Human Immunodeficiency Virus-Associated Neurocognitive Disorders Mind the Gap
Human Immunodeficiency Virus-Associated Neurocognitive Disorders Mind the Gap
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DOI：
10.1002/ana.22053
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发表时间：
2010-06-01
影响因子：
11.2
通讯作者：
Nath, Avi
中科院分区：
文献类型：
--
作者：
McArthur, Justin C.;Steiner, Joseph;Nath, Avi
即使在广泛采用有效的抗逆转录病毒疗法的时代，人类免疫缺陷病毒（HIV）相关的神经认知障碍（HAND）仍然是艾滋病毒感染者最常见的疾病之一。本综述讨论了 HAND 的临床特征以及对更有效治疗的影响。随着接受抗逆转录病毒药物治疗的个体生存率的提高，合并症变得越来越突出，特别是丙型肝炎的合并感染和衰老的影响。本综述试图回答为什么抗逆转录病毒治疗的有益效果与神经功能正常化之间似乎存在治疗差距。第二个差距存在于对 HAND 病理生理学的理解中。这篇综述讨论了这个问题，并讨论了有助于阐明这些机制的动物模型。尽管是由大脑巨噬细胞的生产性 HIV 感染引发的，但异常和持续的免疫激活似乎在诱导 HAND 中发挥着重要作用，并且可以解释对高活性抗逆转录病毒治疗的神经系统反应常常不完全。需要针对持续性中枢神经系统炎症的新疗法来缩小这一差距。安神经学 2010；67:699-714
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HANDs) remain among the most common disorders in people infected with HIV, even in an era when potent antiretroviral therapy is widely deployed. This review discusses the clinical features of HANDs and the implications for more effective treatment. With the improved survival of individuals treated with antiretrovirals, comorbid conditions are increasingly salient, including particularly coinfection with hepatitis C and the effects of aging. This review attempts to answer why there appears to be a therapeutic gap between the salutary effects of antiretroviral regimens and normalization of neurological function. A second gap is found in the understanding of the pathophysiology of HANDs. This review addresses this and discusses the animal models that have helped to elucidate these mechanisms. Although triggered by productive HIV infection of brain macrophages, aberrant and sustained immune activation appears to play a major role in inducing HANDs, and may explain the often incomplete neurological response to highly active antiretroviral therapy. Novel therapies aimed at persistent central nervous system inflammation will be needed to close this gap. ANN NEUROL 2010;67:699-714