Wright Edwina J
aDepartment of Infectious Diseases, Alfred Health bMonash University cBurnet Institute, Melbourne, Victoria, Australia.
Curr Opin HIV AIDS. 2014 Nov;9(6):539-44. doi: 10.1097/COH.0000000000000109.
To review recent studies that address the pathogenesis, diagnosis and treatment of HIV positive patients with cryptococcal and tuberculous meningitis and progressive multifocal leukoencephalopathy in resource-different settings.
Central nervous system opportunistic infections remain globally prevalent in HIV+ populations. Several recent papers have highlighted the urgent need for rapid point of care tests in low-income settings for cryptococcal and tuberculous meningitis, better access to antifungal therapy for cryptococcal meningitis and better treatment strategies for tuberculous meningitis. In one recent study of 299 HIV+ patients with cryptococcal meningitis, amphotericin plus flucytosine was associated with less mortality and disability compared to amphotericin alone. In a study of patients with tuberculous meningitis in Indonesia, short-term, high dose rifampicin and moxifloxacin, designed to achieve higher levels of anti-TB drugs in the brain, saw significantly reduced patient mortality at 6 months. The timing of ART initiation in patients with central nervous system opportunistic infections remains challenging and a recent study reported that deferred vs early antiretroviral therapy was associated with better survival outcomes in patients diagnosed with cryptococcal meningitis. Recent studies have reported on predictors of immune reconstitution inflammatory syndrome for patients with central nervous system opportunistic infections, but require validation in resource-different settings.
Recent studies related to the diagnosis and treatment of central nervous system opportunistic infections in HIV+ populations show promising findings. Increased funding and research commitment are required to maintain this positive momentum and to achieve improved global outcomes for people who develop central nervous system opportunistic infections.
回顾近期关于资源条件不同地区HIV阳性患者合并隐球菌性脑膜炎、结核性脑膜炎及进行性多灶性白质脑病的发病机制、诊断和治疗的研究。
中枢神经系统机会性感染在全球HIV阳性人群中仍然普遍存在。近期的几篇论文强调了在低收入地区对隐球菌性脑膜炎和结核性脑膜炎进行快速即时检测的迫切需求，改善隐球菌性脑膜炎抗真菌治疗的可及性以及结核性脑膜炎更好的治疗策略。在最近一项对299例HIV阳性隐球菌性脑膜炎患者的研究中，两性霉素联合氟胞嘧啶与单独使用两性霉素相比，死亡率和残疾率更低。在印度尼西亚一项对结核性脑膜炎患者的研究中，旨在使大脑中抗结核药物达到更高水平的短期、高剂量利福平和莫西沙星治疗，6个月时患者死亡率显著降低。中枢神经系统机会性感染患者开始抗逆转录病毒治疗（ART）的时机仍然具有挑战性，最近一项研究报告称，对于诊断为隐球菌性脑膜炎的患者，延迟与早期抗逆转录病毒治疗相比，生存结局更好。近期研究报告了中枢神经系统机会性感染患者免疫重建炎症综合征的预测因素，但需要在资源条件不同的地区进行验证。
近期关于HIV阳性人群中枢神经系统机会性感染诊断和治疗的研究显示出有前景的结果。需要增加资金和研究投入，以维持这一积极势头，并为发生中枢神经系统机会性感染的人群实现更好的全球治疗效果。
