Clifford D B, Fagan A M, Holtzman D M, Morris J C, Teshome M, Shah A R, Kauwe J S K
Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Neurology. 2009 Dec 8;73(23):1982-7. doi: 10.1212/WNL.0b013e3181c5b445. Epub 2009 Nov 11.
HIV-associated neurologic disorders (HAND) continue to develop in many patients with HIV. CSF amyloid measurements in HAND have been reported to be similar to those in dementia of the Alzheimer type (DAT). Confirmatory evaluation of this finding in carefully evaluated subjects is needed.
CSF specimens were obtained from subjects clinically categorized with normal cognition from the general population, HIV+ subjects with normal cognition, HIV+ subjects with impaired cognition, or presumed HIV- subjects with mild DAT. CSF measurements of beta-amyloid((1-42)) (Abeta42), beta-amyloid((1-40)) (Abeta40), total tau (t-tau), and phosphorylated tau (p-tau181) were performed.
CSF Abeta42 measured in 49 HAND subjects had a median level of 501 pg/mL, which was lower than that of 50 controls of similar age who had median of 686 pg/mL (p < 0.0001) or 21 HIV+ subjects without cognitive impairment who had median of 716 pg/mL (p < 0.003). HAND subjects had similar CSF Abeta42 to 68 subjects with mild DAT. There was no difference of CSF Abeta40 between the groups. Tau and p-tau181 was elevated in DAT, but slightly lower than control in both HIV+ groups.
beta-Amyloid((1-42)) (Abeta42) measurements in CSF of cognitively impaired patients with HIV are similar to those in patients with mild dementia of the Alzheimer type (DAT). Normal or slightly depressed CSF tau and p-tau181 measurements distinguish these patients with HIV-associated neurologic disorders (HAND) from patients with DAT. Further evaluation of amyloid metabolism in patients with HIV cognitive disorder is needed to understand the implications of depressed CSF Abeta42 in the setting of HAND.
许多艾滋病病毒（HIV）感染者仍会出现HIV相关神经障碍（HAND）。据报道，HAND患者脑脊液淀粉样蛋白的测量结果与阿尔茨海默病型痴呆（DAT）患者相似。需要在经过仔细评估的受试者中对这一发现进行验证性评估。
从临床分类为认知正常的普通人群、认知正常的HIV阳性受试者、认知受损的HIV阳性受试者或疑似患有轻度DAT的HIV阴性受试者中获取脑脊液样本。对脑脊液中的β-淀粉样蛋白（1-42）（Aβ42）、β-淀粉样蛋白（1-40）（Aβ40）、总tau蛋白（t-tau）和磷酸化tau蛋白（p-tau181）进行测量。
49名HAND患者脑脊液中Aβ42的中位水平为501 pg/mL，低于年龄相仿的50名对照者的中位水平686 pg/mL（p<0.0001），也低于21名无认知障碍的HIV阳性受试者的中位水平716 pg/mL（p<0.003）。HAND患者脑脊液Aβ42水平与68名轻度DAT患者相似。各组间脑脊液Aβ40无差异。tau蛋白和p-tau181在DAT患者中升高，但在两个HIV阳性组中均略低于对照组。
认知受损的HIV感染者脑脊液中β-淀粉样蛋白（1-42）（Aβ42）的测量结果与轻度阿尔茨海默病型痴呆（DAT）患者相似。脑脊液tau蛋白和p-tau181测量结果正常或略有降低，可将这些HIV相关神经障碍（HAND）患者与DAT患者区分开来。需要对HIV认知障碍患者的淀粉样蛋白代谢进行进一步评估，以了解脑脊液Aβ42降低在HAND中的意义。
