HIV Infection and Related Mental Disorders

Abstract

Over the more than thirty-year period of the human immunodeficiency virus type 1 (HIV-1) epidemic, many data have been accumulated indicating that HIV infection predisposes one to the development of mental pathologies. It has been proven that cognitive disorders in HIV-positive individuals are the result of the direct exposure of the virus to central nervous system (CNS) cells. The use of antiretroviral therapy has significantly reduced the number of cases of mental disorders among people infected with HIV. However, the incidence of moderate to mild cognitive impairment at all stages of HIV infection is still quite high. This review describes the most common forms of mental pathology that occur in people living with HIV and presents the current concepts on the possible pathogenetic mechanisms of the influence of human immunodeficiency virus (HIV-1) and its viral proteins on the cells of the CNS and the CNS’s functions. This review also provides the current state of knowledge on the impact of the antiretroviral therapy on the development of mental pathologies in people living with HIV, as well as current knowledge on the interactions between antiretroviral and psychotropic drugs that occur under their simultaneous administration.

Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV

“…In addition, participants’ baseline mental states were not evaluated in our study. A high rate of depression, anxiety, and sleep disturbance among treatment-naïve PLWH was previously reported in China [28] ; chronic HIV infection can directly impair CNS functions [5,21] . However, beneficial effects regarding CNS toxicity were observed in our switching therapy, which indicates that the impaired CNS function in our study may probably be EFV related.…”

“…A high rate of depression, anxiety, and sleep disturbance among treatment-naïve PLWH was previously reported in China [ 28 ] ; chronic HIV infection can directly impair CNS functions. [ 5 , 21 ] However, beneficial effects regarding CNS toxicity were observed in our switching therapy, which indicates that the impaired CNS function in our study may probably be EFV related. Finally, the relatively small sample size, the absence of a control arm, and the fact that most subjects were male limit the generalizability of our results.…”

“…EFV is still widely used in many resource-limited settings as a first-line ART regimen. [ 21 ] Currently, in China, the EFV-based regimen is freely provided by the government to most PLWH through the NFATP. Only a fraction of individuals can afford newer generation ART drugs.…”

“…Neuropsychiatric side effects in PLWH taking EFV are clinically meaningful, can potentially impact adherence to ART medications, the quality of life, and may weaken their immune system. [ 21 ] These results may provide valuable suggestions for recommendations regarding appropriate regimens for PLWH who had suffered chronic CNS side effects from EFV in China.…”

Human microglial models to study HIV infection and neuropathogenesis: a literature overview and comparative analyses

“…In addition to viral factors, the onset or progression of HAND is exacerbated by systemic inflammation, myeloid activation, and a variety of common comorbid conditions including cardiovascular disease, chronic lung disease, diabetes, anemia, obesity, and substance abuse (Ances et al 2021 ; Ances and Letendre 2019 ; Heaton et al 2010 , 2015 ). Besides optimizing the antiretroviral drug combination for better CNS penetration and encouraging the patients’ adherence to treatment, no other clear recommendation can be formulated for the treatment of HAND (Calcagno et al 2017 ; Nosik et al 2021 ; Ulfhammer et al 2018 ; Winston and Spudich 2020 ). To develop novel therapeutic strategies that target this CNS reservoir and diminish HIV-associated pathogenesis in the CNS, it is therefore of primary interest to understand how HIV reservoirs in the brain are established and maintained.…”