HIV-positive patients are living longer, healthier lives thanks to combination antiretroviral therapy (cART), which prevents the virus from replicating and infecting additional cells. However, HIV's ability to persist in the body despite ongoing cART treatment remains a major obstacle to curing patients. Now, clinical trial results published in the Journal of Clinical Investigation show that HIV can be detected in the central nervous system of patients undergoing long-term cART, and its presence is linked to poor performance on cognitive tests.
While it was known that cART cannot completely prevent HIV-associated neurological dysfunction, Serena Spudich (Yale University School of Medicine) and colleagues' study appears to be the first to detect the virus in the cerebrospinal fluid (CSF) of patients on long-term cART. Their discovery indicates that HIV can persist in the brain and spinal cord despite years of successful viral suppression. Importantly, Spudich et al. linked the presence of HIV in CSF with poorer performance on a series of cognitive tests, concluding that the brain and spinal cord remain vulnerable to the virus even when the immune system is spared.