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Optimal treatment of HIV-associated neurocognitive disorders: myths and reality. A critical review

机译：艾滋病毒相关神经认知障碍的最佳治疗：神话与现实。批判性评审

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The aim of this study was to review the clinical data on the effectiveness of the pharmacotherapy of HIV-associated neurocognitive disorders (HANDs). A literature search of PubMed was performed (from January 1996 to October 2018) using the terms: 'HIV-associated neurocognitive disorders', 'HIV-associated dementia', 'mild neurocognitive disorder (MND)', 'asymptomatic neurocognitive impairment (ANI)', 'adjuvant therapies', 'antiretroviral treatment (cART)', 'neurotoxicity', 'cART intensification', 'fluid markers', 'cerebrospinal fluid', 'protease inhibitors', 'nonnucleoside reverse transcriptase inhibitor', 'nucleoside reverse transcriptase inhibitors', and 'integrase strand transfer inhibitors'. Additional references were identified from a review of literature citations. All English language clinical studies of adjunctive therapies and neuronal markers were selected in order to evaluate a closer relationship between the early involvement and the onset of cognitive decline. We identified 407 relevant studies, of which 248 were excluded based on abstract analysis. Finally, we analyzed 35 articles, organizing the results by cART, adjuvant and neuronal markers (total of 7716 participants). It is important to inform clinicians about the importance of accurate phenotyping of HIV patients, incorporating an array of markers relevant to HAND pathophysiology, in order to assess the individual's risk and potential response to future personalized antiretroviral treatment. So far, no clinical trials of HAND therapies are effective beyond optimal suppression of HIV replication in the central nervous system. Combination of validated neuronal markers should be used to distinguish between milder HAND subtypes and improve efficiency of clinical trials, after strict control of confounders.
机译：本研究的目的是审查艾滋病毒相关神经认知障碍药物治疗的临床数据（手）。使用条款（1996年1月至2018年10月）使用条款：“艾滋病毒相关神经认知疾病”，“艾滋病毒相关性痴呆”，“轻度神经认知障碍（MND）”，“无症状神经认知障碍（ANI）进行了文献搜索” '，'佐剂疗法'，'抗逆转录病毒治疗（推车）'，'神经毒性'，'推车强化'，'液体标志物'，'脑脊液'，'脑脊液'，'蛋白酶抑制剂'，'蛋白酶抑制剂'，'inn核苷逆转录酶抑制剂'，'核苷逆转录酶'核苷逆转录酶抑制剂'和'整合酶链转移抑制剂'。从文献引用的审查中确定了其他参考文献。选择了辅助疗法和神经元标记的所有英语语言临床研究，以评估早期参与和认知下降发作之间的更紧密关系。我们确定了407项相关研究，其中348基于抽象分析排除。最后，我们分析了35篇文章，通过推车，佐剂和神经元标志物组织结果（共7716名参与者）。重要的是向临床医生通知临床医生对HIV患者的准确表型表现的重要性，其中包含与手势病理生理学相关的标记阵列，以评估个人的风险和对未来个性化抗逆转录病毒治疗的潜在应对。到目前为止，没有临床试验的手疗法是有效的，超越了中枢神经系统中HIV复制的最佳抑制。经过验证的神经元标志物的组合应用于区分较温和的手亚型，并在严格控制混凝剂后提高临床试验的效率。

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