HIV-Associated Polyneuropathy in Resource-Limited Settings: Genetic Predisposition and Vitamin Variations

HIV-Associated Polyneuropathy in Resource-Limited Settings: Genetic Predisposition and Vitamin Variations
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资源有限环境下的 HIV 相关多发性神经病：遗传倾向和维生素变异

DOI：
10.4236/wja.2017.72010
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发表时间：
2017
期刊：
World Journal of AIDS
影响因子：
--
通讯作者：
M. Oluka
M. Oluka
中科院分区：
--
文献类型：
--
作者：
F. Ndakala;J. Oyugi;M. Oluka

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人类免疫缺陷病毒相关的多发性神经病仍然是一种由神经末梢受损引起的疼痛性疾病。HIV感染与主要由HIV感染本身引起的多发性神经病或与联合抗逆转录病毒治疗（CART）相关的毒性神经病密切相关。在非HIV感染者中，维生素缺乏和大量摄入都与多发性神经病有关。因此，临床医生建议在CART之前和期间补充维生素。虽然一些，但不是全部，HIV相关的维生素缺乏症可能在CART治疗期间补充，但可以预见的是，高维生素补充剂摄入量可能会导致神经疾病。在资源有限的情况下，多发性神经病的诊断严重依赖于症状，多发性神经病的风险因素，包括维生素状况，饮酒和合并感染的数据是有限的。此外，关于遗传对CART长期使用者血液中微量营养素浓度影响的研究很少。维生素摄入量高的可能原因可能是一些艾滋病毒感染者自我免疫。此外，由于艾滋病毒感染者的寿命延长，仅依靠症状来特异性诊断艾滋病毒相关神经病变可能是资源贫乏环境中有效治疗的障碍。本文综述了单核苷酸多态性（SNPs）的证据，有可能影响HIV感染患者的维生素的生物利用度。全基因组关联研究已报道碱性磷酸酶、岩藻糖基转移酶2、cubilin、转钴胺素1和肿瘤坏死因子中的SNP是维生素B-6、B-12和E的各种血液水平的潜在决定因素。随着长期CART越来越个性化，未来的研究应该集中在影响维生素血液水平的SNP上，并有可能增加CART的长期治疗。
Human immunodeficiency virus-related polyneuropathy remains a painful condition resulting from damaged nerve endings. HIV infection strongly associates with a predominantly polyneuropathy that is attributed to HIV infection itself, or a toxic neuropathy associated with combination antiretroviral therapy (CART). In non-HIV-infected individuals, both deficiency and high intake of vitamins have been associated with polyneuropathy. For that reason, clinicians recommend vitamin supplements before and during CART. Although some, but not all, HIV-related vitamin deficiencies may replete during treatment with CART, it is predictable that high vitamin supplement intakes may contribute to nerve disorders. In resource-limited settings where the diagnosis of polyneuropathy heavily relies on symptoms, data on risk factors for polyneuropathy including vitamin status, alcohol consumption, and co-infections are limited. In addition, studies on genetic influence on the concentration of micronutrients in the blood of long-term users of CART are scarce. Possible sources of high intakes of vitamins could arise from the fact that a number of HIV-infected persons self-medicate. In addition, since HIV-infected individuals have an increased lifespan, relying on symptoms alone to specifically diagnose HIV-associated neuropathies could be a barrier to effective treatment in recourse-poor settings. This paper reviews evidence on single nucleotide polymorphisms (SNPs) with the potential to influence bioavailability of vitamins in HIV-infected patients. Genome-wide association studies have reported SNPs in alkaline phosphatase, fucosyltransferase 2, cubilin, transcobalamin 1, and tumor necrosis factor as potential determinants of various blood levels of vitamin B-6, B-12 and E. As long term CART increasingly become, personalized, future research should focus on SNPs, which influence vitamin blood levels, and with potential to augment long-term treatment with CART.