Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy.
Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy.
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DOI：
10.1212/01.con.0000423849.24900.ec
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发表时间：
2012-12-01
期刊：
影响因子：
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通讯作者：
Nath, Avindra
中科院分区：
文献类型：
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作者：
Kranick, Sarah M;Nath, Avindra
回顾的目的：不幸的是，即使在有效的抗逆转录病毒治疗（ART）时代，HIV感染的神经系统并发症也是常见的。咨询神经科医生经常被要求区分由机会性感染（OI）、免疫重建或病毒本身的影响引起的神经系统恶化，并评论免疫调节剂在HIV感染患者中的作用。此外，由于成功的病毒学控制延长了HIV感染患者的寿命，神经学家被要求处理长期并发症，如神经认知障碍和周围神经病变。最近的发现：尽管使用了抗逆转录病毒治疗，但仍有相当数量的患者继续受到艾滋病毒相关神经认知障碍的影响，尽管与抗逆转录病毒治疗前相比，其形式较轻。抗逆转录病毒治疗方案根据中枢神经系统的渗透程度进行了排名，目前正在对其神经心理学结果进行研究。具有最大周围神经毒性潜力的核苷类似物不再被认为是HIV治疗的一线药物。Efavirenz是一种非核苷类逆转录酶抑制剂，在较新的抗逆转录病毒治疗方案中出现神经系统副作用的频率最高。免疫重建炎症综合征（IRIS）的临床表现谱不断增加，包括无潜在成骨不全的IRIS。对病理生理学和危险因素的更深入了解表明，虽然艾滋病毒应及早治疗以防止严重的免疫功能低下，但延迟开始抗逆转录病毒治疗可能有助于治疗oi。摘要：本文回顾了HIV感染的神经系统并发症及其治疗，这是神经科医生最常遇到的。
PURPOSE OF REVIEW: Neurologic complications of HIV infection are unfortunately common, even in the era of effective antiretroviral treatment (ART). The consulting neurologist is often asked to distinguish among neurologic deterioration due to opportunistic infection (OI), immune reconstitution, or the effect of the virus itself, and to comment on the role of immunomodulatory agents in patients with HIV infection. Additionally, as successful virologic control has extended the life span of patients with HIV infection, neurologists are called upon to manage long-term complications, such as neurocognitive disorders and peripheral neuropathy.RECENT FINDINGS: Despite the use of ART, significant numbers of patients continue to be affected by HIV-associated neurocognitive disorders, although with milder forms compared to the pre-ART era. Regimens of ART have been ranked according to CNS penetration and are being studied with regard to neuropsychological outcomes. Nucleoside analogs with the greatest potential for peripheral neurotoxicity are no longer considered first-line agents for HIV treatment. Efavirenz, a non-nucleoside reverse transcriptase inhibitor, has the greatest frequency of neurologic side effects among newer ART regimens. The spectrum of clinical manifestations of immune reconstitution inflammatory syndrome (IRIS) continues to grow, including IRIS without underlying OI. A greater understanding of pathophysiology and risk factors has shown that while HIV should be treated early to prevent severe immunocompromise, delayed initiation of ART may be helpful while treating OIs.SUMMARY: This article reviews the neurologic complications of HIV infection, or its treatment, most commonly encountered by neurologists.