title: Treating HIV Infection in the Central Nervous System.
abstract: Combination antiretroviral treatment is associated with clear benefits in HIV-positive subjects, and is also effective in the central nervous system (CNS), meaning HIV-associated dementia is now an uncommon event. Nevertheless, a significant number of patients show symptoms of neurocognitive impairment which may negatively affect their quality of life. Although several risk factors for HIV-associated neurocognitive disorders have been identified, there is no clear recommendation for their prevention and management. In this review, the penetration of drugs into the cerebrospinal fluid/CNS is discussed as well as the viral and clinical consequences associated with higher/lower compartmental exposure. We also review the potential interventions according to the currently identified underlying mechanisms, including persistent CNS immune activation, legacy effects, low-level viral replication and escape, co-morbidities, and antiretroviral-associated direct and indirect 'neurotoxicity'. Adjunctive therapies and interventions (including neuro-rehabilitation) are then briefly discussed. The treatment of HIV infection in the CNS is a complex area of therapeutics requiring multidisciplinary interventions and further study.
authors.affiliation: Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy. andrea.calcagno@unito.it.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-2534-8815
authors.initials: A
authors.lastname: Calcagno
authors.affiliation: Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Perri
authors.affiliation: Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bonora
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy* / Q000821:virology*; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002490:Central Nervous System / Q000187:drug effects / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans
chemical_list: D019380:Anti-HIV Agents