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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。
The HIV-associated neurocognitive disorder (HAND), a primary central nervous system injury caused by HIV infection, has become an important chronic central nervous system complication of HIV infection and has caused a huge impact on their lives and work influences. According to the degree of neurocognitive impairment, HAND is divided into asymptomatic neurocognitive impairment, mild neurocognitive disorder and HIV-related dementia. The current diagnostic criteria for HAND use a self-report subjective assessment method. Relying on neuropsychological tests to assess the severity of neurocognitive impairment, it is difficult to accurately diagnose and classify HAND. More objective biomarkers need to be found to aid in the diagnosis . At present, peripheral blood and cerebrospinal fluid biomarkers and new imaging techniques have important clinical application potential in the diagnosis and evaluation of HAND. Although the use of combination antiretroviral therapy in the treatment of HAND reduces the incidence of opportunistic infections of the central nervous system and HIV-related dementia, the most clinically significant form of HAND, it does not completely improve the patient’s neurocognitive performance, The incidence of light HAND is rising. Downstream adjuvant therapy for HAND pathogenesis is under study.