McCarty E J, Quah S P, Dinsmore W W, Emerson C R
Genitourinary Medicine, Royal Victoria Hospital, Belfast, UK.
Int J STD AIDS. 2010 Nov;21(11):777-9. doi: 10.1258/ijsa.2010.009466.
HIV-1 infection may persist in the central nervous system (CNS) despite antiretroviral therapy. We present a case of severe cognitive decline in a man with HIV-1 infection on a fully active regimen for five years. All infective causes were excluded. Despite fully suppressed virus in the blood, HIV RNA in the cerebrospinal fluid measured 3.52 log(10) RNA copies/mL and genotyping of this sample showed an extensive pattern of resistance. This suggested that either the antiretroviral agents were not adequately penetrating the CNS or the CNS had resistant virus as a result of adherence problems. This case highlights the possibility that drug-resistant mutations may develop in the CNS compartment while plasma virus remains suppressed.
尽管接受了抗逆转录病毒治疗，HIV-1感染仍可能在中枢神经系统（CNS）持续存在。我们报告一例HIV-1感染男性患者，其接受了五年完全有效的治疗方案后出现严重认知功能衰退。所有感染性病因均被排除。尽管血液中的病毒被完全抑制，但脑脊液中的HIV RNA为3.52 log(10) RNA拷贝/毫升，对该样本进行基因分型显示出广泛的耐药模式。这表明要么抗逆转录病毒药物未能充分穿透中枢神经系统，要么由于依从性问题中枢神经系统存在耐药病毒。该病例凸显了在血浆病毒被抑制的情况下，中枢神经系统区域可能出现耐药突变的可能性。
