Central Nervous System HIV Persistence and Clinical Consequences During Suppressive ART

Area of Science:

• Neuroscience
• Infectious Diseases
• Immunology

Background:

• Human immunodeficiency virus (HIV) infection can affect the central nervous system (CNS).
• Neurologic complications are common in individuals with HIV.
• Antiretroviral therapy (ART) can suppress systemic viral load but may not eliminate HIV from the CNS.

Purpose of the Study:

• To review recent advances in understanding HIV invasion and persistence within the CNS.
• To examine the relationship between CNS HIV persistence and neurologic complications.
• To discuss implications for HIV cure strategies.

Main Methods:

• Literature review of recent studies on CNS HIV.
• Analysis of mechanisms of HIV entry and persistence in the CNS.
• Evaluation of treatment strategies for neurosymptomatic HIV RNA escape.
• Assessment of novel HIV cure strategies in the context of CNS reservoir dynamics.

Main Results:

• Compelling evidence supports the existence of a CNS HIV reservoir, with HIV persisting in macrophages and microglia despite suppressive ART.
• HIV enters the CNS early in infection and can establish a persistent reservoir.
• CNS HIV persistence is linked to symptomatic CSF HIV RNA escape and cognitive dysfunction.
• Understanding CNS reservoir dynamics is vital for designing effective HIV cure strategies and managing neurotoxicity.

Conclusions:

• CNS HIV persistence represents a significant barrier to HIV cure.
• Effective management of neurosymptomatic HIV requires evaluating CNS-specific drug resistance and optimizing ART.
• Comprehensive evaluation of cognitive symptoms in people with HIV is essential.
• Novel cure strategies must consider CNS reservoir dynamics and potential neurotoxicity.