Global HIV neurology: A comprehensive review

Kiran T. Thakur, Alexandra Boubour, Deanna Saylor, Mitashee Das, David R. Bearden, Gretchen L. Birbeck

Research output: Contribution to journalReview articlepeer-review

Abstract

Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.

Original languageEnglish (US)
Pages (from-to)163-184
Number of pages22
JournalAIDS
Volume33
Issue number2
DOIs
StatePublished - Feb 1 2019

Keywords

  • HIV
  • aging
  • antiretroviral therapy
  • central nervous system escape
  • cerebrovascular disease
  • global health
  • neurology
  • viral reservoir

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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