HIV's tendency to hide in the central nervous system may be a major barrier to disease eradication.
Global progress in addressing the HIV epidemic has been ongoing over the last few years. Between 2014 and 2015, the number of individuals living with HIV who were taking antiretroviral therapy reached 17 million. Although the infection rate is decreasing, eliminating infection transmission is still a formidable challenge.
A continuing concern is HIV-associated neurologic syndromes. People living with HIV (PLWH) are at elevated risk for neurologic syndromes due to opportunistic infection, immune reconstitution, and adverse events associated with antiretroviral treatment. And, HIV itself can affect the nervous system.
A multinational team of researchers has assembled a comprehensive review of HIV-associated neurologic complications. Published in the journalAIDS, the overview could be a go-to resource for questions about this topic.
The authors reported that increased global access to antiretroviral therapy has led to an aging HIV-positive population and the combination has revealed some cognitive, cerebrovascular, and peripheral neuropathy consequences. Patients who are most likely to be affected reside in resource-limited settings or are severely immunocompromised.
The authors indicated that mounting evidence supports the hypothesis that the central nervous system (CNS) is a reservoir for HIV virus and contributes to persistence of this deadly infection. HIV's tendency to hide in the CNS may be a major barrier to disease eradication.
The review highlights a number of different neurologic consequences:
The authors also addressed the mechanisms that may explain each of these neurologic consequences and examined comorbid conditions, seizure disorders, the impact of the aging population, and special concerns in children.
Overall, the authors concluded that acute and chronic effects of HIV on the nervous system are increasing, especially in aging populations, with synergistic effects on cognitive function and cerebrovascular disease. Additionally, barriers continue to limit the quality of life in patients with HIV with major neurological manifestations.
Thakur KT, Boubour A, Saylor D, Das M, Bearden DR, Birbeck GL. Global HIV neurology: a comprehensive review.AIDS. 2018 Mar 15. doi: 10.1097/QAD.0000000000001796. [Epub ahead of print]