The brain and HAART: collaborative and combative connections

Area of Science:

• Neuroscience
• Infectious Diseases
• Pharmacology

Background:

• The brain is a key reservoir for HIV-1, despite treatment.
• Understanding antiretroviral therapy (ART) effects on the central nervous system (CNS) is crucial for HIV/AIDS management.

Purpose of the Study:

• To review current knowledge on how highly active antiretroviral therapy (HAART) impacts the brain in HIV/AIDS patients.
• To assess the variable effects of different HAART regimens on neurocognition and viral load in cerebrospinal fluid (CSF).

Main Methods:

• Review of contemporary observations and experimental studies on HAART and the brain.
• Analysis of data on neurocognitive impairment, viral quantity in CSF, and CNS penetration-effectiveness scores.
• Examination of experimental findings on the neurotoxicity of various antiretroviral drugs (ARVs).

Main Results:

• HAART's impact on neurocognitive impairment in HIV/AIDS is uncertain, with mixed outcomes reported.
• Viral load in CSF and neurocognitive function show variable responses to different HAART regimens.
• Experimental data indicate potential neurotoxic effects from several classes of antiretroviral drugs (ARVs), including NRTIs, NNRTIs, and PIs.

Conclusions:

• Current HAART selection balances efficacy, toxicity, and CNS penetration.
• Further research is needed to understand ART effects on neural tissues for improved HIV/AIDS brain-targeted therapies.
• Rational HAART strategies must maximize efficacy while minimizing neurotoxic complications.