The Alfred, Melbourne, Victoria, Australia.
Curr Opin HIV AIDS. 2011 Jul;6(4):303-8. doi: 10.1097/COH.0b013e3283477c46.
To review recent cohort studies that have examined the relationship between combination antiretroviral therapy (cART) regimens with superior central nervous system (CNS) penetration (neuroCART) in the prevention, treatment and subsequent survival of patients with HIV-associated neurocognitive disorders (HAND).
HAND remains prevalent including within virologically suppressed populations. The CNS-penetrating effectiveness (CPE) scoring system is an important and evolving tool to determine the therapeutic role of neuroCART in HAND patients. NeuroCART was associated with improved survival in children with HIV encephalopathy and also in adults diagnosed with HIV-associated dementia during the pre and early-cART calendar periods. In one cohort study the benefit of neuroCART was best conferred when cART regimens with high CPE scores and containing more than three drugs were used. Recent data suggest also that neuroCART may be associated with CNS toxicity and poorer neurocognitive performance.
The therapeutic importance of neuroCART in the treatment of HAND remains a vitally relevant, unanswered question. Recent cohort studies have demonstrated that neuroCART may improve survival in children and adults with HIV dementia, although adults may require several drugs to receive full therapeutic benefit. NeuroCART/cART may be neurotoxic in some populations. A randomized controlled trial to address the role of neuroCART in HAND is needed.
回顾近期队列研究，这些研究检查了具有更好中枢神经系统（CNS）穿透性的联合抗逆转录病毒疗法（cART）方案（神经 CART）在预防、治疗和随后 HIV 相关认知障碍（HAND）患者生存中的作用。
HAND 仍然普遍存在，包括在病毒学抑制人群中。CNS 穿透效能（CPE）评分系统是确定神经 CART 在 HAND 患者中治疗作用的重要且不断发展的工具。神经 CART 与 HIV 脑病儿童的生存率提高以及在 cART 日历前和早期诊断为 HIV 相关痴呆的成人的生存率提高有关。在一项队列研究中，当使用 CPE 评分高且含有三种以上药物的 cART 方案时，神经 CART 的益处最佳。最近的数据还表明，神经 CART 可能与 CNS 毒性和较差的神经认知表现有关。
神经 CART 在 HAND 治疗中的治疗重要性仍然是一个至关重要的、未解决的问题。近期的队列研究表明，神经 CART 可能改善 HIV 痴呆儿童和成人的生存率，尽管成人可能需要多种药物才能获得全部治疗益处。神经 CART/cART 在某些人群中可能具有神经毒性。需要进行一项随机对照试验来确定神经 CART 在 HAND 中的作用。
