Kidney and central nervous system as reservoirs of HIV infection

To summarize recent investigations into the establishment and maintenance of the kidney and central nervous system as reservoirs of HIV infection and the resultant pathogenesis of HIV infection in these organs.

Significant progress has been made in understanding the pathogenesis of HIV-associated nephropathy with the demonstration that HIV gene expression within podocytes was sufficient to recapitulate HIV-associated nephropathy -like renal disease in mouse models. Little progress has been made, however, in understanding how the HIV reservoir in the kidney is established and maintained. Studies of the central nervous system reservoir have further characterized the compartmentalization of HIV between the central nervous system and lymphoid organs and within brain regions. The relationship between HIV in the cerebrospinal fluid and in the brain and the utility of cerebrospinal fluid as a surrogate for the brain have been reevaluated in patients receiving antiretroviral medication and in patients at different stages of HIV infection and neurologic impairment. Finally, nonproductive infection of astrocytes in vivo has been demonstrated and mechanisms to explain viral entry and the block to productive infection of these cells have been described.

Although much progress has been made in the understanding of the pathogenesis of HIV-associated nephropathy, much work remains to be done to better understand the establishment and maintenance of the HIV reservoir in both the kidney and the brain, and in particular, the mechanisms of neurologic dysfunction resulting from HIV infection of the brain.