联合性抗逆转录病毒治疗可减轻HIV/AIDS晚期患者中枢神经系统感染

作     者：McArthur J.C. McDermott M.P. McClernon D. 王英鹏 

作者机构：Department of Neurology Johns Hopkins Univ. Sch. of Medici ne 600 N Wolfe St Baltimore MD 21287-7609 United States Dr. 

出 版 物：《世界核心医学期刊文摘（神经病学分册）》 (Digest of the World Core Medical Journals:Clinical Neurology)

年 卷 期：2005年第1卷第3期

页      面：20-21页

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 100401[医学-流行病与卫生统计学] 10[医学] 

主　　题：HIV/AIDS 细胞计数 联合性 神经病学 队列研究 基线水平 轻度认知障碍 免疫激活 肿瘤坏死因子α 神经功能状态 

摘      要：Background: Before the introduction of combination antiretroviral therapy (CAR T), neurological disease correlated with cerebrospinal fluid (CSF) levels of hum an immunodeficiency virus (HIV) RNA. Objective: To investigate the relationships among HIV RNA levels, immune activation markers, and neurological status in pat ients receiving CART. Design: Multicenter cohort study. Setting: Academic neurol ogy departments. Patients: A total of 371 patients unselected for neurological c omplaints and with CD4 cell counts less than 200/μL or with cognitive symptoms and CD4 cell counts less than 300/μL were enrolled into the Northeastern AIDS D ementia cohort in 1998-2002. Diagnoses of HIV associated dementia (HIV D) and minor cognitive motor disorder (MCMD) were obtained with a computerized algori thm. Plasma and CSF levels of HIV RNA, monocyte chemotactic protein 1, macrophag e colony stimulat ing factor, and tumor necrosis factor αwere quantified. Res ults: The mean±SD age was 41.5±7.2 years, and the mean±SD educational level w as 12.3±2.2 years. Seventy percent of the cohort was black, and 30%were women. The mean±SD CD4 cell count was 136.8±87.9/μL, and CART was used in 71%. Twe nty nine percent of the patients were unimpaired (n=106) , 36%had MCMD (n= 13 3), and 35%had HIV D (n=128). Mean log10 CSF HIV RNA copies per milliliter was 2.6±0.8, with no differences among the neurological groups, even after adjustm ents for baseline CD4 cell counts and antiretroviral therapy. Cerebrospinal flui d HIV RNA was undetectable in 47%of unimpaired, 46%of MCMD, and 43%of HIV D patients (P=.91). Plasma levels of monocyte chemotactic protein type 1 and tumor necrosis factor αcorrelated weakly with HIV RNA levels but did not distinguish those with neurological deficits. Conclusions: In contrast to observations in i ndividuals not treated with CART, we found no relationship between CSF markers a nd neurological status in this CART using cohort with advanced HIV/AIDS. This w as not explicab