Missouri Institute of Mental Health, St. Louis, MO, USA.
Curr Top Behav Neurosci. 2021;50:245-269. doi: 10.1007/7854_2020_185.
People living with HIV (PLWH) residing in high-income countries (HICs) are, in theory, well positioned to benefit from clinical care strategies that predict optimal neurocognitive and neuropsychiatric outcomes. However, there is substantial inter-individual variability in access to clinical care, prevalence of co-occurring risk factors, and comorbid health conditions that represent barriers to achieving the full potential of antiretroviral therapy (ART). Complex interactions between these variables translate into heterogeneity in HIV clinical phenotypes, including abnormalities in brain structure and function. The growing population of PLWH in HICs who are now reaching advanced age introduces additional causal pathways of neurocognitive variability among PLWH receiving ART. These patterns foreshadow trends expected to develop globally in response to increased access to ART. This chapter reviews the combination of highly dimensional risk factors for neurocognitive complications among PLWH residing in HICs. We begin with a brief description of the neuropathological, neuroimaging, and neurocognitive signatures of HIV, followed by a summary of controversies regarding the clinical presentation of HIV-associated neurocognitive disorders (HAND), including putative synergies between HIV disease dynamics and advanced age. Finally, we introduce innovative research strategies that have potential to advance the existing conceptual framework of HAND and, ideally, catalyze the development and of clinical interventions needed to achieve HIV treatment and eradication efforts.
生活在高收入国家（HICs）的艾滋病毒感染者（PLWH）理论上处于有利地位，可以从预测最佳神经认知和神经精神结局的临床护理策略中获益。然而，在获得临床护理、共存风险因素的普遍性以及代表实现抗逆转录病毒治疗（ART）全部潜力的障碍的共病健康状况方面，个体之间存在很大的差异。这些变量之间的复杂相互作用转化为 HIV 临床表型的异质性，包括大脑结构和功能的异常。现在已经达到老年的 HICs 中的 PLWH 人数不断增加，这为接受 ART 的 PLWH 中的神经认知变异性引入了额外的因果途径。这些模式预示着全球范围内由于更多地获得 ART 而出现的趋势。本章综述了居住在 HICs 的 PLWH 中神经认知并发症的高度多维风险因素的组合。我们首先简要描述了 HIV 的神经病理学、神经影像学和神经认知特征，然后总结了关于 HIV 相关认知障碍（HAND）临床表现的争议，包括 HIV 疾病动态和老年之间的潜在协同作用。最后，我们介绍了具有潜在推进 HAND 现有概念框架并理想地促进开发治疗和根除 HIV 所需的临床干预措施的创新研究策略。
