Neurocognitive function in HIV-infected persons with asymptomatic cryptococcal antigenemia: a comparison of three prospective cohorts

作者：Montgomery Martha P; Nakasujja Noeline^*; Morawski Bozena M; Rajasingham Radha; Rhein Joshua; Nalintya Elizabeth; Williams Darlisha A; Hullsiek Kathy Huppler; Kiragga Agnes; Rolfes Melissa A; Carlson Renee Donahue; Bahr Nathan C; Birkenkamp Kate E; Manabe Yukari C; Bohjanen Paul R; Kaplan Jonathan E; Kambugu Andrew; Meya David B; Boulware David R^*

来源：BMC Neurology, 2017, 17(1): 110.

DOI：10.1186/s12883-017-0878-2

• AIDS dementia complex
• Neurocognitive disorders
• Cryptococcal meningitis
• HIV
• Neuropsychological tests
• Cryptococcus

Background: HIV-infected persons with detectable cryptococcal antigen (CrAg) in blood have increased morbidity and mortality compared with HIV-infected persons who are CrAg-negative. This study examined neurocognitive function among persons with asymptomatic cryptococcal antigenemia.
Methods: Participants from three prospective HIV cohorts underwent neurocognitive testing at the time of antiretroviral therapy (ART) initiation. Cohorts included persons with cryptococcal meningitis (N = 90), asymptomatic CrAg + (N = 87), and HIV-infected persons without central nervous system infection (N = 125). Z-scores for each neurocognitive test were calculated relative to an HIV-negative Ugandan population with a composite quantitative neurocognitive performance Z-score (QNPZ-8) created from eight tested domains. Neurocognitive function was measured pre-ART for all three cohorts and additionally after 4 weeks of ART (and 6 weeks of pre-emptive fluconazole) treatment among asymptomatic CrAg + participants.
Results: Cryptococcal meningitis and asymptomatic CrAg + participants had lower median CD4 counts (17 and 26 cells/mu L, respectively) than the HIV-infected control cohort (233 cells/mu L) as well as lower Karnofsky performance status (60 and 70 vs. 90, respectively). The composite QNPZ-8 for asymptomatic CrAg + (-1.80 Z-score) fell between the cryptococcal meningitis cohort (-2.22 Z-score, P = 0.02) and HIV-infected controls (-1.36, P = 0.003). After four weeks of ART and six weeks of fluconazole, the asymptomatic CrAg + cohort neurocognitive performance improved (-1.0 Z-score, P < 0.001).
Conclusion: Significant deficits in neurocognitive function were identified in asymptomatic CrAg + persons with advanced HIV/ AIDS even without signs or sequelae of meningitis. Neurocognitive function in this group improves over time after initiation of pre-emptive fluconazole treatment and ART, but short term adherence support may be necessary.

• 出版日期2017-6-12