析仅限于那些接触过相关药物类别和核苷逆转录酶抑制剂 (NRTI) 主链的人。使用广义估计方程来评估随时间推移与 ART 课程接触相关的认知重复测量。其中1，n  = 247）曾单独接触过非核苷逆转录酶抑制剂 (NNRTI)，18% ( n  = 219) 接触过蛋白酶抑制剂 (PI)，6% ( n  = 79) 接触过具有 NRTI 主链的整合酶抑制剂。认知评估在每两年访视中位数为 3 次的情况下进行（IQR 2-4 次访视）。在指数评估中，21% 的 WLWH 表现出整体认知障碍，而在上次认知评估中这一比例为 29%。在针对高血压、抑郁症、糖尿病、艾滋病定义疾病史、饮酒、药物数量和抗逆转录病毒治疗时间进行调整的多变量分析中，接触 NNRTI 的 WLWH 表现出语言学习的改善（平均 T 分数变化 1.3，p = .020）与其他接受治疗的女性相比。 与 HIV 血清阴性女性相比，接触 PI 的 WLWH在基线时的言语学习（平均 T 分数差异 -2.62，p  = .002）和言语记忆表现（平均 T 分数差异 -1.74，p = .032）较差。与 HIV 血清阴性女性相比，接触 PI 的 WLWH 在语言学习（平均 T 分数斜率差异 0.36，p  = .025）和语言记忆（平均 T 分数斜率差异 0.32，p ）方面有所改善。 =.042）。其他治疗组和 HIV 血清阴性组的 T 指数指数和 T 指数变化斜率相似。我们注意到接触特定药物类别的 WLWH 认知的新趋势。随着治疗指南的发展，对这一相对年轻群体的持续研究对于描述长期认知结果和抗逆转录病毒药物的作用非常重要。