Underwood Jonathan, Winston Alan
Division of Infectious Diseases, Imperial College London, London, UK.
Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, London, W2 1NY, UK.
Curr HIV/AIDS Rep. 2016 Oct;13(5):235-40. doi: 10.1007/s11904-016-0324-x.
Antiretroviral therapy has revolutionised the treatment for people living with HIV (PLWH). Where antiretroviral coverage is high, the treatment paradigm for HIV-disease is now one of managing the long-term consequences of the virus and its treatment rather than the consequences of untreated HIV-disease such as immunosuppression and opportunistic infections. One such long-term consequence is HIV-associated cognitive impairment which is reported to occur in up to 50 % of treated PLWH and has been associated with poorer outcomes. Given the ageing cohort and increased frequency of comorbidities, the prevalence of symptomatic cognitive impairment may increase with time. High quality evidence for management strategies including screening, diagnosis and treatment of HIV-associated cognitive impairment are lacking and in general guidelines are based on best clinical practice. In this article, we assessed recent guidelines concerning the management of HIV-associated cognitive impairment by performing a systematic review of the MEDLINE database using PubMed. We report that, in general, guidelines from around the world regarding the management of HIV-associated cognitive impairment are converging. Screening is generally not recommended in asymptomatic PLWH. Diagnosis of HIV-associated cognitive impairment should be made only after a comprehensive assessment and exclusion of other potential causes. Antiretroviral therapy forms the cornerstone of management of HIV-associated cognitive impairment and should be guided by plasma and cerebrospinal fluid (CSF) genotype(s).
抗逆转录病毒疗法彻底改变了对艾滋病毒感染者（PLWH）的治疗方式。在抗逆转录病毒治疗覆盖率较高的地区，目前艾滋病毒疾病的治疗模式是管理病毒及其治疗的长期后果，而非像免疫抑制和机会性感染等未治疗的艾滋病毒疾病的后果。其中一个这样的长期后果就是与艾滋病毒相关的认知障碍，据报道在高达50%的接受治疗的PLWH中出现，并且与较差的预后相关。鉴于这一人群的老龄化以及合并症频率的增加，有症状的认知障碍患病率可能会随着时间推移而上升。目前缺乏关于包括筛查、诊断和治疗与艾滋病毒相关的认知障碍在内的管理策略的高质量证据，总体而言指南是基于最佳临床实践制定的。在本文中，我们通过使用PubMed对MEDLINE数据库进行系统综述，评估了有关与艾滋病毒相关的认知障碍管理的近期指南。我们报告称，总体而言，世界各地关于与艾滋病毒相关的认知障碍管理的指南正在趋同。通常不建议对无症状的PLWH进行筛查。只有在进行全面评估并排除其他潜在病因后，才能诊断与艾滋病毒相关的认知障碍。抗逆转录病毒疗法是与艾滋病毒相关的认知障碍管理的基石，并且应以血浆和脑脊液（CSF）基因型为指导。
