联合抗逆转录病毒治疗(cART)彻底改变了人类免疫缺陷病毒(HIV)的管理,并显着改善了HIV感染者的疾病负担和预期寿命。HIV在感染过程中早期进入中枢神经系统(CNS),建立延迟,并产生可能影响认知功能的促炎环境,即使在cART时代。尽管严重形式的神经认知障碍(NCI)如HIV相关痴呆在过去几十年中有所下降,更温和的形式变得更加普遍,通常是多因素的,并与合并症负担有关,心理健康,cART神经毒性,和衰老。自2007年以来,Frascati标准已用于将HIV相关神经认知障碍(HAND)表征和分类为三个阶段,即无症状性神经认知障碍(ANI),轻度神经认知障碍(MND),和HIV相关性痴呆(HAD)。这些标准基于全面的神经心理学评估,该评估以验证的可用性为前提。人口统计调整,和规范的人口数据。为了补充NCI评估,已经提出了新的神经影像学模式和生物标志物。阐明神经致病机制,并支持与HIV相关的NCI诊断,监测,和预后。通过将神经心理学评估与生物标志物和神经影像学整合到整体护理方法中,临床医生可以提高诊断的准确性,预后,和患者结果。这篇评论询问了这些评估模式的价值,并提出了一种统一的NCI诊断方法。
Combination antiretroviral treatment (cART) has revolutionized the management of human immunodeficiency virus (HIV) and has markedly improved the disease burden and life expectancy of people living with HIV. HIV enters the central nervous system (CNS) early in the course of infection, establishes latency, and produces a pro-inflammatory milieu that may affect cognitive functions, even in the cART era. Whereas severe forms of neurocognitive impairment (NCI) such as HIV-associated dementia have declined over the last decades, milder forms have become more prevalent, are commonly multifactorial, and are associated with comorbidity burdens, mental health, cART neurotoxicity, and ageing. Since 2007, the Frascati criteria have been used to characterize and classify HIV-associated neurocognitive disorders (HAND) into three stages, namely asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). These criteria are based on a comprehensive neuropsychological assessment that presupposes the availability of validated, demographically adjusted, and normative population data. Novel neuroimaging modalities and biomarkers have been proposed in order to complement NCI assessments, elucidate neuropathogenic mechanisms, and support HIV-associated NCI diagnosis, monitoring, and prognosis. By integrating neuropsychological assessments with biomarkers and neuroimaging into a holistic care approach, clinicians can enhance diagnostic accuracy, prognosis, and patient outcomes. This
review interrogates the value of these modes of assessment and proposes a unified approach to NCI diagnosis.