Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
J Neurol. 2023 Mar;270(3):1337-1345. doi: 10.1007/s00415-022-11503-2. Epub 2022 Dec 2.
In the 1980s, after the HIV pandemic was recognised, neuropathology identified cerebral white matter lesions that were found in the brains of infected persons with a severe irreversible dementia syndrome, this became known as 'HIV encephalitis'. Subsequent work in Europe and north America found subtle morphological abnormalities in cerebral neurones and their connections. With the advent of effective anti-retroviral therapies after 1996, the incidence of severe HIV-related dementia declined, as did investigative tissue pathology into this HIV brain disease. Currently, the intense interest over HIV neurocognitive impairment focuses on neuroimaging, comparative blood and cerebrospinal fluid analysis, viral subtype analysis, and the search for biomarkers that correlate with brain function. Tissue neuropathology in HIV is more restricted to the diagnosis of acute disease such as opportunistic infections and tumours, and confirmation of the acute CD8 + T-cell encephalitis syndrome. But correlative tissue pathology will still be needed as newer therapeutic measures are developed to prevent and manage chronic HIV brain impairment.
20 世纪 80 年代，艾滋病毒大流行被确认后，神经病理学发现了感染艾滋病毒的人脑部存在大脑白质病变，这种病变被称为“HIV 脑炎”。随后在欧洲和北美开展的工作发现了大脑神经元及其连接的微妙形态异常。1996 年后，随着有效的抗逆转录病毒疗法的出现，严重的与 HIV 相关的痴呆发病率下降，对这种 HIV 脑部疾病的组织病理学研究也随之减少。目前，人们对 HIV 认知神经功能障碍的强烈兴趣集中在神经影像学、比较血液和脑脊液分析、病毒亚型分析以及寻找与大脑功能相关的生物标志物上。HIV 相关的组织病理学更局限于诊断急性疾病，如机会性感染和肿瘤，以及急性 CD8+T 细胞脑炎综合征的确诊。但是，随着开发出预防和管理慢性 HIV 脑损伤的新治疗措施，仍然需要进行相关性组织病理学研究。
