Central Neurologic Complications of HIV Infection

Human immunodeficiency virus enters the brain at the time of infection and remains in the central nervous system (CNS) throughout the infection. Three currently active topics of clinical importance will be reviewed. First, the role of cerebrospinal fluid (CSF) viral loads as a function of brain infection and performance will be assessed. Evidence is building that CSF viral load is a useful measure in assessing CNS infection in clinical trial settings with possible application to monitoring the effect of therapy in neurologically symptomatic subjects. Second, potential roles of cytokines and their receptors for CNS disease will be updated. The impact of cytokine receptors on modes of invasion of endothelial cells, monocytes, microglia, and neurons will be discussed. Finally, recently reported controlled therapeutic trials will be reviewed including the impact of antiretroviral therapy and hypothesis-driven neuroprotective strategy studies.