HIV相关神经认知紊乱的临床研究进展

Progresses in HIV-associated neurocognitive disorder

艾滋病病毒(HIV)相关的神经认知紊乱(HAND),是由HIV感染引起的原发性中枢神经系统损伤,已成为HIV感染者重要的慢性中枢神经系统并发症,对其生活和工作造成巨大影响。依据神经认知功能损伤程度,HAND分为无症状性神经认知损害、轻度神经认知紊乱和HIV相关痴呆症。现行的HAND诊断标准采用的是自我报告的主观评价法,依赖神经心理学测试评估神经认知损伤的严重程度,难以准确对HAND诊断和分类,尚需发现更多客观的生物标志物来辅助诊断。目前,在HAND诊断和疗效评估上,外周血、脑脊液的生物标志物以及新的影像学技术具有重要的临床应用潜力。在HAND的治疗方面,虽然联合抗反转录病毒治疗的使用,降低了中枢神经系统机会性感染和HAND最严重临床类型HIV相关痴呆症的发病率,但无法完全改善病人的神经认知表现,轻型的HAND的发病率却在提高。针对HAND发病机制下游环节辅助治疗正在研究中。

HIV-associated neurocognitive disorder （HAND） is a primary neurocognitive impairment caused by HIV infection. In the combined antiretroviral therapy （cART） era, HAND has become a feared complication of HIV infection and has a significant impact on patients＇ quality of life. A consensus definition of HAND includes the cate- gories as HIV-associated dementia, mild neurocognitive disorder, and asymptomatic neuroeognitive impairment. In practice, assessment of neuroeognitive impairment is challenging and probably imprecise. Self-reporting has been used but is a subjective approach. Moreover, both diagnosis and monitoring have relied heavily on ncuropsychometric performance testing, which is not sensitive and specific for the detection of milder forms of neurocognitive impair- ment. Severat biological markers are evaluated for potential clinical use. Neuroimaging techniques are continuing to develop and might have increased usefulness in the diagnosis and management of HAND. The introduction of cART has dramatically reduced the risk of central nervous system opportunistic infection and severe HAND. However, since cART probably can＇t improve neurocognitive performance, milder forms of HAND remain prevalent in the cART era, and several adjuvant strategies based on potential downstream pathological mechanisms have also been considered.