Assessing the efficacy of highly active antiretroviral therapy in the brain
Assessing the efficacy of highly active antiretroviral therapy in the brain
复制标题
评估高效抗逆转录病毒疗法在大脑中的疗效
DOI：
10.1111/j.1750-3639.2003.tb00011.x
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发表时间：
2003-01-01
期刊：
影响因子：
6.4
通讯作者：
Everall, IP
中科院分区：
文献类型：
--
作者：
Kandanearatchi, A;Williams, B;Everall, IP
在过去的20年里，艾滋病毒感染的破坏性影响已经得到了记录。自1980年代以来，已有6000多万人受到感染，目前全球有4000万艾滋病毒携带者(72人)。艾滋病毒在疾病过程的早期感染中枢神经系统(CNS)。事实上，许多研究记录了脑脊液中存在艾滋病毒(14，15)。艾滋病毒直接感染大脑最终导致艾滋病毒相关性痴呆(HAD)，在抗逆转录病毒治疗出现之前，20%的患者(48，55)受到影响。越来越多的药物被开发出来治疗这种感染并延缓艾滋病的发展。目前的治疗旨在抑制病毒复制，从而降低病毒载量。然而，当患者对药物治疗产生抗药性时，病毒载量可能会随之增加。在HAART时代，HAD的发病率有所下降，而随着艾滋病毒携带者存活时间的延长，HAD的患病率正在上升。然而，在一项最初的艾滋病定义疾病的研究中，在引入HAART后，与艾滋病毒相关的痴呆症的比例并没有下降(19)。在另一项单独的研究中，尽管在这段时间内所有艾滋病定义疾病的发病率有所下降，但痴呆症本身的发病率并没有下降(50)。从大多数研究中可以看出，自从HAART被引入以来，它对HAD的影响并不完全清楚，尽管大多数研究结果表明它是有益的。在这里，我们将概述与预防HAART HAD相关的问题。
The devastating effects of HIV infection have been documented for the last 2 decades. Since the 1980s over 60 million people have been infected and at present 40 million people globally are living with HIV (72). HIV infects the central nervous system (CNS) early in the disease process. Indeed, numerous studies document the presence of HIV within the cerebrospinal fluid (CSF) (14,15). Direct infection of the brain by HIV ultimately results in HIV associated dementia (HAD), which (prior to the advent of antiretroviral therapy) affected 20% of patients (48, 55). An increasing number of drugs have been developed to treat this infection and delay the development of AIDS. Current treatment is aimed at inhibiting viral replication, and thus, lowering the viral load. However a subsequent increase in viral load can occur as patients become resistant to drug therapy. In the era of HAART, the incidence of HAD has been reduced, whereas the prevalence rate is increasing as people with HIV survive longer. However, in a study of initial AIDS defining illnesses, the proportion with HIV related dementia did not decline following introduction of HAART (19). In a separate study, no decrease was found in the incidence of dementia per se, although there was a decrease in the incidence of all AIDS-defining illnesses during this time period (50). It is evident from most studies that since the introduction of HAART, its effect on HAD is not entirely clear, although the majority of findings indicate that it is beneficial. Here we will outline the issues relevant to preventing HAD by HAART.