HIV疾病的神经系统并发症及其治疗
Neurologic complications of HIV disease and their treatment.
作者信息
Letendre Scott, Ances Beau, Gibson Sarah, Ellis Ronald J
机构信息
Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA.
出版信息
Top HIV Med. 2007 Apr-May;15(2):32-9.
Important new information regarding neurologic complications of HIV disease was presented at the 2007 Conference on Retroviruses and Opportunistic Infections. In addition to presentations on pathogenesis and treatment of neurologic complications, the conference included findings that have implications for the management of HIV disease outside the nervous system. Key findings included that the distribution of antiretrovirals into the central nervous system may influence the effectiveness of treatment outside this protected compartment; that postponing initiation of therapy until blood CD4+ counts fall to 300 cells/mm3 may increase the risk for HIV-associated neurocognitive impairment but interruption of antiretroviral therapy in individuals with high CD4+ counts may have neuropsychologic benefits; that substantial changes, including macrophage activation and neuronal injury can occur shortly after HIV transmission; that HIV can influence neural progenitor cells to decrease neuronal differentiation; that newer neuroimaging technologies, such as diffusion tensor imaging and blood oxygen level-dependent functional magnetic resonance imaging can identify important effects of HIV on the brain such as alterations in cerebral oxygen consumption; that serotonin reuptake inhibitors and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors may reduce HIV RNA levels in cerebral spinal fluid; and that erythropoietin and the non-immunosuppressive immunophilin ligand, GPI-1046, may improve HIV-associated injury of peripheral nerves. The conference also included an important focus on JC virus encephalitis (also known as progressive multifocal leukoencephalopathy).
在2007年逆转录病毒与机会性感染会议上,公布了有关HIV疾病神经并发症的重要新信息。除了关于神经并发症发病机制和治疗的报告外,该会议还包括了对神经系统以外HIV疾病管理有影响的研究结果。主要研究结果包括:抗逆转录病毒药物在中枢神经系统中的分布可能会影响该保护区域外治疗的有效性;将治疗开始时间推迟到血液CD4+细胞计数降至300个细胞/mm3可能会增加HIV相关神经认知障碍的风险,但在CD4+细胞计数高的个体中中断抗逆转录病毒治疗可能有神经心理益处;在HIV传播后不久可能会发生包括巨噬细胞活化和神经元损伤在内的实质性变化;HIV可影响神经祖细胞以减少神经元分化;更新的神经成像技术,如扩散张量成像和血氧水平依赖性功能磁共振成像,可识别HIV对大脑的重要影响,如脑氧消耗的改变;5-羟色胺再摄取抑制剂和3-羟基-3-甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂可能会降低脑脊液中的HIV RNA水平;促红细胞生成素和非免疫抑制性亲免素配体GPI-1046可能会改善HIV相关的外周神经损伤。该会议还重点关注了JC病毒脑炎(也称为进行性多灶性白质脑病)。