Department of Neurology, Yale University, 300 George Street, Room 8300c, New Haven, CT 06510, USA.
Curr HIV/AIDS Rep. 2013 Sep;10(3):235-43. doi: 10.1007/s11904-013-0171-y.
The spectrum of HIV-associated neurocognitive disorder (HAND) has been dramatically altered in the setting of widely available effective antiretroviral therapy (ART). Once culminating in dementia in many individuals infected with HIV, HAND now typically manifests as more subtle, though still morbid, forms of cognitive impairment in persons surviving long-term with treated HIV infection. Despite the substantial improvement in severity of this disorder, the fact that neurologic injury persists despite ART remains a challenge to the community of patients, providers and investigators aiming to optimize quality of life for those living with HIV. Cognitive dysfunction in treated HIV may reflect early irreversible CNS injury accrued before ART is typically initiated, ongoing low-level CNS infection and progressive injury in the setting of ART, or comborbidities including effects of treatment which may confound the beneficial reduction in viral replication and immune activation effected by ART.
在广泛应用有效抗逆转录病毒疗法（ART）的背景下，艾滋病相关神经认知障碍（HAND）的谱发生了显著变化。在许多感染 HIV 的个体中，HAND 曾经导致痴呆，但现在通常表现为长期接受 HIV 治疗的个体中更微妙但仍然致命的认知障碍形式。尽管这种疾病的严重程度有了很大改善，但 ART 仍能持续存在神经损伤这一事实，对旨在为 HIV 感染者优化生活质量的患者、提供者和研究人员构成挑战。接受治疗的 HIV 患者的认知功能障碍可能反映了在通常开始 ART 之前积累的早期不可逆转的中枢神经系统损伤、持续的低水平中枢神经系统感染以及 ART 背景下的进行性损伤，或合并症，包括治疗的影响，这可能会干扰 ART 对病毒复制和免疫激活的有益降低。
