Potential for early antiretroviral therapy to reduce central nervous system HIV-1 persistence.
Potential for early antiretroviral therapy to reduce central nervous system HIV-1 persistence.
复制标题
早期抗逆转录病毒治疗有可能减少中枢神经系统 HIV-1 的持续存在。
DOI：
10.1097/qad.0000000000002326
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Gisslen,Magnus
中科院分区：
文献类型：
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作者：
Spudich,Serena;Peterson,Julia;Fuchs,Dietmar;Price,RichardW;Gisslen,Magnus
尽管抗逆转录病毒疗法（ART）可改善中枢神经炎症，限制脑脊液中检测到的病毒复制，并在大多数个体中预防严重的临床神经系统疾病，但尽管抗逆转录病毒疗法（ART）， HIV-1仍可在中枢神经系统（CNS）中持续存在。最近的观察结果表明，在感染过程早期开始抗逆转录病毒治疗限制了全身HIV储存库的大小，平行的临床报告显示，在早期治疗队列中治疗后病毒控制率增加，以及对早期感染期间HIV-1感染和神经发病机制的动力学的理解，为考虑在HIV-1感染过程早期开始抗逆转录病毒治疗可能对中枢神经系统HIV-1的持久性有有益的影响提供了理由。早期抗逆转录病毒治疗可能会限制HIV-1感染在中枢神经系统细胞中的初始建立，此外，可能会降低免疫激活和炎症水平，从而使中枢神经系统感染持续存在。在这篇综述中，我们考虑了早期治疗对全身HIV-1储存库影响的研究先例，总结了目前对早期CNS HIV-1暴露及其影响的理解，并检查了早期治疗对CNS室有益的证据。
Although treatment with antiretroviral therapy (ART) improves central nervous inflammation, limits viral replication detected in the cerebrospinal fluid, and prevents severe clinical neurological disease in most individuals, HIV-1 can persist in the central nervous system (CNS) despite ART. Recent observations that initiation of ART early in the course of infection limits the size of systemic HIV reservoirs, parallel clinical reports of increased rates of posttreatment viral control in early treatment cohorts, and an understanding of the dynamics of HIV-1 infection and neuropathogenesis during early infection provides rationale to consider that ART started early in the course of HIV-1 infection may have a beneficial effect on CNS HIV-1 persistence. Early ART may restrict the initial establishment of HIV-1 infection in cells of the CNS, and furthermore, may reduce levels of immune activation and inflammation that allow perpetuation of CNS infection. In this review, we consider the precedent set by studies of the impact of early treatment on systemic HIV-1 reservoirs, summarize the current understanding of early CNS HIV-1 exposure and its effects, and examine the evidence for a benefit in the CNS compartment of early treatment.