Developments in Neuroprotection for HIV-Associated Neurocognitive Disorders (HAND).

IF 3.7 2区医学 Q2 INFECTIOUS DISEASES

Current HIV/AIDS Reports Pub Date : 2022-10-01 Epub Date: 2022-07-22 DOI:10.1007/s11904-022-00612-2

Dennis L Kolson

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Abstract

Purpose of review: Reducing the risk of HIV-associated neurocognitive disorders (HAND) is an elusive treatment goal for people living with HIV. Combination antiretroviral therapy (cART) has reduced the prevalence of HIV-associated dementia, but milder, disabling HAND is an unmet challenge. As newer cART regimens that more consistently suppress central nervous system (CNS) HIV replication are developed, the testing of adjunctive neuroprotective therapies must accelerate.

Recent findings: Successes in modifying cART regimens for CNS efficacy (penetrance, chemokine receptor targeting) and delivery (nanoformulations) in pilot studies suggest that improving cART neuroprotection and reducing HAND risk is achievable. Additionally, drugs currently used in neuroinflammatory, neuropsychiatric, and metabolic disorders show promise as adjuncts to cART, likely by broadly targeting neuroinflammation, oxidative stress, aerobic metabolism, and/or neurotransmitter metabolism. Adjunctive cognitive brain therapy and aerobic exercise may provide additional efficacy. Adjunctive neuroprotective therapies, including available FDA-approved drugs, cognitive therapy, and aerobic exercise combined with improved cART offer plausible strategies for optimizing the prevention and treatment of HAND.

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艾滋病相关神经认知障碍 (HAND) 的神经保护进展。

综述的目的：降低 HIV 相关神经认知障碍（HAND）的风险是 HIV 感染者难以实现的治疗目标。抗逆转录病毒联合疗法（cART）降低了艾滋病相关痴呆症的发病率，但较轻的、致残性 HAND 仍是一个尚未解决的难题。随着能更稳定地抑制中枢神经系统（CNS）HIV复制的新型cART疗法的开发，必须加快对辅助性神经保护疗法的测试：在试点研究中，针对中枢神经系统疗效（渗透性、趋化因子受体靶向性）和给药方式（纳米制剂）修改 cART 方案的成功表明，改善 cART 神经保护和降低 HAND 风险是可以实现的。此外，目前用于治疗神经炎症、神经精神和代谢性疾病的药物有望成为 cART 的辅助药物，这些药物可能广泛针对神经炎症、氧化应激、有氧代谢和/或神经递质代谢。辅助性脑认知疗法和有氧运动可能会带来更多疗效。辅助性神经保护疗法，包括现有的经 FDA 批准的药物、认知疗法和有氧运动，结合改进的 cART，为优化手足口病的预防和治疗提供了可行的策略。

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来源期刊

Current HIV/AIDS Reports INFECTIOUS DISEASES-

CiteScore

8.10

自引率

2.20%

发文量

期刊介绍： This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of HIV/AIDS. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antiretroviral therapies, behavioral aspects of management, and metabolic complications and comorbidity. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.