Ances Beau M, Clifford David B
Department of Neurology, University of Washington, St. Louis, MO 63130, USA.
Curr Neurol Neurosci Rep. 2008 Nov;8(6):455-61. doi: 10.1007/s11910-008-0073-3.
HIV-associated neurocognitive disorders (HAND) are the most common preventable and treatable cause of dementia. While the incidence of the most severe form of HAND, HIV-associated dementia, has decreased since the introduction of combination antiretroviral therapy (cART), the prevalence of less severe forms of HAND has continued to rise. HAND leads to a subcortical dementia consisting of a triad of cognitive, behavior, and motor dysfunction. No single laboratory test can establish HAND, but ancillary studies including neuropsychological testing, neuroimaging studies, and cerebrospinal fluid (CSF) analysis are useful for supporting or refuting the diagnosis. More recent evidence has suggested that higher central nervous system-penetrating cART may lead to greater suppression of CSF HIV viral loads and improved cognition. Because viral control generally has been successful without eliminating cognitive dysfunction, further clinical studies that assess adjunctive neuroprotective drugs are likely to be required.
人类免疫缺陷病毒相关神经认知障碍（HAND）是痴呆最常见的可预防和可治疗病因。自联合抗逆转录病毒疗法（cART）引入以来，HAND最严重形式即人类免疫缺陷病毒相关痴呆的发病率有所下降，但较轻形式HAND的患病率持续上升。HAND导致一种皮质下痴呆，其由认知、行为和运动功能障碍三联征组成。没有单一实验室检查能确诊HAND，但包括神经心理学测试、神经影像学研究和脑脊液（CSF）分析在内的辅助研究有助于支持或反驳诊断。最新证据表明，具有更高中枢神经系统穿透性的cART可能会更有效地抑制脑脊液中的HIV病毒载量并改善认知。由于在未消除认知功能障碍的情况下病毒控制通常已取得成功，可能需要进一步开展评估辅助性神经保护药物的临床研究。
