Chang Linda, Ernst Thomas, Witt Mallory D, Ames Nina, Walot Irwin, Jovicich Jorge, DeSilva Menaka, Trivedi Neha, Speck Oliver, Miller Eric N
Medical Department, Brookhaven National Laboratory, Upton, NY, USA
Antivir Ther. 2003 Feb;8(1):17-26.
Proton magnetic resonance spectroscopy (1H-MRS) and neuropsychological tests may be useful for monitoring the effectiveness of highly active antiretroviral therapy (HAART) in HIV-associated brain injury. We aimed to evaluate whether brain abnormalities will improve 3 months after HAART.
Thirty-three HIV patients naive to antiretroviral medications were evaluated before and 3 months after HAART using 1H-MRS and neuropsychological tests; results were compared with those of 26 seronegative control subjects.
Despite significant improvement in CD4 counts, and suppression of plasma and cerebrospinal fluid (CSF) viral loads, elevated brain metabolites (choline compounds and myoinositol in the frontal lobes) and neuropsychological tests abnormalities (including the computerized tests [CalCAP]) persisted after 3 months of HAART. In the basal ganglia, choline and myoinositol became elevated only after treatment. No interaction effect was observed between the number of CSF-penetrating drugs (one vs two) and changes (baseline vs 3 months) in any of the brain metabolites, cognitive performance or CSF viral load.
The persistent brain abnormalities suggest ongoing repair or reactive inflammatory processes in the brain after 3 months of HAART. Regimens with two CSF-penetrating antiretroviral medications do not appear to be more effective than those with one CSF-penetrating drug in treating HIV brain injury at 3 months.
质子磁共振波谱（1H-MRS）和神经心理学测试可能有助于监测高效抗逆转录病毒治疗（HAART）对HIV相关脑损伤的疗效。我们旨在评估HAART治疗3个月后脑部异常是否会改善。
对33例未接受过抗逆转录病毒药物治疗的HIV患者在HAART治疗前和治疗3个月后进行1H-MRS和神经心理学测试评估；结果与26例血清学阴性对照受试者的结果进行比较。
尽管CD4细胞计数显著改善，血浆和脑脊液（CSF）病毒载量得到抑制，但HAART治疗3个月后，脑代谢物（额叶中的胆碱化合物和肌醇）升高及神经心理学测试异常（包括计算机化测试[CalCAP]）仍然存在。在基底神经节中，胆碱和肌醇仅在治疗后升高。未观察到脑脊液穿透性药物数量（一种与两种）与任何脑代谢物、认知表现或脑脊液病毒载量的变化（基线与3个月）之间存在交互作用。
持续存在的脑部异常表明HAART治疗3个月后大脑仍在进行修复或发生反应性炎症过程。在治疗3个月时，使用两种脑脊液穿透性抗逆转录病毒药物的方案在治疗HIV脑损伤方面似乎并不比使用一种脑脊液穿透性药物的方案更有效。
