Department of Neurology, University of New South Wales, University of Notre Dame, Sydney, Australia.
Department of Neurology, HIV Medicine, Neurosciences Program, Peter Duncan Neurosciences Unit, St Vincent's Hospital, St Vincent's Centre for Applied Medical Research, University of New South Wales, University of Notre Dame, Level 4 Xavier Building, Victoria Street, Darlinghurst, Sydney, Australia.
Neurol Clin. 2018 Nov;36(4):751-765. doi: 10.1016/j.ncl.2018.07.002.
In the era of combination antiretroviral therapy, the diagnosis and management of HIV-associated neurocognitive disorders (HANDs) has arisen. Traditionally, severe HAND was seen in those with untreated HIV infection and had a guarded prognosis. Antiretroviral therapy has provided longevity and viral control to many living with the disease, revealing an increase in prevalence of less severe forms of HAND. Despite peripheral blood and cerebrospinal fluid viral suppression, cognitive impairment occurs and progresses for reasons that are unclear at present. This article provides a review of current theories behind the development of HAND, clinical and pathologic findings, recent developments, and future research opportunities.
在联合抗逆转录病毒疗法时代，出现了与 HIV 相关的神经认知障碍（HAND）的诊断和管理。传统上，未经治疗的 HIV 感染者会出现严重的 HAND，预后不佳。抗逆转录病毒疗法为许多患者提供了长寿和病毒控制，揭示了HAND 较不严重形式的患病率增加。尽管外周血和脑脊液中的病毒得到了抑制，但认知障碍仍会发生并进展，目前原因尚不清楚。本文综述了 HAND 发病机制的现有理论、临床和病理发现、最新进展以及未来的研究机会。
