Neuropathology of HAND With Suppressive Antiretroviral Therapy: Encephalitis and Neurodegeneration Reconsidered.
Neuropathology of HAND With Suppressive Antiretroviral Therapy: Encephalitis and Neurodegeneration Reconsidered.
复制标题
抑制性抗逆转录病毒疗法的手神经病理学：重新考虑脑炎和神经变性。
DOI：
10.1007/s11904-015-0266-8
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发表时间：
2015-06
影响因子：
4.6
通讯作者：
Gelman, Benjamin B.
中科院分区：
文献类型：
--
作者：
Gelman, Benjamin B.
关键词：
HIV-1在初始感染期间浸润中枢神经系统（CNS），此后随着疾病进展在产生CNS功能障碍中起持续作用。HIV相关神经认知障碍（HAND）在HIV感染患者人群中非常普遍，包括目前感染的患者，这些患者可以很好地获得抑制性抗逆转录病毒治疗（cART）。cART显著降低了CNS功能障碍的严重程度，并且这样做，颠覆了HAND病理生理学的神经病理学基础。很明显，cART之前由炎症、脑炎和神经变性驱动的病理生理学工作概念需要被取代。神经艾滋病领域不愿意迈出这重要的一步。这篇综述探讨了这样一个事实，即在cART时代之前驱动该领域的神经病理学概念似乎不再符合在cART成功治疗的患者中通常观察到的情况。该领域坚持cART前的观点，即HAND依次由CNS中的病毒复制、脑炎症（脑炎）和神经变性驱动。然而，cART治疗患者的神经病毒学、临床病理学和基因表达相关性并没有提供有力的支持，将cART引入临床实践可以减少HIVE、炎症和变性，但不能治愈HAND。脑基因阵列数据表明神经血管单位是HAND病毒抑制患者的关键靶点。神经艾滋病领域需要注入新的想法，以引导研究走向与病毒抑制患者最相关的问题。由于没有合适的替代品可以立即实现，因此贬低形成性想法是难以接受的。病毒抑制患者的临床神经病理学相关性需要更好地定义。
HIV-1 infiltrates the central nervous system (CNS) during the initial infection and thereafter plays a persistent role in producing CNS dysfunction as the disease progresses. HIV-associated neurocognitive disorders (HAND) are highly prevalent in HIV-infected patient populations, including currently infected patients with good access to suppressive antiretroviral therapy (cART). cART decreased the severity of CNS dysfunction dramatically and, in doing so, upended the neuropathological foundation of HAND pathophysiology. It is clear that the working concept of pathophysiology prior to cART, which was driven by inflammation, encephalitis, and neurodegeneration, needs to be replaced. The NeuroAIDS field is reluctant to take that important step. This review explores the fact that the neuropathological concept that drove the field before the era of cART no longer seems to fit with what is commonly observed in patients treated successfully with cART. The field clings to the pre-cART idea that HAND is sequentially driven by virus replication in CNS, brain inflammation (encephalitis), and neurodegeneration. Neurovirological, clinicopathological, and gene expression correlations in cART-treated patients, however, provide little strong support for it. Introducing cART into clinical practice decreased HIVE, inflammation, and degeneration but did not cure HAND. Brain gene array data suggest that the neurovascular unit is a critical target in virally suppressed patients with HAND. The NeuroAIDS field needs an infusion of new ideas to steer research toward issues of the highest relevance to virally suppressed patients. With no suitable replacement immediately within reach, devaluating formative ideas is understandably difficult to accept. The cliniconeuropathological correlation in virally suppressed patients needs to be better defined.
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影响因子：
3.2
作者：
Jernigan, Terry L.;Archibald, Sarah L.;Fennema-Notestine, Christine;Taylor, Michael J.;Theilmann, Rebecca J.;Julaton, Michelle D.;Notestine, Randy J.;Wolfson, Tanya;Letendre, Scott L.;Ellis, Ronald J.;Heaton, Robert K.;Gamst, Anthony C.;Franklin, Donald R., Jr.;Clifford, David B.;Collier, Ann C.;Gelman, Benjamin B.;Marra, Christina;McArthur, Justin C.;McCutchan, J. Allen;Morgello, Susan;Simpson, David M.;Grant, Igor
通讯作者：
Grant, Igor
影响因子：
2.5
作者：
Krause BW;Wijtenburg SA;Holcomb HH;Kochunov P;Wang DJ;Hong LE;Rowland LM
通讯作者：
Rowland LM
影响因子：
3.7
作者：
Massanella M;Ouchi D;Marfil S;Llibre JM;Puertas MC;Buzón MJ;Richman DD;Orna E;Stevenson M;Gatell JM;Domingo P;Negredo E;Martinez-Picado J;Clotet B;Blanco J
通讯作者：
Blanco J
影响因子：
11.2
作者：
GELMAN, BB
通讯作者：
GELMAN, BB
影响因子：
5.3
作者：
Ginhoux F;Lim S;Hoeffel G;Low D;Huber T
通讯作者：
Huber T