Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of COVID-19, a disease that as of July 10, 2020, has infected >12 million people and killed >500,000. COVID-19 infection leads to acute respiratory distress syndrome in a subset of patients and is a primary driver of acute morbidity in infected persons. However, it is becoming increasingly clear that SARS-CoV-2 infection drives dysfunction and pathology outside the lungs, including reports of renal, cardiac, and neurological complications. In this study, we summarize the known incidence and evidence of neurological complications associated with SARS-CoV-2 infection and other pathogenic coronaviruses. These studies describe a poorly understood spectrum of COVID-19 central nervous system symptoms, ranging from common and subclinical issues such as anosmia and headache to more concerning reports of stroke and encephalopathy. We discuss potential mechanisms of pathogenesis, including a discussion of how the understanding of neurological complications known to occur in HIV-1 patients may provide insight into SARS-CoV-2-associated neurological manifestations. Specifically, three hypotheses are discussed that are informed by decades of knowledge about HIV pathogenesis in the brain, which include a potential direct viral effect, an indirect viral effect, and/or a neuroimmune axis effect. Individually or in combination these potential effects may contribute to COVID-19 neurological complications.

中文翻译：

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大脑中的 HIV 可以帮助我们了解 SARS-CoV-2 神经系统并发症吗？

严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 是 COVID-19 的病原体，截至 2020 年 7 月 10 日，该疾病已感染超过 1,200 万人，并导致超过 50 万人死亡。COVID-19 感染会导致部分患者出现急性呼吸窘迫综合征，并且是感染者急性发病的主要驱动因素。然而，越来越清楚的是，SARS-CoV-2 感染会导致肺外的功能障碍和病理，包括肾脏、心脏和神经系统并发症的报道。在这项研究中，我们总结了与 SARS-CoV-2 感染和其他致病性冠状病毒相关的神经系统并发症的已知发病率和证据。这些研究描述了人们对 COVID-19 中枢神经系统症状知之甚少的范围，从嗅觉丧失和头痛等常见和亚临床问题，到更令人担忧的中风和脑病报告。我们讨论了潜在的发病机制，包括讨论如何了解 HIV-1 患者中已知发生的神经系统并发症，从而深入了解 SARS-CoV-2 相关的神经系统表现。具体来说，讨论了三个假设，这些假设是基于数十年有关大脑中艾滋病毒发病机制的知识而得出的，其中包括潜在的直接病毒效应、间接病毒效应和/或神经免疫轴效应。这些潜在影响单独或组合可能会导致 COVID-19 神经系统并发症。