Carroll Antonia, Brew Bruce
Department of Neurology, St Vincent's Hospital, Level 4, Xavier Building, Victoria Street, Darlinghurst, Sydney, Australia.
University of New South Wales, St. Vincent's Clinical School, Delacy Building, Victoria Street, Darlinghurst, Sydney, Australia.
F1000Res. 2017 Mar 23;6:312. doi: 10.12688/f1000research.10651.1. eCollection 2017.
HIV-associated neurocognitive disorders (HAND) remain prevalent despite plasma viral suppression by antiretroviral agents. In fact, the prevalence of milder subtypes of cognitive impairment is increasing. Neuropsychologic testing remains the "gold standard" of diagnosis; however, this is time consuming and costly in a resource-poor environment. Recently developed screening tools, such as CogState and the revised HIV dementia scale, have very good sensitivity and specificity in the more severe stages of HAND. However, questions remain regarding the utility of, optimal population for, and insensitivity of tests in mild HAND. Recognition of ongoing viral persistence and the inflammatory milieu in the central nervous system (CNS) has advanced our understanding of the pathogenesis of HAND and facilitated the development of biomarkers of CNS disease. The importance of the monocyte-macrophage lineage cell and the astrocyte as viral reservoirs, HIV viral proteins, self-perpetuating CNS inflammation, and CCR5 chemokine receptor neurotropism has been identified. Whilst biomarkers demonstrate monocyte activation, inflammation, and neuronal injury, they remain limited in their clinical utility. The improved understanding of pathogenic mechanisms has led to novel approaches to the treatment of HAND; however, despite these advances, the optimal management is still undefined.
尽管抗逆转录病毒药物可抑制血浆病毒，但人类免疫缺陷病毒相关神经认知障碍（HAND）仍然普遍存在。事实上，较轻亚型的认知障碍患病率正在上升。神经心理学测试仍然是诊断的“金标准”；然而，在资源匮乏的环境中，这既耗时又昂贵。最近开发的筛查工具，如CogState和修订后的HIV痴呆量表，在HAND的更严重阶段具有非常好的敏感性和特异性。然而，对于轻度HAND测试的效用、最佳人群以及不敏感性等问题仍然存在。对中枢神经系统（CNS）中持续的病毒持续性和炎症环境的认识，推动了我们对HAND发病机制的理解，并促进了CNS疾病生物标志物的开发。单核细胞-巨噬细胞谱系细胞和星形胶质细胞作为病毒储存库、HIV病毒蛋白、持续的CNS炎症以及CCR5趋化因子受体嗜神经性的重要性已得到确认。虽然生物标志物显示出单核细胞活化、炎症和神经元损伤，但其临床效用仍然有限。对致病机制的进一步理解带来了治疗HAND的新方法；然而，尽管有这些进展，最佳管理方案仍未明确。
