RESUMEN
It is yet unclear if people infected with human immunodeficiency virus (HIV+) on stable, combined antiretroviral therapies (cARTs) decline with age at the same or greater rate than healthy people. In this study, we examined independent and interactive effects of HIV, age, and HIV-related clinical parameters on neuropsychological functioning and brain regional volume in a sizable group of Polish HIV+ men receiving cART. We also estimated the impact of nadir CD4 cell count, CD4 cell count during participation in the study, duration of HIV infection, or duration of cART along with age. Ninety-one HIV+ and 95 control (HIV-) volunteers ages 23-75 completed a battery of neuropsychological tests, and 54 HIV+ and 62 HIV- of these volunteers participated in a brain imaging assessment. Regional brain volume in the cortical and subcortical regions was measured using voxel-based morphometry. We have found that HIV and older age were independently related to lower attention, working memory, nonverbal fluency, and visuomotor dexterity. Older age but not HIV was associated with less volume in several cortical and subcortical brain regions. In the oldest HIV+ participants, age had a moderating effect on the relationship between the duration of cART and visuomotor performance, such as that older age decreased speed of visuomotor performance along with every year on cART. Such results may reflect the efficacy of cART in preventing HIV-associated brain damage. They also highlight the importance of monitoring neuropsychological functioning and brain structure in HIV+ patients. This is particularly important in older patients with long adherence to cART.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Corteza Cerebral/fisiopatología , Infecciones por VIH/fisiopatología , Adulto , Factores de Edad , Anciano , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/virología , Estudios de Casos y Controles , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/efectos de los fármacos , Corteza Cerebral/virología , Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Humanos , Imagen por Resonancia Magnética , Masculino , Memoria a Corto Plazo/efectos de los fármacos , Persona de Mediana Edad , Neuroimagen , Pruebas Neuropsicológicas , Tamaño de los Órganos/efectos de los fármacosRESUMEN
This study is a test of the so-called subversion hypothesis, which posits that mentally disordered persons who commit minor offenses are prosecuted primarily for the purpose of imposing mental health treatment on them through evaluation and treatment for incompetency to stand trial. These persons, according to the subversion hypothesis, find themselves in the criminal process because they do not meet the stringent civil commitment standards, but do meet the less stringent criteria for a disorderly conduct prosecution. The findings, based on 893 disorderly conduct prosecutions in a single jurisdiction over a two-year period, do not lend general support to the subversion hypothesis.