Kolson D L, Gonzalez-Scarano F
Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, USA.
J Peripher Nerv Syst. 2001 Mar;6(1):2-7. doi: 10.1046/j.1529-8027.2001.006001002.x.
The role of the human immunodeficiency virus (HIV) and other viruses in the development of neuropathies associated with HIV infection is controversial. Distal symmetric polyneuropathy (DSP), the most common subtype of HIV-associated neuropathy, is characterized by an abundance of reactive macrophages within the peripheral nerve, but HIV replication is limited to a small percentage of the macrophages. Thus, the pathological destruction may be mediated by pro-inflammatory signals amplified by activated glial elements within the nerve, similar to the proposed mechanism of damage caused by HIV within the central nervous system. In contrast, in mononeuropathy multiplex (MM) and progressive polyneuropathy (PP), cytomegalovirus (CMV) replication in the peripheral nerve is consistently demonstrable, and this replication likely results in direct damage to the infected cells (neurons and glia). The rarest form of HIV-associated neuropathy, the diffuse infiltrative lymphocytosis syndrome (DILS), is characterized by an intense CD8+ T lymphocyte infiltration into the nerve and abundant HIV infection of macrophages. Finally, while other viruses (varicella zoster, herpes simplex) are associated with myelitis in HIV-infected individuals, there is little support for a role for these viruses in HIV-associated neuropathy.
人类免疫缺陷病毒（HIV）及其他病毒在与HIV感染相关的神经病变发展过程中的作用存在争议。远端对称性多发性神经病（DSP）是HIV相关神经病最常见的亚型，其特征是周围神经内存在大量反应性巨噬细胞，但HIV复制仅限于一小部分巨噬细胞。因此，病理破坏可能是由神经内活化的神经胶质细胞放大的促炎信号介导的，这与HIV在中枢神经系统中造成损伤的机制类似。相比之下，在多灶性单神经病（MM）和进行性多发性神经病（PP）中，外周神经中持续可检测到巨细胞病毒（CMV）复制，这种复制可能导致对受感染细胞（神经元和神经胶质细胞）的直接损伤。HIV相关神经病最罕见的形式，即弥漫性浸润性淋巴细胞增多综合征（DILS），其特征是CD8 + T淋巴细胞强烈浸润神经，且巨噬细胞大量感染HIV。最后，虽然其他病毒（水痘带状疱疹病毒、单纯疱疹病毒）与HIV感染个体的脊髓炎有关，但几乎没有证据支持这些病毒在HIV相关神经病中起作用。
