Memory and Aging Center, Department of Neurology, University of California–San Francisco, USA.
Clin Infect Dis. 2011 Oct;53(8):836-42. doi: 10.1093/cid/cir524.
Recent publications estimate the prevalence of human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) exceeds 50%, and this rate is likely higher among older patients. Cognitive impairment may impact medication adherence, and symptomatic impairment has been linked to all-cause mortality providing some impetus for early detection. There are currently insufficient data to inform solid recommendations on screening methods. Most HIV-specific tools have poor performance characteristics for all but the most severe form of impairment, which accounts for <5% of cases. Reliance on symptoms is likely to miss a substantial proportion of individuals with HAND due to poor insight, confounding mood disturbances, and lack of well-informed proxies. In the aging HIV-positive population, broader screening tools may be required to allow sensitivity for both HIV and neurodegenerative disorders. We describe the clinical presentation of HAND, review existing data related to screening tools, and provide preliminary and practical recommendations in the absence of more definitive studies.
最近的出版物估计，与人类免疫缺陷病毒（HIV）相关的神经认知障碍（HAND）的患病率超过 50%，而在老年患者中，这一比率可能更高。认知障碍可能会影响药物的依从性，而有症状的损害与全因死亡率有关，这为早期发现提供了一些动力。目前，关于筛查方法的信息还不够充分，无法提供可靠的建议。大多数 HIV 特异性工具的性能特征较差，除了最严重的损害形式外，而这种形式仅占病例的<5%。由于洞察力差、情绪障碍和缺乏知情的代理人，仅凭症状来判断可能会错过相当一部分 HAND 患者。在老龄化的 HIV 阳性人群中，可能需要更广泛的筛查工具，以同时对 HIV 和神经退行性疾病具有敏感性。我们描述了 HAND 的临床表现，回顾了与筛查工具相关的现有数据，并在缺乏更明确研究的情况下提供了初步和实用的建议。
