Arendt G
Neurologische Klinik des Universitätsklinikums Düsseldorf.
Fortschr Neurol Psychiatr. 2005 Oct;73(10):577-86. doi: 10.1055/s-2004-830283.
After the introduction of highly active antiretroviral therapy (HAART) in 1996 the neurological manifestations of human immunodeficiency virus (HIV-1)-infection did not decline in incidence and prevalence like the other complications of immunodeficiency; in contrast, due to the longer survival times of HAART treated HIV-1-positive individuals, prevalence of virus associated neurological disease increased during the last years, as international studies underline. Therefore, clinicians and HIV-therapists should be able to diagnose HIV-1-associated neurological disease even in early stages. This article describes symptoms and signs, neuro-imaging and cerebrospinal fluid findings as well as therapy options in primary HIV-1-associated neurological disease like encephalo- and myelopathy and polyneuropathy. Furthermore, those opportunistic infections, caused by bacteria, viruses other than HIV and parasites emerging with manifest immunodeficiency and remaining to be relevant in the HAART era are presented from diagnostic, differential-diagnostic and therapeutic points of view. An extra paragraph describes the interaction of HAART with neurological/psychiatric standard therapies.
1996年高效抗逆转录病毒疗法(HAART)引入后,人类免疫缺陷病毒(HIV-1)感染的神经表现发病率和患病率并未像免疫缺陷的其他并发症那样下降;相反,正如国际研究强调的,由于接受HAART治疗的HIV-1阳性个体存活时间延长,与病毒相关的神经疾病患病率在过去几年有所上升。因此,临床医生和HIV治疗师即使在早期阶段也应能够诊断出HIV-1相关神经疾病。本文描述了原发性HIV-1相关神经疾病如脑脊髓病和多发性神经病的症状和体征、神经影像学和脑脊液检查结果以及治疗选择。此外,还从诊断、鉴别诊断和治疗角度介绍了由细菌、HIV以外的病毒和寄生虫引起的机会性感染,这些感染在明显免疫缺陷时出现且在HAART时代仍具有相关性。另有一段描述了HAART与神经/精神科标准疗法的相互作用。