HIV相关神经认知功能障碍的发病机制及诊断研究进展

Advances of pathogenesis and diagnosis in HIV-associated neurocognitive disorder

艾滋病病毒(HIV)可以通过血脑屏障进入中枢神经系统,导致HIV相关神经认知功能障碍(HAND),主要发病机制有HIV蛋白如gp120、Tat、Nef和Vpr的直接神经毒性和间接神经毒性-神经系统炎症,HIV诱导的代谢变化,中枢系统内病毒逃逸,衰老和抗反转录病毒药物的神经毒性。HAND的诊断主要根据神经心理测验的评估,诊断标准包括:Frascati标准、Gisslén标准和DSM-5标准;筛查测试包括:艾滋病病毒痴呆量表、Cogstate测验、蒙特利尔认知评估以及简易精神状态检查等,本文对HAND发病机制和诊断进展进行全面综述。

HIV can enter the central nervous system through blood-brain barrier, resulting in HIV-related neurocognitive impairment(HAND). Pathogenesis includes direct neurotoxicity of HIV proteins such as gp120, Tat, Nef and Vpr, indirect neurotoxicity-neuroinflammation, HIV-induced metabolic changes, virus escape, aging and neurotoxicity of combined anti-retroviral therapy. The diagnosis of HAND is mainly based on the evaluation of neuropsychological tests. Diagnostic criteria include Frascati, Gisslén and DSM-5. Screening tests include HIV dementia scale, Cogstate procedure, Montreal cognitive assessment and simple mental state examination. This article reviews the pathogenesis and diagnosis of HAND.