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Neuropharmacology.

Alan Winston¹, Hadi Manji²

¹Section of Infectious Diseases, Department of Medicine, Imperial College London, London, United Kingdom; Department of HIV Medicine, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.

Handbook of Clinical Neurology

|April 2, 2018

Summary

This summary is machine-generated.

Antiretroviral therapy improves immune function in people with HIV (PLWH), but cognitive issues persist. This review examines antiretroviral drug effects in the brain to understand these persistent neurological challenges.

Keywords:

CSF CSF escape HIV blood–brain barrier cognitive neuropharmacology

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Area of Science:

Neuroscience
Immunology
Pharmacology

Background:

Effective antiretroviral therapy (ART) enables immune recovery in people living with HIV (PLWH), reducing AIDS-defining illnesses.
Despite ART, many PLWH experience persistent cognitive disturbances, with underlying causes remaining unclear.
Potential factors include pre-ART brain damage, ongoing neuroinflammation, lifestyle, and co-infections.

Purpose of the Study:

To review the clinical pharmacology of antiretroviral therapy within the central nervous system (CNS).
To explore the pharmacokinetic and pharmacodynamic effects of ART on HIV-associated cognitive disturbances.

Main Methods:

This is a review chapter, synthesizing existing research on ART in the CNS.
Focuses on the penetration and effects of antiretroviral agents in the brain.

Main Results:

ART penetration into the CNS is variable and impacts HIV suppression in the brain.
Neurotoxicity of antiretroviral agents is a potential concern.
Understanding ART's CNS effects is crucial for managing cognitive issues in PLWH.

Conclusions:

Further research is needed to fully elucidate the mechanisms of ART's CNS effects.
Optimizing ART for CNS penetration and minimizing neurotoxicity may improve cognitive outcomes for PLWH.
Addressing residual neuroinflammation and other contributing factors alongside ART is essential.