Global HIV neurology: a comprehensive review

Area of Science:

• Neuroscience
• Infectious Diseases
• Virology

Background:

• HIV-associated neurological conditions contribute significantly to illness and death, particularly in aging individuals on long-term combination antiretroviral therapy (cART).
• The central nervous system (CNS) is increasingly recognized as a viral reservoir, impacting HIV eradication strategies.
• Despite advances, substantial knowledge gaps persist regarding HIV neurological complications.

Discussion:

• Resource-limited settings often use neurotoxic antiretrovirals, leading to severe immunosuppression and opportunistic CNS infections.
• An aging HIV-positive population globally experiences cognitive decline, cerebrovascular issues, and peripheral neuropathy due to increased cART access.
• Understanding CNS viral reservoirs is critical for developing effective HIV eradication strategies.

Key Insights:

• HIV neurological conditions remain a major health burden, exacerbated by aging and cART.
• The CNS serves as a critical viral reservoir, posing challenges for HIV eradication.
• Disparities in treatment and research exist, particularly in low- and middle-income countries (LMICs).

Outlook:

• Further neurological research in LMICs is essential to address the burden of HIV complications.
• Investigating CNS viral reservoirs is crucial for advancing HIV eradication efforts.
• Addressing neurotoxicity and long-term effects of cART in diverse populations is a priority.