Bowen Lauren N, Tyagi Richa, Li Wenxue, Alfahad Tariq, Smith Bryan, Wright Mary, Singer Elyse J, Nath Avindra
From the Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke (L.N.B., R.T., W.L., T.A., B.S., A.N.), and National Institute of Allergy and Infectious Diseases (M.W.), NIH, Bethesda, MD; and National Neurological AIDS Bank and Department of Neurology (E.J.S.), University of California, Los Angeles.
Neurology. 2016 Oct 25;87(17):1756-1762. doi: 10.1212/WNL.0000000000003258. Epub 2016 Sep 24.
To determine whether there is activation of human endogenous retrovirus K (HERV-K) in amyotrophic lateral sclerosis in HIV infection and whether it might respond to treatment with antiretroviral drugs.
In this case series, we present 5 patients with HIV infection who subsequently developed motor neuron disease involving both upper and lower motor neurons. We monitored HERV-K levels in plasma of 4 of these patients.
Three patients who received antiretroviral therapy had reversal of symptoms within 6 months of onset of neurologic symptoms and the other 2 had slow neurologic progression over several years. Three patients in whom the levels were measured at onset of neurologic symptoms showed elevated HERV-K levels that responded to optimization of antiretroviral therapy for CNS penetration.
Thus, motor neuron disease in individuals with HIV infection may a treatable entity, but early treatment with CNS-penetrating antiretroviral therapy may be necessary. Monitoring of HERV-K levels may help guide treatment.
确定人类免疫缺陷病毒（HIV）感染的肌萎缩侧索硬化症患者中人类内源性逆转录病毒K（HERV-K）是否被激活，以及其是否可能对抗逆转录病毒药物治疗产生反应。
在这个病例系列中，我们报告了5例HIV感染患者，这些患者随后发展为涉及上下运动神经元的运动神经元病。我们监测了其中4例患者血浆中的HERV-K水平。
3例接受抗逆转录病毒治疗的患者在神经症状出现后6个月内症状逆转，另外2例患者在数年中神经功能进展缓慢。3例在神经症状出现时测量了HERV-K水平的患者显示，HERV-K水平升高，对抗逆转录病毒治疗进行中枢神经系统渗透优化后有反应。
因此，HIV感染个体的运动神经元病可能是一种可治疗的疾病，但可能需要早期使用能穿透中枢神经系统的抗逆转录病毒疗法进行治疗。监测HERV-K水平可能有助于指导治疗。
