Neuropathogenesis of human immunodeficiency virus infection

Brady Sillman, Christopher Woldstad, JoEllyn M McMillan, Howard Eliot Gendelman

Research output: Chapter in Book/Report/Conference proceedingChapter

10 Scopus citations

Abstract

Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) remain a common end-organ manifestation of viral infection. Subclinical and mild symptoms lead to neurocognitive and behavioral abnormalities. These are associated, in part, with viral penetrance and persistence in the central nervous system. Infections of peripheral blood monocytes, macrophages, and microglia are the primary drivers of neuroinflammation and neuronal impairments. While current antiretroviral therapy (ART) has reduced the incidence of HIV-associated dementia, milder forms of HAND continue. Depression, comorbid conditions such as infectious liver disease, drugs of abuse, antiretroviral drugs themselves, age-related neurodegenerative diseases, gastrointestinal maladies, and concurrent social and economic issues can make accurate diagnosis of HAND challenging. Increased life expectancy as a result of ART clearly creates this variety of comorbid conditions that often blur the link between the virus and disease. With the discovery of novel biomarkers, neuropsychologic testing, and imaging techniques to better diagnose HAND, the emergence of brain-penetrant ART, adjunctive therapies, longer life expectancy, and better understanding of disease pathogenesis, disease elimination is perhaps a realistic possibility. This review focuses on HIV-associated disease pathobiology with an eye towards changing trends in the face of widespread availability of ART.

Original languageEnglish (US)
Title of host publicationHandbook of Clinical Neurology
PublisherElsevier B.V.
Pages21-40
Number of pages20
DOIs
StatePublished - 2018

Publication series

NameHandbook of Clinical Neurology
Volume152
ISSN (Print)0072-9752
ISSN (Electronic)2212-4152

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Keywords

  • HIV-associated neurocognitive disorders
  • antiretroviral therapy
  • astrocytes
  • biomarkers
  • blood–brain barrier
  • monocyte-macrophages
  • mononuclear phagocytes
  • neuroAIDS

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Sillman, B., Woldstad, C., McMillan, J. M., & Gendelman, H. E. (2018). Neuropathogenesis of human immunodeficiency virus infection. In Handbook of Clinical Neurology (pp. 21-40). (Handbook of Clinical Neurology; Vol. 152). Elsevier B.V.. https://doi.org/10.1016/B978-0-444-63849-6.00003-7