HIV-1-related central nervous system disease: current issues in pathogenesis, diagnosis, and treatment.
HIV-associated central nervous system (CNS) injury continues to be clinically significant in the modern era of HIV infection and therapy. A substantial proportion of patients with suppressed HIV infection on optimal antiretroviral therapy have impaired performance on neuropsychological testing, suggesting persistence of neurological abnormalities despite treatment and projected long-term survival. In the underresourced setting, limited accessibility to antiretroviral medications means that CNS complications of later-stage HIV infection continue to be a major concern. This article reviews key recent advances in our understanding of the neuropathogenesis of HIV, focusing on basic and clinical studies that reveal viral and host features associated with viral neuroinvasion, persistence, and immunopathogenesis in the CNS, as well as issues related to monitoring and treatment of HIV-associated CNS injury in the current era.
Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
Serena
S
Spudich
Francisco
F
González-Scarano
D015526:AIDS Dementia Complex / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D003072:Cognition Disorders / Q000821:virology; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D053586:Virus Internalization
D019380:Anti-HIV Agents; D015415:Biomarkers