Attenuated Central Nervous System Infection in Advanced HIV/AIDS With Combination Antiretroviral Therapy

Abstract

In contrast to observations in individuals not treated with CART, we found no relationship between CSF markers and neurological status in this CART-using cohort with advanced HIV/AIDS. This was not explicable by demographic differences or plasma virological control. CART may substantially attenuate the degree of central nervous system HIV infection and immune activation, and in CART users, CSF HIV RNA and immune activation markers may fail to discriminate milder degrees of HIV-D and MCMD.

Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy

“…After starting cART, older patients show a reduced recovery of CD4+ T cells and an increased risk of progression to AIDS diagnosis, neurocognitive disorders, and death with respect to younger patients having comparable levels of CD4+ T cells and HIV viral loads [67,68]. Therefore, in this patient population, the initiation of cART could be indicated at an earlier stage of disease.…”

“…Attention will focus on special populations, such as the elderly, who show a slower immune recovery, patients with neurocognitive disorders, who are frequently observed during severe immunosuppression [67,68], and those co-infected with hepatitis viruses [69,70].…”

Whole Brain and Localized Magnetization Transfer Measurements Are Associated with Cognitive Impairment in Patients Infected with Human Immunodeficiency Virus

“…Eleven HIV-seropositive subjects (mean age, 49.4 Ϯ 7.27; 9 men and 2 women) participating in an investigation of the natural history of neurologic impairment in advanced HIV infection 19 were included.…”

Functional Synergy between CD40 Ligand and HIV-1 Tat Contributes to Inflammation: Implications in HIV Type 1 Dementia

“…With respect to the virus reservoir in the brain, it has been noted that many antiretroviral drugs fail to adequately penetrate the CNS-raising questions about the ability of HAART to fully contain residual virus replication in this site (2). Finally, although the widespread use of HAART has resulted in a significant decline in the incidence of HAD, the prevalence of HAD has actually increased-as HIVinfected individuals live longer (10). In addition, a more subtle form of CNS dysfunction, known as minor cognitive motor disorder, has become more common in HIV-1 patients receiving HAART (11).…”