Peluso Michael J, Valcour Victor, Ananworanich Jintanat, Sithinamsuwan Pasiri, Chalermchai Thep, Fletcher James L K, Lerdlum Sukalya, Chomchey Nitiya, Slike Bonnie, Sailasuta Napapon, Gisslén Magnus, Zetterberg Henrik, Spudich Serena
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Memory and Aging Center, Department of Neurology, University of California, San Francisco.
J Infect Dis. 2015 Dec 1;212(11):1759-67. doi: 10.1093/infdis/jiv296. Epub 2015 May 20.
It is unknown whether neuronal injury begins during acute human immunodeficiency virus (HIV) infection, and whether immediate initiation of combination antiretroviral therapy (cART) prevents neuronal injury.
Cerebrospinal fluid (CSF) neurofilament light chain (NFL), a measure of axonal injury, was assessed before and after cART initiation in individuals starting treatment during acute or chronic HIV infection. Nonparametric statistics examined relationships between NFL and disease progression, neuroinflammation, and cognitive performance.
Before treatment, subjects with acute infection had lower CSF NFL levels, with elevations for their age in 1 of 32 subjects with acute infection (3.1%) and 10 of 32 with chronic infection (31%) (P = .006). This persisted after cART initiation, with 1 of 25 acute (4%) and 4 of 9 chronic subjects (44%) showing elevated NFL levels (P = .01). In acute infection, pre-cART NFL levels were inversely correlated with proton magnetic resonance spectroscopic findings of N-acetylaspartate/creatine in frontal gray matter (r = -0.40; P = .03), frontal white matter (r = -0.46; P = .01), and parietal gray matter (r = -0.47; P = .01); correlations persisted after treatment in the frontal white matter (r = -0.51; P = .02) and parietal gray matter (r = -0.46; P = .04).
CSF NFL levels are not elevated in untreated acute HIV infection or after 6 months of immediately initiated cART but are abnormal in chronic HIV infection before and after treatment. In acute HIV infection, CSF NFL levels are inversely associated with neuroimaging markers of neuronal health.
尚不清楚在人类免疫缺陷病毒（HIV）急性感染期间神经元损伤是否开始，以及立即开始联合抗逆转录病毒治疗（cART）是否能预防神经元损伤。
在急性或慢性HIV感染期间开始治疗的个体中，在开始cART治疗前后评估脑脊液（CSF）神经丝轻链（NFL），这是一种轴突损伤的指标。非参数统计检验了NFL与疾病进展、神经炎症和认知表现之间的关系。
治疗前，急性感染患者的CSF NFL水平较低，32例急性感染患者中有1例（3.1%）、32例慢性感染患者中有10例（31%）的NFL水平随年龄升高（P = 0.006）。开始cART治疗后这种情况仍然存在，25例急性感染患者中有1例（4%）、9例慢性感染患者中有4例（44%）的NFL水平升高（P = 0.01）。在急性感染中，cART治疗前的NFL水平与额叶灰质（r = -0.40；P = 0.03）、额叶白质（r = -0.46；P = 0.01）和顶叶灰质（r = -0.47；P = 0.01）中N-乙酰天门冬氨酸/肌酸的质子磁共振波谱结果呈负相关；治疗后，额叶白质（r = -0.51；P = 0.02）和顶叶灰质（r = -0.46；P = 0.04）中仍存在相关性。
未经治疗的急性HIV感染或立即开始cART治疗6个月后，CSF NFL水平并未升高，但在慢性HIV感染治疗前后均异常。在急性HIV感染中，CSF NFL水平与神经元健康的神经影像学标志物呈负相关。
