Morgello Susan, Estanislao Lydia, Simpson David, Geraci Anthony, DiRocco Alessandro, Gerits Pieter, Ryan Elizabeth, Yakoushina Tatiana, Khan Shafat, Mahboob Rashid, Naseer Mubasher, Dorfman David, Sharp Victoria
Department of Pathology, The Mount Sinai Medical Center, New York, NY 10029, USA.
Arch Neurol. 2004 Apr;61(4):546-51. doi: 10.1001/archneur.61.4.546.
To examine distal sensory polyneuropathy (DSP) in a highly active antiretroviral therapy era, human immunodeficiency virus (HIV)-infected cohort, to determine whether clinical manifestations are affected by demographic or other clinical variables.
One hundred eighty-seven patients with HIV infection enrolled in the Manhattan HIV Brain Bank underwent baseline neurologic evaluations between January 29, 1999, and June 17, 2002. Distal sensory polyneuropathy was diagnosed if patients displayed abnormalities in 2 or more of the following: ankle reflexes or vibratory or pinprick perception. Patients were classified as symptomatic if they described pain, paresthesia, or numbness. Nonneurologic information was obtained by interview, laboratory testing, and medical chart review. Psychiatric and substance use disorders were elucidated by semistructured interview. In 36 patients, morphometric analysis was performed on autopsy-derived sural nerves.
Of 187 patients, 99 (53%) had DSP. Patients with neuropathy were older than those without (mean +/- SD age, 45.3 +/- 0.7 vs 41.2 +/- 0.8 years, P <.001), and DSP was significantly more common in men (58% [83/99]) than in women (37% [16/99]) (P =.02). The presence of neuropathy was not correlated with plasma viral load, decreased CD4 cell counts, or neurotoxic antiretroviral therapy. Twenty-six of 99 patients with DSP were asymptomatic. Asymptomatic neuropathy was correlated with histories of opiate and sedative abuse and dependence. Symptomatic DSP correlated with ethanol and hallucinogen syndromes, but not neurotoxic therapy. Sural nerve morphometric findings did not distinguish between patients with substance use syndromes and those without.
In contrast to populations before the era of highly active antiretroviral therapy, DSP in the Manhattan HIV Brain Bank cohort is not associated with increased viral load or decreased CD4 cell counts in this cross-sectional analysis. Symptoms in DSP are associated with substance use disorders, but no difference in morphologic structure is seen in nerves of patients with HIV infection with and without substance use histories. Previously reported virologic and immunologic underpinnings of DSP may be affected by highly active antiretroviral therapy. Furthermore, symptoms of DSP in substance users may be altered by central mechanisms of increased or decreased tolerance to sensory disturbance.
在高效抗逆转录病毒治疗时代，对感染人类免疫缺陷病毒（HIV）的队列进行远端感觉性多发性神经病（DSP）检查，以确定临床表现是否受人口统计学或其他临床变量影响。
1999年1月29日至2002年6月17日期间，187名参与曼哈顿HIV脑库研究的HIV感染患者接受了基线神经学评估。若患者出现以下2项或更多异常，则诊断为远端感觉性多发性神经病：踝反射、振动觉或针刺觉。若患者自述疼痛、感觉异常或麻木，则分类为有症状。通过访谈、实验室检测和病历审查获取非神经学信息。通过半结构化访谈阐明精神疾病和物质使用障碍情况。对36例患者尸检获得的腓肠神经进行形态学分析。
187例患者中，99例（53%）患有DSP。患有神经病的患者比未患神经病的患者年龄更大（平均±标准差年龄，45.3±0.7岁对41.2±0.8岁，P<.001），且DSP在男性中比在女性中更常见（58%[83/99]对37%[16/99]）（P=.02）。神经病的存在与血浆病毒载量、CD4细胞计数降低或神经毒性抗逆转录病毒治疗无关。99例DSP患者中有26例无症状。无症状神经病与阿片类药物和镇静剂滥用及依赖史相关。有症状的DSP与乙醇和致幻剂综合征相关，但与神经毒性治疗无关。腓肠神经形态学结果无法区分有物质使用综合征的患者和无物质使用综合征的患者。
与高效抗逆转录病毒治疗时代之前的人群相比，在这项横断面分析中，曼哈顿HIV脑库队列中的DSP与病毒载量增加或CD4细胞计数降低无关。DSP的症状与物质使用障碍相关，但在有和无物质使用史的HIV感染患者的神经中，未见形态学结构差异。先前报道的DSP的病毒学和免疫学基础可能受高效抗逆转录病毒治疗影响。此外，物质使用者中DSP的症状可能因对感觉障碍耐受性增加或降低的中枢机制而改变。
