The Neurology of AIDS
http://www.100md.com
《新英格兰医药杂志》
Neurologic disorders in AIDS have been numerous, diverse, common, and prominent from the time the human immunodeficiency virus (HIV) emerged more than two decades ago. These disorders have changed steadily as infection with HIV has been transformed by potent antiretroviral therapy into a manageable chronic condition. The potential of the brain as a sanctuary for HIV gives AIDS neurology special importance in the eventual eradication of the disease. Large populations worldwide continue to have the intense neurologic complications of AIDS that were seen at the beginning of the epidemic. Keeping abreast of this field is a challenge even for clinicians who specialize in HIV-related disorders.
This large book, in small print, offers a wealth of up-to-date information on the myriad neurologic disorders associated with HIV infection. It was written by 156 contributors; most are from the United States, a few are from Europe and Australia, and many of them are leaders in the field. The bulk of the book is devoted to the complex, changing, often elusive, intertwining immunologic and neurobiologic mechanisms that underlie HIV-associated cognitive disturbances. This topic, presented in exhaustive detail, includes insights and factual information about fundamental molecular mechanisms derived from human disease and from simian, feline, and murine animal models.
The clinical aspects of the cerebral, spinal cord, peripheral-nerve, and neuromuscular disorders are treated competently and concisely, with emphasis on pathogenesis. Brief sections present clear plans for the treatment of common opportunistic nervous system infections and the major clinical problem of chronic pain and provide hard-to-find information on central nervous system penetration of antiretroviral drugs.
Five chapters deal with the unique and intrinsically interesting aspects of HIV encephalopathy, which occurs in children and adolescents owing to the interaction of HIV with the developing brain. Social, ethical, legal, psychological, and psychiatric issues and dilemmas in the care of patients with HIV are discussed. Useful chapters deal with the influence of the common coexisting conditions of hepatitis C virus and drug and alcohol abuse on HIV neurology. A panel discussion provides insight into the most important current issues in HIV neurology, such as neuroprotective treatments, the burden of neuropathy, the role of new brain-imaging techniques, and the relevance of HIV encephalopathy to the pathogenesis of non-HIV neurodegenerative conditions. A special feature of the book is the inclusion of three personal accounts of patients who are surviving with dementia or coping with depression and other neurologic dysfunctions related to HIV.
The book is at its best as a source of in-depth, extensive, and scholarly analysis of the neurobiology of HIV, especially regarding the cognitive impairments that prevail despite highly active antiretroviral therapy. This book would be useful to investigators in AIDS neurology and to neuroscientists researching the molecular mechanisms of other neurodegenerative and demyelinating diseases.
For clinicians, useful and current knowledge of HIV neurology exists in this book but is embedded and dispersed in the text. The personal accounts are an interesting innovation, but they are not illuminating beyond the experience in compassionate clinical practice. The book's appeal and readability, and the accessibility of its wealth of information, could have been enhanced by streamlining the flow and sequence of the chapters. The collection of good photomicrographs in the midsection of the book would have been more useful accompanying the relevant chapters.
Nagagopal Venna, M.D.
Massachusetts General Hospital
Boston, MA 02114
nvenna1@partners.org(Second edition. Edited by)
This large book, in small print, offers a wealth of up-to-date information on the myriad neurologic disorders associated with HIV infection. It was written by 156 contributors; most are from the United States, a few are from Europe and Australia, and many of them are leaders in the field. The bulk of the book is devoted to the complex, changing, often elusive, intertwining immunologic and neurobiologic mechanisms that underlie HIV-associated cognitive disturbances. This topic, presented in exhaustive detail, includes insights and factual information about fundamental molecular mechanisms derived from human disease and from simian, feline, and murine animal models.
The clinical aspects of the cerebral, spinal cord, peripheral-nerve, and neuromuscular disorders are treated competently and concisely, with emphasis on pathogenesis. Brief sections present clear plans for the treatment of common opportunistic nervous system infections and the major clinical problem of chronic pain and provide hard-to-find information on central nervous system penetration of antiretroviral drugs.
Five chapters deal with the unique and intrinsically interesting aspects of HIV encephalopathy, which occurs in children and adolescents owing to the interaction of HIV with the developing brain. Social, ethical, legal, psychological, and psychiatric issues and dilemmas in the care of patients with HIV are discussed. Useful chapters deal with the influence of the common coexisting conditions of hepatitis C virus and drug and alcohol abuse on HIV neurology. A panel discussion provides insight into the most important current issues in HIV neurology, such as neuroprotective treatments, the burden of neuropathy, the role of new brain-imaging techniques, and the relevance of HIV encephalopathy to the pathogenesis of non-HIV neurodegenerative conditions. A special feature of the book is the inclusion of three personal accounts of patients who are surviving with dementia or coping with depression and other neurologic dysfunctions related to HIV.
The book is at its best as a source of in-depth, extensive, and scholarly analysis of the neurobiology of HIV, especially regarding the cognitive impairments that prevail despite highly active antiretroviral therapy. This book would be useful to investigators in AIDS neurology and to neuroscientists researching the molecular mechanisms of other neurodegenerative and demyelinating diseases.
For clinicians, useful and current knowledge of HIV neurology exists in this book but is embedded and dispersed in the text. The personal accounts are an interesting innovation, but they are not illuminating beyond the experience in compassionate clinical practice. The book's appeal and readability, and the accessibility of its wealth of information, could have been enhanced by streamlining the flow and sequence of the chapters. The collection of good photomicrographs in the midsection of the book would have been more useful accompanying the relevant chapters.
Nagagopal Venna, M.D.
Massachusetts General Hospital
Boston, MA 02114
nvenna1@partners.org(Second edition. Edited by)