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Antiretroviral therapy (ART) has reduced severe HIV-1 associated neurocognitive disorders (HAND). However, mild HAND persists, and research continues to understand HIV neuropathogenesis and target latent CNS infections for a cure.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Neuroimmunology

Background:

  • The clinical presentation of HIV-1 affecting the Central Nervous System (CNS) has shifted significantly over 30 years.
  • Effective antiretroviral therapy (ART) has decreased severe neurocognitive and motor deficits, but mild to moderate HIV-associated neurocognitive disorders (HAND) remain prevalent (21-77.6%).
  • Chronic inflammation, neurotoxicity from long-term ART, and an aging HIV-positive population contribute to HAND pathogenesis.

Purpose of the Study:

  • To provide an overview of research progress in HIV-CNS disease.
  • To define new challenges and research areas in the field.
  • To highlight domestic and global research priorities for HIV-CNS complications.

Main Methods:

  • Review of current research on HIV neuropathogenesis.
  • Analysis of the impact of ART on neurological complications.
  • Identification of gaps in understanding and treatment strategies.

Main Results:

  • ART has altered the landscape of HIV-CNS disease, reducing severe manifestations.
  • The precise pathophysiology of HAND remains elusive, hindering effective prevention and treatment.
  • Latent HIV infection within the CNS presents a significant challenge for viral eradication and cure efforts.

Conclusions:

  • Preventing and treating neurological complications of HIV, alongside eradicating the virus from the CNS, are critical research priorities.
  • Further research is needed to elucidate the mechanisms of HAND and develop targeted therapies.
  • Efforts toward an HIV cure must address the persistent viral reservoirs within the CNS.