HIV-1在神经腔室耐药的临床意义。

Andrea Antinori, Antonella Cingolani, Maria Letizia Giancola, Federica Forbici, Andrea De Luca, Carlo Federico Perno
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引用次数: 26

摘要

人类免疫缺陷病毒1型(HIV-1)对中枢神经系统(CNS)的倾向在感染过程中早期发展。强有力的抗逆转录病毒疗法已被证明可有效控制HIV-1在脑脊液(CSF)中的复制,尽管已观察到脑脊液与血浆中的反应不同。在脑脊液中发现了不同浓度的抗逆转录病毒药物,并且认为需要使用穿透血脑屏障的抗逆转录病毒药物来控制晚期患者的中枢神经系统感染,特别是那些患有神经系统疾病的患者。HIV-1感染在中枢神经系统中的区室化可能影响治疗反应,这可能导致病毒在两个区室中产生不同的耐药进化。尽管不建议对病毒学失败的患者进行脑脊液HIV-1耐药检测,但神经系统疾病患者的治疗决策可能需要了解脑脊液中病毒的耐药情况。
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Clinical implications of HIV-1 drug resistance in the neurological compartment.

The tropism of human immunodeficiency virus type 1 (HIV-1) for the central nervous system (CNS) develops early during the course of the infection. Potent antiretroviral therapy has been demonstrated to be effective in controlling the replication of HIV-1 in cerebrospinal fluid (CSF), even though a variable response in this compartment compared with that in plasma has been observed. Different concentrations of antiretroviral drugs are found in CSF and the use of antiretroviral drugs penetrating across the blood-brain barrier is considered to be required for controlling CNS infection in advanced patients, particularly in those with neurological disorders. The compartmentalization of HIV-1 infection in the CNS may affect the treatment response, which may cause a different evolution of viral drug resistance in the 2 compartments. Although HIV-1 resistance testing in CSF is not recommended for the routine management of patients with virological failure, treatment decisions in patients with neurological disorders may require knowledge of the resistance profile of the virus in the CSF.

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