Clinical Treatment Options and Randomized Clinical Trials for Neurocognitive Complications of HIV Infection: Combination Antiretroviral Therapy, Central Nervous System Penetration Effectiveness, and Adjuvants.
Clinical Treatment Options and Randomized Clinical Trials for Neurocognitive Complications of HIV Infection: Combination Antiretroviral Therapy, Central Nervous System Penetration Effectiveness, and Adjuvants.
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DOI：
10.1007/7854_2020_186
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发表时间：
2021
影响因子：
--
通讯作者：
Ma Q
中科院分区：
文献类型：
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作者：
Lin SP;Calcagno A;Letendre SL;Ma Q
人类免疫缺陷病毒 I 型 (HIV) 相关神经认知障碍 (HAND) 的病因和发病机制仍未确定，可能是多种机制的产物。这主要包括艾滋病毒引起的神经元损伤、炎症过程和心理健康问题。因此，我们测试了多种治疗方案，包括基于抗逆转录病毒疗法 (ART) 的中枢神经系统 (CNS) 渗透有效性 (CPE) 的 NeuroHIV 靶向治疗方案和 HAND 的辅助疗法。以 NeuroHIV 为靶点的 ART 方案在中枢神经系统中产生了一致且具有统计显着性的 HIV 抑制，但认知和功能领域的情况并非如此。大多数辅助疗法，如米诺环素、美金刚和司来吉兰，对于改善患有轻度至中度神经认知障碍的艾滋病毒感染者 (PLWH) 的认知功能的益处微乎其微。人们提出了新的实验性治疗方法来针对 HAND 的认知和功能症状以及潜在的潜在发病机制。本综述旨在通过重点关注 NeuroHIV 靶向 ART 方案开发、CPE 和辅助治疗，对 HAND 的临床治疗方案和临床试验提供分析概述。
The etiology and pathogenesis of human immunodeficiency virus type-I (HIV)-associated neurocognitive disorders (HAND) remain undetermined and are likely the produce of multiple mechanisms. This can mainly include neuronal injury from HIV, inflammatory processes, and mental health issues. As a result, a variety of treatment options have been tested including NeuroHIV-targeted regimens based on the central nervous system (CNS) penetration effectiveness (CPE) of antiretroviral therapy (ART) and adjuvant therapies for HAND. NeuroHIV-targeted ART regimens have produced consistent and statistically significant HIV suppression in the CNS, but this is not the case for cognitive and functional domains. Most adjuvant therapies such as minocycline, memantine, and selegiline have negligible benefit in the improvement of cognitive function of people living with HIV (PLWH) with mild to moderate neurocognitive impairment. Newer experimental treatments have been proposed to target cognitive and functional symptoms of HAND as well as potential underlying pathogenesis. This review aims to provide an analytical overview of the clinical treatment options and clinical trials for HAND by focusing on NeuroHIV-targeted ART regimen development, CPE, and adjuvant therapies.