脑卒中和艾滋病毒:在不断变化的流行病中,新出现的机制和管理
Tiwonge E Phiri1, Kathryn B Holroyd2, Shannon A Bernard Healey3,4
1Kamuzu University of Health Sciences, Blantyre, Malawi.
概括
对于艾滋病毒感染者 (PLWH) 来说,中风是越来越令人担忧的,即使有有效的抗逆转录病毒疗法 (ART). 了解其原因,诊断和管理对于改善这一群体的结果至关重要.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
背景情况:
- 脑卒中是艾滋病毒感染者 (PLWH) 疾病和死亡的重要原因.
- 尽管抗逆转录病毒疗法 (ART) 取得了进展,但脑血管并发症仍然存在,并且在PLWH中经常被忽视.
- 与艾滋病毒相关的中风由于多因素原因和加速血管风险而带来了独特的挑战.
研究的目的:
- 审查PLWH中关于中风的当前知识.
- 总结病变发生,临床特征,诊断方法和治疗策略.
- 确定与艾滋病毒相关的中风的研究缺口和未来研究重点.
主要方法:
- 关于艾滋病毒相关中风的当前文献的综述.
- 分析多因素机制,包括艾滋病毒相关的血管病变,机会性感染,IRIS和加速的传统风险因素.
- 讨论诊断方法,包括标准成像,脑脊液分析和先进的血管壁成像.
- 评估治疗可行性,包括再注射疗法,以及影响结果的因素.
主要成果:
- 在PLWH中,中风是多因素的,涉及血管病变,感染,IRIS和加速血管风险.
- 临床表现可以模仿HIV阴性个体的中风,但发生在较年轻的年龄,具有明显的特征.
- 调查需要一个分层的方法,虽然再注射疗法可能是可行的,但证据有限.
- 结果受到免疫状况,获得护理,并发症以及耻辱和意识差距等挑战的影响.
结论:
- 在PLWH中,中风是一个新兴的全球健康问题,需要高度临床怀疑,特别是在年轻的患者或晚期艾滋病毒或最近开始ART的患者中.
- 多学科护理,平等获得诊断和二次预防至关重要.
- 需要对血管病,IRIS,小血管疾病和认知结果进行进一步的研究,以告知基于证据的管理.
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