Aventura Hospital, Aventura, FL, USA.
Department of Psychiatry and Behavioral Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
Curr Top Behav Neurosci. 2021;50:401-426. doi: 10.1007/7854_2020_131.
This chapter will address the issue of risk for HIV-associated neurocognitive disorder (HAND), focusing on HIV-associated dementia (HAD), among persons living with HIV in relationship to the risk for other dementias. Advances in effective antiretroviral therapy (ART) have led to an increase in the prevalence of older persons surviving with HIV - in addition to older persons who become infected by HIV later in life. Hence, HIV is no longer a disease of younger persons, and additional attention has been brought to bear against the plight of older persons living with HIV - not only as it pertains to treatment but also to prevention. The additional risk caused by aging among older persons living with HIV is complex to asses, and HIV infection is a research area that requires a robust approach to multiple other factors causing neurocognitive impairment with older age. The long-term and potentially neurotoxic exposure to ART and the deleterious consequences of chronic infection with HIV and its associated neuro-inflammation have been described for health. This aids in the understanding of dementia risk factors in this patient population, but the comorbidities (HIV- and non-HIV-associated) occurring among older persons living with HIV must also be addressed to properly assess the overall impact on dementia risk in this group. This need also warrants our examination of the risk factors for other dementias (and comorbid dementias) in persons living with HIV versus the general population through the assessment and quantification of modifiable and non-modifiable risk factors identified as major contributors toward dementia.
这一章将讨论与其他类型痴呆症相关的 HIV 相关神经认知障碍（HAND）风险，重点关注 HIV 相关痴呆（HAD）。有效的抗逆转录病毒疗法（ART）的进步导致了 HIV 感染者中存活的老年人比例增加——除了那些在晚年感染 HIV 的老年人。因此，HIV 不再是年轻人的疾病，人们更加关注感染 HIV 的老年人的困境——不仅涉及治疗，还涉及预防。HIV 感染者中老年人因衰老而增加的额外风险很难评估，而且 HIV 感染是一个需要对导致老年人认知障碍的多种其他因素采取强有力方法的研究领域。长期且潜在神经毒性的 ART 暴露以及慢性 HIV 感染及其相关神经炎症的有害后果已经对健康造成了影响。这有助于理解该患者群体中痴呆症的危险因素，但 HIV 感染者中老年人的合并症（HIV 和非 HIV 相关）也必须得到解决，以正确评估该群体中痴呆症风险的整体影响。这也需要我们通过评估和量化被确定为导致痴呆症的主要因素的可改变和不可改变的危险因素，来检查 HIV 感染者与普通人群中其他类型痴呆症（和合并痴呆症）的危险因素。
