Department of Neurology, Johns Hopkins Neurology School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, 301 Building, Suite 2100, Baltimore, MD, 21224, USA.
J Neurovirol. 2018 Apr;24(2):141-145. doi: 10.1007/s13365-017-0556-6. Epub 2017 Jul 27.
HIV-associated neurocognitive disorder (HAND) remains a common cause of cognitive impairment and persists in 15-55% of HIV+ individuals in the combination antiretroviral therapy (CART) era. CART is now the primary treatment for HAND, but it is effective in only a subset of patients. In the pre-CART era, HIV-associated dementia was the most common form of HAND. However, in CART-treated patients, the prevalence of HIV-associated dementia has declined substantially, and milder stages of HAND, i.e., ANI and MND predominate. HIV+ patients with mild neurocognitive disorder (MND) can still have significant functional impairment in some activities of daily living. There have been several other significant changes in the clinical features of HAND in the CART era. The mean survival for an individual diagnosed with HIV dementia has increased dramatically. In HIV+ individuals on CART with a suppressed systemic viral load, the majority of individuals with HAND remain stable, with a small proportion showing deterioration. Extrapyramidal signs are now less common in patients with HAND on CART. In the CART era, HAND may have a mixed pattern of both cortical and subcortical features with greater deficits in executive functioning and working memory. Despite the milder clinical phenotype, in the CART era, patients with HAND still have persistent laboratory and neuroimaging abnormalities in the central nervous system even with systemic viral suppression. As the HIV+ patient population ages, cerebrovascular disease risk factors such as hypertension, diabetes, and hypercholesterolemia are increasingly recognized as risk factors for cognitive impairment in HIV+ patients on CART. HAND remains a common neurological condition globally in the CART era, necessitating the need for new animal models to examine pathogenesis and potential treatments for HAND.
HIV 相关神经认知障碍（HAND）仍然是认知障碍的常见原因，在联合抗逆转录病毒治疗（CART）时代，HIV 阳性个体中有 15-55%持续存在HAND。CART 现在是 HAND 的主要治疗方法，但仅对一部分患者有效。在 CART 前时代，HIV 相关痴呆是 HAND 最常见的形式。然而，在接受 CART 治疗的患者中，HIV 相关痴呆的患病率已大幅下降，HAND 的轻度阶段，即 ANI 和 MND 占主导地位。轻度神经认知障碍（MND）的 HIV 阳性患者在某些日常生活活动中仍可能存在严重的功能障碍。在 CART 时代，HAND 的临床特征还发生了其他一些重大变化。诊断为 HIV 痴呆的个体的平均存活时间大大增加。在接受 CART 治疗且系统病毒载量得到抑制的 HIV 阳性个体中，大多数 HAND 患者保持稳定，少数患者病情恶化。CART 治疗的 HAND 患者现在锥体外系体征较少见。在 CART 时代，HAND 可能具有皮质和皮质下特征的混合模式，执行功能和工作记忆的缺陷更大。尽管临床表型较轻，但在 CART 时代，即使在系统病毒抑制的情况下，HAND 患者的中枢神经系统仍存在持续的实验室和神经影像学异常。随着 HIV 阳性患者人群的老龄化，高血压、糖尿病和高胆固醇血症等脑血管疾病危险因素越来越被认为是 CART 治疗的 HIV 阳性患者认知障碍的危险因素。HAND 在 CART 时代仍然是全球常见的神经系统疾病，需要新的动物模型来研究 HAND 的发病机制和潜在治疗方法。
