Marra Christina M
Departments of Neurology and Medicine, University of Washington School of Medicine, Seattle, WA, United States.
Handb Clin Neurol. 2018;152:151-166. doi: 10.1016/B978-0-444-63849-6.00012-8.
Human immunodeficiency virus (HIV)-infected individuals are particularly susceptible to several central nervous system infections: human cytomegalovirus, which may cause encephalitis, ventriculitis, polyradiculitis, or polyradiculomyelitis; Mycobacterium tuberculosis, which can cause meningitis or space-occupying lesions; and Treponema pallidum subspecies pallidum (T. pallidum), which affects the meninges, cerebrospinal fluid, cranial nerves, and vasculature in early neurosyphilis, and additionally the brain and spinal cord parenchyma in late neurosyphilis. Central nervous system cytomegalovirus infection is seen in HIV-infected individuals with very advanced immunosuppression. Its prognosis is poor and optimal therapy has not been determined. Tuberculous meningitis has a high mortality in those also infected with HIV, especially in the developing world, and better therapies are urgently needed. As the rates of syphilis increase in the developed world, neurosyphilis and in particular ocular syphilis are increasingly reported. The likelihood of all three of these central nervous system infections is decreased in individuals who receive potent antiretroviral therapy.
感染人类免疫缺陷病毒（HIV）的个体尤其易患几种中枢神经系统感染：人巨细胞病毒，可引起脑炎、脑室炎、多发性神经根炎或多发性神经根脊髓炎；结核分枝杆菌，可引起脑膜炎或占位性病变；梅毒螺旋体苍白亚种（T. pallidum），在早期神经梅毒中影响脑膜、脑脊液、颅神经和脉管系统，在晚期神经梅毒中还会影响脑和脊髓实质。中枢神经系统巨细胞病毒感染见于免疫抑制非常严重的HIV感染个体。其预后较差，尚未确定最佳治疗方法。结核性脑膜炎在同时感染HIV的患者中死亡率很高，尤其是在发展中世界，迫切需要更好的治疗方法。随着发达国家梅毒发病率的上升，神经梅毒尤其是眼梅毒的报告越来越多。接受强效抗逆转录病毒治疗的个体发生这三种中枢神经系统感染的可能性降低。
