title: Opiate drug use and the pathophysiology of neuroAIDS.
abstract: Opiate abuse and HIV-1 have been described as interrelated epidemics, and even in the advent of combined anti-retroviral therapy, the additional abuse of opiates appears to result in greater neurologic and cognitive deficits. The central nervous system (CNS) is particularly vulnerable to interactive opiate-HIV-1 effects, in part because of the unique responses of microglia and astroglia. Although neurons are principally responsible for behavior and cognition, HIV-1 infection and replication in the brain is largely limited to microglia, while astroglia and perhaps glial progenitors can be latently infected. Thus, neuronal dysfunction and injury result from cellular and viral toxins originating from HIV-1 infected/exposed glia. Importantly, subsets of glial cells including oligodendrocytes, as well as neurons, express µ-opioid receptors and therefore can be direct targets for heroin and morphine (the major metabolite of heroin in the CNS), which preferentially activate µ-opioid receptors. This review highlights findings that neuroAIDS is a glially driven disease, and that opiate abuse may act at multiple glial-cell types to further compromise neuron function and survival. The ongoing, reactive cross-talk between opiate drug and HIV-1 co-exposed microglia and astroglia appears to exacerbate critical proinflammatory and excitotoxic events leading to neuron dysfunction, injury, and potentially death. Opiates enhance synaptodendritic damage and a loss of synaptic connectivity, which is viewed as the substrate of cognitive deficits. We especially emphasize that opioid signaling and interactions with HIV-1 are contextual, differing among cell types, and even within subsets of the same cell type. For example, astroglia even within a single brain region are heterogeneous in their expression of µ-, δ-, and κ-opioid receptors, as well as CXCR4 and CCR5, and Toll-like receptors. Thus, defining the distinct targets engaged by opiates in each cell type, and among brain regions, is critical to an understanding of how opiate abuse exacerbates neuroAIDS.
authors.affiliation: Department of Pharmacology and Toxicology, 1217 East Marshall Street, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA. kfhauser@vcu.edu
authors.forename: Kurt F
authors.initials: KF
authors.lastname: Hauser
authors.forename: Sylvia
authors.initials: S
authors.lastname: Fitting
authors.forename: Seth M
authors.initials: SM
authors.lastname: Dever
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Podhaizer
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Knapp
mesh_terms: D015526:AIDS Dementia Complex / Q000378:metabolism* / Q000503:physiopathology; D000163:Acquired Immunodeficiency Syndrome / Q000378:metabolism* / Q000503:physiopathology; D001253:Astrocytes / Q000187:drug effects / Q000378:metabolism* / Q000821:virology; D005260:Female; D015497:HIV-1 / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D008297:Male; D017628:Microglia / Q000187:drug effects / Q000378:metabolism / Q000821:virology; D009294:Narcotics / Q000378:metabolism / Q000494:pharmacology*; D009457:Neuroglia / Q000187:drug effects / Q000378:metabolism / Q000821:virology; D009293:Opioid-Related Disorders / Q000378:metabolism* / Q000503:physiopathology; D015398:Signal Transduction / Q000187:drug effects; D019966:Substance-Related Disorders; D054322:tat Gene Products, Human Immunodeficiency Virus / Q000187:drug effects / Q000378:metabolism*
chemical_list: D009294:Narcotics; D054322:tat Gene Products, Human Immunodeficiency Virus