Radziwill A J, Kappos L, Battegay M, Steck A J
Neurologische Universitätsklinik und Poliklinik, Kantonsspital Basel.
Schweiz Med Wochenschr. 2000 Apr 1;130(13):457-70.
About one third of patients with HIV infection show neurological complications with considerable morbidity and high mortality. This is an actualized review of the most important neurological manifestations resulting from primary HIV infection, from secondary opportunistic infections, or as complications of antiretroviral therapy. The primary neurological manifestations, including HIV-associated dementia complex, myelopathies, peripheral neuropathies and myopathies, the more common opportunistic infections, primary central nervous system lymphoma and cerebrovascular diseases, are discussed in the light of new evidence in diagnosis, therapy and prognosis. Cognitive and psychiatric symptoms, visual changes, headache, seizures, dizziness, involuntary movements, gait disturbances, cranial neuropathies and focal deficits are the common neurological symptoms in HIV infection which are described under the aspect of differential diagnosis. It is important to bear in mind that nearly all information available to date on this subject concerns HIV patients in the period before combination therapies (including protease inhibitors). The introduction of highly active antiretroviral therapy (HAART) with protease inhibitors in 1995, and non-nucleoside reverse transcriptase inhibitors, have opened up new therapeutic modalities with a new emphasis on earlier detection and treatment of neurological complications. The prognosis of different HIV-associated neurological diseases has considerably improved, as recently shown in the case, for example, of progressive multifocal leucoencephalopathy.
约三分之一的HIV感染患者会出现神经并发症，其发病率相当高且死亡率也很高。本文对原发性HIV感染、继发性机会性感染或抗逆转录病毒治疗并发症所导致的最重要的神经表现进行了最新综述。根据诊断、治疗和预后方面的新证据，讨论了原发性神经表现，包括HIV相关痴呆综合征、脊髓病、周围神经病和肌病，以及更常见的机会性感染、原发性中枢神经系统淋巴瘤和脑血管疾病。认知和精神症状、视觉变化、头痛、癫痫发作、头晕、不自主运动、步态障碍、颅神经病变和局灶性缺损是HIV感染中常见的神经症状，并从鉴别诊断的角度进行了描述。必须牢记，迄今为止关于这一主题的几乎所有现有信息都涉及联合疗法（包括蛋白酶抑制剂）之前时期的HIV患者。1995年引入含蛋白酶抑制剂的高效抗逆转录病毒疗法（HAART）以及非核苷类逆转录酶抑制剂，开辟了新的治疗方式，重新强调了对神经并发症的早期检测和治疗。不同的HIV相关神经疾病的预后已得到显著改善，例如最近在进行性多灶性白质脑病的病例中就有所体现。
