Deshpande Alaka K, Patnaik Mrinal M
Department of Retroviral Medicine, Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India.
MedGenMed. 2005 Oct 4;7(4):2.
HIV-1 is a neurotropic virus. In a resource-limited country such as India, large populations of affected patients now have access to adequate chemoprophylaxis for opportunistic infections (OIs), allowing them to live longer. Unfortunately the poor availability of highly active antiretroviral therapy (HAART) has allowed viral replication to proceed unchecked. This has resulted in an increase in the debilitating neurologic manifestations directly mediated by the virus.
The main objective of this study was to identify and describe in detail the direct neurologic manifestations of HIV-1 in antiretroviral treatment (ART)-naive, HIV-infected patients (excluding the neurologic manifestations produced by opportunistic pathogens).
Three hundred successive cases of HIV-1 infected, ART-naive patients with neurologic manifestations were studied over a 3-year period. Each case was studied in detail to identify and then exclude manifestations due to opportunistic pathogens. The remaining cases were then analyzed specially in regard to their occurrence and the degree of immune suppression (CD4+ cell counts).
The study was carried out in an apex, tertiary, referral care center for HIV/AIDS in India. All patients were admitted for a detailed analysis. No interventions were carried out, as this was an observational study.
Of the 300 cases, 67 (22.3%) had neurologic manifestations due to the direct effects of HIV-1. The HIV infection involved the neuroaxis at all levels. The distribution of cases showed that the region most commonly involved was the brain (50.7%). The manifestations included stroke syndromes (29.8%), demyelinating illnesses (5.9%), AIDS dementia complex (5.9%), and venous sinus thrombosis (4.4%). The other manifestations seen were peripheral neuropathies (35.8% of cases), spinal cord pathologies (5.9% of cases), radiculopathies (4.4% of cases), and a single case of myopathy. The onset of occurrence of these diseases and their progression were then correlated with the CD4+ cell counts.
HIV infection is responsible for a large number of nonopportunistic neurologic manifestations that occur across a large immune spectrum. During the early course of the disease, the polyclonal hypergammaglobulinemia induced by the virus results in demyelinating diseases of the central- and peripheral nervous systems (CNS and PNS). As the HIV infection progresses, the direct toxic effects of the virus unfold, directly damaging the CNS and PNS, resulting in protean clinical manifestations.
人类免疫缺陷病毒1型（HIV-1）是一种嗜神经病毒。在印度这样资源有限的国家，大量受影响患者现在能够获得针对机会性感染（OI）的充分化学预防，从而延长了寿命。不幸的是，高效抗逆转录病毒疗法（HAART）供应不足，使得病毒复制得以不受控制地进行。这导致了由病毒直接介导的使人衰弱的神经学表现增加。
本研究的主要目的是识别并详细描述未接受抗逆转录病毒治疗（ART）的HIV感染患者中HIV-1的直接神经学表现（不包括机会性病原体产生的神经学表现）。
在3年期间对300例连续的有神经学表现、未接受ART的HIV-1感染患者进行了研究。对每例患者进行详细研究，以识别并排除由机会性病原体引起的表现。然后对其余病例的发生情况及其免疫抑制程度（CD4+细胞计数）进行专门分析。
该研究在印度一家顶级的三级HIV/AIDS转诊护理中心进行。所有患者均入院进行详细分析。由于这是一项观察性研究，未进行干预。
在300例病例中，67例（22.3%）有由HIV-1直接作用引起的神经学表现。HIV感染累及神经轴的各个层面。病例分布显示最常受累的区域是大脑（50.7%）。表现包括中风综合征（29.8%）、脱髓鞘疾病（5.9%）、艾滋病痴呆综合征（5.9%）和静脉窦血栓形成（4.4%）。其他所见表现为周围神经病变（占病例的35.8%）、脊髓病变（占病例的5.9%）、神经根病（占病例的4.4%）以及1例肌病。然后将这些疾病的发生及其进展与CD4+细胞计数进行关联。
HIV感染导致大量在广泛免疫范围内出现的非机会性神经学表现。在疾病早期，病毒诱导的多克隆高球蛋白血症导致中枢和周围神经系统（CNS和PNS）的脱髓鞘疾病。随着HIV感染进展，病毒的直接毒性作用显现，直接损害CNS和PNS，导致多种多样的临床表现。
