Диагностические подходы при нетипичном (неврологическом) дебюте ВИЧ-инфекции
НЕВРОЛОГИЯ И СМЕЖНЫЕ МЕДИЦИНСКИЕ СПЕЦИАЛЬНОСТИ
Дата публикации: апреля 2, 2015
Ключевые слова
синдром приобретенного иммунодефицита
вирус иммунодефицита человека
неврологический дебют
acquired immunodeficiency syndrome
human immunodeficiency virus
neurological debut
вирус иммунодефицита человека
неврологический дебют
acquired immunodeficiency syndrome
human immunodeficiency virus
neurological debut
Как цитировать
[1]
Е. Безрукова, Диагностические подходы при нетипичном (неврологическом) дебюте ВИЧ-инфекции, КМКВ, вып. 4, апр. 2015.
Аннотация
В 10–20% случаев синдрома приобретенного иммунодефицита неврологические расстройства бывают первы-ми проявлениями заболевания. Нередко неврологические расстройства у иммунокомпетентных пациентов не связа-ны с вирусом иммунодефицита человека (ВИЧ), достоверная связь обнаружена только с энцефалопатией и вакуоль-ной миелопатией, поэтому анализ всех случаев инфицирования ВИЧ, дебютирующих расстройствами со сторонынервной системы, очень сложен, неврологическое обследование должно сочетаться с определением антител к ВИЧ.В случаях положительного ответа выявленная неврологическая симптоматика учитывается как первое клиническоепроявление данного заболевания. Описаны 3 клинических наблюдения диагностики и лечения пациентов с атипич-ным неврологическим дебютом ВИЧ-инфекции в неврологическом отделении №1 ФГБУ «Центральная клиническаябольница» УД Президента РФ.In 10–20% of cases neurological disorders are the primary manifestations of the acquired immunodeficiency syndrome. Not infrequently, neurological disorders in immunocompetent patients are not associated with the human immunodeficiencyvirus. A reliable association has been revealed only for encephalopathies and vacuolar myelopathy. That is why to analyzeall cases of infectioning with the human immunodeficiency virus which have a neurologic debut is a complicated task and, insuch cases neurological examination must be accompanied by revealing antibodies to the human immunodeficiency virus. Incase of a positive response the observed neurological symptoms should be considered as a primary clinical manifestationof the discussed disease. For the last year, three patients with the atypical neurological HIV debut were hospitalized intothe neurological department No 1 of the Central Clinical Hospital subordinate to the Affair Management Department of thePresident of Russian Federation.Литература
1. Бобкова М.Р. Иммунитет и ВИЧ-инфекция. М.:
Олимпия-пресс, 2006.
2. Малашхия Ю.А., Надареишвили З.Г., Малашхия
Н.Ю., Малашхия В.Ю. Мозг как орган иммунитета. Жур-
нал неврологии и психиатрии. 1999; 9: 62–65.
3. Покровский В.В., Ермак Т.Н., Беляева В.В., Юрин
О.Г. ВИЧ-инфекция: клиника, диагностика и лечение. М.:
Медицина, 2000.
4. Штульман Д.Р., Левин О.С. Неврология: Справоч-
ник практического врача. 2-е изд., перераб. и доп. М.:
МЕДпресс-информ, 2002.
5. Bagasra O., Lavi E., Bobroski L. et al. Cellular reservoirs
of HIV-1 in the central nervous system of infected individuals:
identification by the combination of in situ polymerase chain
reaction and immunohistochemistry. AIDS (London, England).
1996; 10 (6): 573–585.
6. Bos M.M., Overeem S., Engelen B.G. et al. A case of
neuromuscular mimicry. Neuromuscul Disord. 2006; 16: 510–
513.
7. Byrd D.A., Robinson-Papp J., Mindt M.R. et al.
Manhattan HIV Brain Bank. Isolating Cognitive and Neurologic
HIV Effects in Substance-Dependent, Confounded Cohorts: A
Pilot Study. J. Int. Neuropsychol. Soc. 2013; 19 (4): 463–473.
8. Herrero D., Gallo P.R., Fujimori M., de Mello Monteiro
C.B. Motor development of infants exposed to maternal human
immunodeficiency virus (HIV) but not infected. Int. Arch. Med.
2013; 316 (1): 45.
9. HIV-related neuromuscular diseases: nemaline
myopathy, amyotrophic lateral sclerosis and bibrachial
amyotrophic diplegia. Acta Myol. 2011; 30 (1): 29–31. Review.
10. Hoffman P.M., Festoff B.W., Giron L.T. Jr. et al.
Isolation of LAV/ HTLV-III from a patient with amyotrophic
lateral sclerosis. N. Engl. J. Med. 1985; 313: 324–325.
11. Janssen R.S., Cornblath D.R., Epstein L.G., Foa R.P.
Nomenclature and research case definitions for neurologic
manifestations of human immunodeficiency virus-type 1 (HIV-
1) infection. — Report of a working group of the American
Academy of Neurology AIDS task force. Neurology. 1991; 41:
778–785.
12. Merritt В., Gahagan J., Kottorp A. HIV and disability:
a pilot study exploring the use of the Assessment of Motor and
Process Skills to measure daily life performance. J. Int. AIDS
Soc. 2013; 16 (1): 17339.
13. Meybeck A., Fortin С., Abgrall S. et all. Spondylitis Due
to Mycobacterium xenopi in a human immunodeficiency virus
type 1-infected patient: case report and review of the literature.
J. Clin. Microbiol. 2005; 43 (3): 1465–1466.
14. Robinson-Papp J., Byrd D., Rivera Mindt M. et
al. Manhattan HIV Brain Bank. Motor function and HIVassociated
cognitive impairment in a HAART era cohort. Arch.
Neurol. 2008; 65 (8): 1096–1101.
15. Sher J.H., Wrzolek M.A., Schmuter Z.B. Motor neuron
disease associated with AIDS. J. Neuropathol. Exp. Neurol.
1988; 407: 303–303.
16. Siewe J., Oppermann J., Eysel P. et al. Diagnosis and
treatment of spondylodiscitis in HIV-positive patients. Acta
Orthop. Belg. 2013; 79 (5): 475–482.
17. Singh K.K., Nathamu S., Adame A. , Alire T.U.,
Dumaop W., Gouaux B., Moore D.J., Masliah et all. and
HIV Neurobehavioral Research Center Group. Expression of
mannose binding lectin in HIV-1-infected brain: implications
for HIV-related neuronal damage and neuroAIDS . Neurobehav
HIV Med. 2011; 3: 41–52.
18. Sobottke R., Zarghooni K., Krengel M. et al. Treatment
of spondylodiscitis in human immunodeficiency virus-infected
patients: a comparison of conservative and operative therapy.
Spine. 2009; 34 (13): 452–458.
19. Soyka M., Lieb M., Kagerer S. et al. Cognitive
functioning during methadone and buprenorphine treatment:
Results of a randomized clinical trial. J. Clin. Psychopharmacol.
2008; 28 (6): 699–703.
20. Verma A., Berger J.R. ALS syndrome in patients with
HIV-1 infection. J. Neurol. Sci. 2006; 240: 59–64.
21. Yeung M., Bhalla A., Birns J. Recreational drug misuse
and stroke. Curr. Drug. Abuse Reviews. 2011; 4 (4): 286–291.
Олимпия-пресс, 2006.
2. Малашхия Ю.А., Надареишвили З.Г., Малашхия
Н.Ю., Малашхия В.Ю. Мозг как орган иммунитета. Жур-
нал неврологии и психиатрии. 1999; 9: 62–65.
3. Покровский В.В., Ермак Т.Н., Беляева В.В., Юрин
О.Г. ВИЧ-инфекция: клиника, диагностика и лечение. М.:
Медицина, 2000.
4. Штульман Д.Р., Левин О.С. Неврология: Справоч-
ник практического врача. 2-е изд., перераб. и доп. М.:
МЕДпресс-информ, 2002.
5. Bagasra O., Lavi E., Bobroski L. et al. Cellular reservoirs
of HIV-1 in the central nervous system of infected individuals:
identification by the combination of in situ polymerase chain
reaction and immunohistochemistry. AIDS (London, England).
1996; 10 (6): 573–585.
6. Bos M.M., Overeem S., Engelen B.G. et al. A case of
neuromuscular mimicry. Neuromuscul Disord. 2006; 16: 510–
513.
7. Byrd D.A., Robinson-Papp J., Mindt M.R. et al.
Manhattan HIV Brain Bank. Isolating Cognitive and Neurologic
HIV Effects in Substance-Dependent, Confounded Cohorts: A
Pilot Study. J. Int. Neuropsychol. Soc. 2013; 19 (4): 463–473.
8. Herrero D., Gallo P.R., Fujimori M., de Mello Monteiro
C.B. Motor development of infants exposed to maternal human
immunodeficiency virus (HIV) but not infected. Int. Arch. Med.
2013; 316 (1): 45.
9. HIV-related neuromuscular diseases: nemaline
myopathy, amyotrophic lateral sclerosis and bibrachial
amyotrophic diplegia. Acta Myol. 2011; 30 (1): 29–31. Review.
10. Hoffman P.M., Festoff B.W., Giron L.T. Jr. et al.
Isolation of LAV/ HTLV-III from a patient with amyotrophic
lateral sclerosis. N. Engl. J. Med. 1985; 313: 324–325.
11. Janssen R.S., Cornblath D.R., Epstein L.G., Foa R.P.
Nomenclature and research case definitions for neurologic
manifestations of human immunodeficiency virus-type 1 (HIV-
1) infection. — Report of a working group of the American
Academy of Neurology AIDS task force. Neurology. 1991; 41:
778–785.
12. Merritt В., Gahagan J., Kottorp A. HIV and disability:
a pilot study exploring the use of the Assessment of Motor and
Process Skills to measure daily life performance. J. Int. AIDS
Soc. 2013; 16 (1): 17339.
13. Meybeck A., Fortin С., Abgrall S. et all. Spondylitis Due
to Mycobacterium xenopi in a human immunodeficiency virus
type 1-infected patient: case report and review of the literature.
J. Clin. Microbiol. 2005; 43 (3): 1465–1466.
14. Robinson-Papp J., Byrd D., Rivera Mindt M. et
al. Manhattan HIV Brain Bank. Motor function and HIVassociated
cognitive impairment in a HAART era cohort. Arch.
Neurol. 2008; 65 (8): 1096–1101.
15. Sher J.H., Wrzolek M.A., Schmuter Z.B. Motor neuron
disease associated with AIDS. J. Neuropathol. Exp. Neurol.
1988; 407: 303–303.
16. Siewe J., Oppermann J., Eysel P. et al. Diagnosis and
treatment of spondylodiscitis in HIV-positive patients. Acta
Orthop. Belg. 2013; 79 (5): 475–482.
17. Singh K.K., Nathamu S., Adame A. , Alire T.U.,
Dumaop W., Gouaux B., Moore D.J., Masliah et all. and
HIV Neurobehavioral Research Center Group. Expression of
mannose binding lectin in HIV-1-infected brain: implications
for HIV-related neuronal damage and neuroAIDS . Neurobehav
HIV Med. 2011; 3: 41–52.
18. Sobottke R., Zarghooni K., Krengel M. et al. Treatment
of spondylodiscitis in human immunodeficiency virus-infected
patients: a comparison of conservative and operative therapy.
Spine. 2009; 34 (13): 452–458.
19. Soyka M., Lieb M., Kagerer S. et al. Cognitive
functioning during methadone and buprenorphine treatment:
Results of a randomized clinical trial. J. Clin. Psychopharmacol.
2008; 28 (6): 699–703.
20. Verma A., Berger J.R. ALS syndrome in patients with
HIV-1 infection. J. Neurol. Sci. 2006; 240: 59–64.
21. Yeung M., Bhalla A., Birns J. Recreational drug misuse
and stroke. Curr. Drug. Abuse Reviews. 2011; 4 (4): 286–291.