HIV-associated neurocognitive disorder.
HIV-associated neurocognitive disorder.
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DOI：
10.1097/qco.0000000000000328
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发表时间：
2017-02
影响因子：
3.9
通讯作者：
Clifford DB
中科院分区：
文献类型：
--
作者：
Clifford DB
HIV相关的神经认知疾病（HAND）是目前神经艾滋病研究中最活跃的课题。虽然现代抗病毒治疗方案成功治疗的患者的损害是轻微的，但它仍然是HIV患者的一个持续问题。重要的是要更新有关手的新兴研究。该病毒在急性感染期间进入大脑，有证据表明可能在早期发生并经常持续存在异常功能。与正在进行的病毒感染的直接关系继续监测，但慢性炎症，往往与单核细胞和巨噬细胞似乎是认知功能障碍的最可能的驱动程序。脑血管疾病作为一种与认知缺陷相关的重要共病的认识正在增加。神经影像学正在积极发展，以解决检测和测量大脑中的变化。最佳的cART治疗极大地改善了神经功能结局，但迄今为止尚未证明可以逆转剩余的轻度损伤。可能需要解决脑功能障碍的炎症和血管机制，以实现更好的结果。需要不断进行研究，以改善艾滋病毒感染者的神经系统结果。很可能需要抗病毒方法以外的干预措施来控制或逆转HAND。
HIV associated neurocognitive disease (HAND) is the most active topic for neuroAIDS investigations at present. Although impairment is mild in patients successfully treated with modern antiviral regimens, it remains an ongoing problem for HIV patients. It is important to update the emerging research concerning HAND. The virus enters the brain during acute infection, with evidence for abnormal functioning that may occur early and often persists. Direct relationships with ongoing viral infection continue to be monitored, but chronic inflammation, often associated with monocytes and macrophages appear to be the most likely driver of cognitive dysfunction. Appreciation for cerebrovascular disease as a significant co-morbidity that is associated with cognitive deficits is increasing. Neuroimaging is actively being developed to address detection and measurement of changes in the brain. Optimal cART therapy has vastly improved neurologic outcomes, but so far has not been demonstrated to reverse the remaining mild impairment. Inflammatory and vascular mechanisms of cerebral dysfunction may need to be addressed to achieve better outcomes. Ongoing research is required to improve neurological outcomes for persons living with HIV. It is likely that interventions beyond antiviral approaches will be required to control or reverse HAND.