Boska Michael D, Mosley R Lee, Nawab Mehmood, Nelson Jay A, Zelivyanskaya Marina, Poluektova Larisa, Uberti Mariano, Dou Huanyu, Lewis Travis B, Gendelman Howard E
Center for Neurovirology and Neurodegenerative Disorders, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Curr HIV Res. 2004 Jan;2(1):61-78. doi: 10.2174/1570162043485095.
Persons with advanced human immunodeficiency virus type one (HIV-1) infection seek medical advice for a wide range of neurological disorders including, but not limited to, peripheral neuropathy, toxoplasmosis, cryptococcal meningitis, cytomegalovirus retinitis progressive multifocal leukoencephalopathy, lymphoma and dementia. The diagnosis of HIV-1-associated dementia (HAD) induced as a direct consequence of HIV infection of the brain comes commonly by exclusion. Diagnostic decisions can often be clouded by concomitant depression, motor impairments, and lethargy that follow debilitating immune suppression and weight loss. Indeed, cognitive, motor and behavior abnormalities underlie a variety of neurological dysfunctions associated with advanced HIV-1 infection. Thus, even combinations of clinical, laboratory and neuroimaging tests [for example, magnetic resonance imaging (MRI), computed tomography (CT), single photon emission computed tomography (SPECT) and positron emission tomography (PET)] often fail to provide conclusive diagnostic information. Nonetheless, the recent development of quantitative MR spectroscopic imaging has improved diagnostic possibilities for HAD. We are pleased to discuss these developments as well as taking a forward look into what will soon be made available to improve neuroimaging diagnostic precision. New MR and SPECT testing are being developed in our laboratories and elsewhere both for animal model systems and in humans with HIV-1 disease. Such tests can facilitate dynamic measures of HIV-1 neuropathogenesis providing information for disease events that even 2 years ago were unattainable.
晚期人类免疫缺陷病毒1型（HIV-1）感染者会就多种神经系统疾病寻求医疗建议，这些疾病包括但不限于周围神经病变、弓形虫病、隐球菌性脑膜炎、巨细胞病毒性视网膜炎、进行性多灶性白质脑病、淋巴瘤和痴呆症。作为脑部HIV感染的直接后果而引发的HIV-1相关痴呆症（HAD），其诊断通常是通过排除法得出的。诊断决策常常会因伴随免疫抑制和体重减轻而出现的抑郁、运动障碍和嗜睡症状而变得模糊不清。事实上，认知、运动和行为异常是晚期HIV-1感染相关的各种神经功能障碍的基础。因此，即使是临床、实验室和神经影像学检查（例如磁共振成像（MRI）、计算机断层扫描（CT）、单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET））的联合使用，也常常无法提供确凿的诊断信息。尽管如此，定量磁共振波谱成像技术的最新发展提高了HAD的诊断可能性。我们很高兴讨论这些进展，并展望即将推出的提高神经影像学诊断精度的方法。我们实验室和其他地方正在针对动物模型系统以及HIV-1疾病患者研发新的磁共振和SPECT检测方法。此类检测能够促进对HIV-1神经发病机制的动态测量，为甚至在两年前都无法获得的疾病事件提供信息。
