无症状脑脊液HIV-1逃生:发生率和后果
Gustaf Ulfhammer1,2, Aylin Yilmaz1,2, Åsa Mellgren1,2
1Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
The Journal of infectious diseases
|November 12, 2024
概括
无症状大脑脊髓液泄漏 (CSFE) 在接受抗逆转录病毒疗法 (ART) 的艾滋病毒感染者中发生了2%. 这种情况与中枢神经系统免疫激活和血脑屏障变化有关,但没有神经元损伤.
科学领域:
- 神经病毒学 神经病毒学
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
背景情况:
- 在接受抗逆转录病毒疗法 (ART) 的艾滋病毒感染者 (PWH) 中,脑脊髓液泄漏 (CSFE) 尚未得到充分理解.
- 无症状CSFE的临床意义需要进一步调查.
研究的目的:
- 确定瑞典艾滋病毒队列中无症状CSFE的发生率和影响.
- 调查无症状的CSFE与中枢神经系统 (CNS) 炎症和损伤的生物标志物之间的关联.
主要方法:
- 长度跟踪神经无症状PWH在ART与抑制病毒载量的治疗.
- CSFE的定义:高的CSFHIV-1RNA与抑制的血病毒载荷或更高的CSF比血HIV-1RNA.
- 对HIV-1RNA,新素,神经丝光蛋白 (NfL),白细胞 (WBC) 计数和白蛋白比率进行对联的CSF和血的分析.
主要成果:
- 在2%的PWH (4/173) 和1%的样本 (5/449) 中检测到无症状的CSFE,使用50拷贝/毫升的切割值.
- 使用20拷贝/毫升的切割值,CSFE在8%的PWH和4%的样本中被发现.
- CSFE样本显示中枢神经液中新素和白蛋白的比例增加,这表明中枢神经系统免疫激活和血脑屏障受损.
- 增加的CSF白细胞计数与CSFE显著相关 (OR 3.9,P = .004).
结论:
- 无症状的CSFE在有效ART的PWH中不常见,没有观察到持续的病例.
- 在ART期间,中枢神经系统HIV-1RNA增加与中枢神经系统免疫激活和血脑屏障功能障碍有关.
- 神经元损伤 (NfL) 的生物标志物与无症状的CSFE无关.
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