Hellmuth Joanna, Milanini Benedetta, Valcour Victor
aDepartment of Neurology, University of California, San Francisco, California, USA bInstitute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy cDivision of Geriatric Medicine, Department of Medicine, University of California, San Francisco, California, USA.
Curr Opin HIV AIDS. 2014 Nov;9(6):527-32. doi: 10.1097/COH.0000000000000104.
The purpose of this study is to summarize recent advances in ageing and neuroAIDS by reviewing relevant articles from the preceding 18 months from PubMed and PsycINFO databases.
The success of combination antiretroviral therapy (cART) has led to ageing of the HIV-infected population, which in turn contributes to the prevalence of HIV-associated neurocognitive disorder (HAND). Biomedical advances continue to clarify the pathophysiology of HAND despite effective cART, including chronic inflammatory and neurovascular causes. In recent months, associations between HAND and nonneurological medical diseases have been identified, as well as linkage to neuroimaging in those ageing with HIV. Developing effective screening tools to detect impairment remains an important scientific gap, although promoting factors associated with successful cognitive ageing is emerging as a possible means of enhancing quality of life.
A greater understanding of HAND pathophysiology among treated individuals with suppressed virus will aid in explaining the high prevalence of HAND despite effective cART and allow for development of novel targeted interventions. Neuroimaging and other biomarkers show promise in discerning HAND from age-associated cognitive disorders. Effective screening tools remain critically needed. Together, this work will inform promising strategies needed to address issues pertinent to an expanding group of older patients living with HIV.
本研究旨在通过回顾过去18个月从PubMed和PsycINFO数据库检索到的相关文章，总结衰老与神经艾滋病的最新进展。
联合抗逆转录病毒疗法（cART）的成功导致了HIV感染人群的老龄化，进而促使了HIV相关神经认知障碍（HAND）的流行。尽管cART有效，但生物医学的进展仍在不断阐明HAND的病理生理学，包括慢性炎症和神经血管方面的病因。近几个月来，已经确定了HAND与非神经医学疾病之间的关联，以及HIV感染者衰老过程中的神经影像学联系。尽管促进与成功认知衰老相关的因素正成为提高生活质量的一种可能手段，但开发有效的筛查工具以检测损伤仍然是一个重要的科学空白。
深入了解病毒得到抑制的治疗个体中HAND的病理生理学，将有助于解释尽管cART有效但HAND患病率仍居高不下的原因，并有助于开发新的靶向干预措施。神经影像学和其他生物标志物在区分HAND与年龄相关认知障碍方面显示出前景。仍然迫切需要有效的筛查工具。总之，这项工作将为解决与不断扩大的老年HIV感染者群体相关问题所需的有前景的策略提供信息。
