Wang Yanli, Yang Jun, Wen Ying
Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
Neurology Department, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
J Clin Med. 2023 Jan 23;12(3):907. doi: 10.3390/jcm12030907.
Guillain-Barré syndrome (GBS) can occur at all stages of human immunodeficiency virus (HIV) infection. HIV, cytomegalovirus (CMV), and varicella zoster virus (VZV) are the main infectious agents in HIV-positive GBS cases. These cases include acute and chronic HIV infection, immune reconstitution inflammatory syndrome (IRIS) shortly after anti-retroviral therapy (ART), those with ART interruption, or those with cerebrospinal fluids (CSF) HIV escape. The mechanisms are involved in both humoral and cellular immunities. Demyelinating and axonal neuropathies are the main pathological mechanisms in GBS. Presentation and prognosis are identical to those in patients without HIV infection. Typical or atypical clinical manifestations, CSF analysis, electrophysiological and pathological examination, and antiganglioside antibody detection can help diagnose GBS and classify its various subtypes. Intravenous immunoglobulin and plasma exchange have been used to treat GBS in HIV-positive patients with a necessary ART, while ganciclovir or foscarnet sodium should be used to treat ongoing CMV- or VZV-associated GBS. Steroids may be beneficial for patients with IRIS-related GBS. We reviewed HIV-positive cases with GBS published since 2000 and summarized their features to highlight the necessity of HIV testing among patients with GBS. Moreover, the establishment of a multidisciplinary team will guarantee diagnostic and therapeutic advantages.
吉兰-巴雷综合征（GBS）可发生于人类免疫缺陷病毒（HIV）感染的各个阶段。HIV、巨细胞病毒（CMV）和水痘带状疱疹病毒（VZV）是HIV阳性GBS病例中的主要感染病原体。这些病例包括急性和慢性HIV感染、抗逆转录病毒治疗（ART）后不久出现的免疫重建炎症综合征（IRIS）、ART中断者或脑脊液（CSF）HIV逃逸者。其机制涉及体液免疫和细胞免疫。脱髓鞘性和轴索性神经病是GBS的主要病理机制。其临床表现和预后与未感染HIV的患者相同。典型或非典型临床表现、CSF分析、电生理和病理检查以及抗神经节苷脂抗体检测有助于诊断GBS并对其各种亚型进行分类。静脉注射免疫球蛋白和血浆置换已被用于在进行必要ART的HIV阳性患者中治疗GBS，而更昔洛韦或膦甲酸钠应被用于治疗正在发生的与CMV或VZV相关的GBS。类固醇可能对与IRIS相关的GBS患者有益。我们回顾了自2000年以来发表的HIV阳性GBS病例并总结了其特征，以强调GBS患者进行HIV检测的必要性。此外，建立多学科团队将确保诊断和治疗优势。
