Brunet P, Bolgert F, Pierrot-Deseilligny C
Service de Neurologie, Hôpital de la Salpêtrière, Paris.
Rev Neurol (Paris). 1988;144(5):317-26.
Neurological manifestations of HIV infection are recognised at different phases of the evolution of the disease. During the late stages opportunistic neuro-meningeal infections and tumors develop as a result of the immuno-suppression. There exist, however, various manifestations which evolve independently of the immune state, and seem to be directly related to the virus itself. One can distinguish central neuro-meningeal syndromes and peripheral syndromes at the onset, or at later stages. Their prognostic implications are uncertain, but often severe, for example in the case of the subacute dementias which, in this setting, may lead to death in several months. There are also other manifestations which may be self limited or slowly evolving in the central and peripheral nervous systems. The neuropathological changes are known for the dementias as mentioned above, though the characteristics lesions due to HIV infection per se remain controversial. The presence of the virus in the nervous system has been established by in situ hybridization techniques, immunohistochemistry and culture. Studies on CSF have also allowed virological (cultures) and immunological studies to be carried out. The physiopathological mechanisms for the apparent neurological effects of this virus remain hypothetical. A better understanding of these mechanisms should lead to a rationalisation of therapeutic strategies, in a disorder which would seem to be an early and persisting viral infection of the nervous system.
HIV感染的神经学表现可在疾病演变的不同阶段被识别。在晚期，由于免疫抑制会发生机会性神经脑膜感染和肿瘤。然而，还存在各种与免疫状态无关、似乎直接与病毒本身相关的表现。在发病时或后期，可以区分中枢神经脑膜综合征和周围综合征。它们的预后意义尚不确定，但往往很严重，例如在亚急性痴呆的情况下，在这种情况下可能在几个月内导致死亡。在中枢和周围神经系统中也有其他可能自限或缓慢演变的表现。如上文所述，痴呆的神经病理学变化是已知的，尽管HIV感染本身所致的特征性病变仍存在争议。通过原位杂交技术、免疫组织化学和培养已证实病毒存在于神经系统中。对脑脊液的研究也使得病毒学（培养）和免疫学研究得以开展。这种病毒明显的神经学效应的生理病理机制仍然是假设性的。在这种似乎是神经系统早期持续性病毒感染的疾病中，更好地理解这些机制应该会使治疗策略更加合理。
