The researchers conducted pathologic evaluation of all major brain regions to characterize the composition of cellular infiltrates and investigated associations between the severity of CNS inflammation and SIV viral loads in the plasma, cerebrospinal fluid (CSF), and brain tissue. Because the CNS lesions found in cART-treated macaques shared some similarities to the inflammation reported in HIV patients with immune-mediated neurologic disorders, such as CNS immune reconstitution inflammatory syndrome and symptomatic CSF escape, researchers also looked for, but found no evidence of known risk factors for these conditions including opportunistic infections and severe immune suppression prior to treatment (low CD4 nadir).

Inflammation was associated with low levels of SIV RNA in the brain and was more common in animals with episodes of CSF viral rebound or sustained detectable levels of virus in the plasma and CSF during treatment.

Although mild and asymptomatic neurologic deficits remain problematic in HIV-infected patients receiving cART, the brain remains a vastly understudied tissue in HIV research because of lack of tissue availability. The high prevalence of CNS inflammation in this group of cART-treated macaques suggests that persistent adaptive immune responses may also develop in neuroasymptomatic or mildly impaired HIV patients receiving antiretroviral treatment, yet remain unrecognized due to lack of access to CNS tissue for histologic evaluation.

"These findings suggest that lymphocyte-dominant encephalitis in cART-treated SIV-infected macaques is associated with residual or re-emergent low-level viral replication in the CNS despite cART," said Dr. Mankowski. Hence, adjunctive immunomodulatory therapies may be useful in patients with HIV manifesting HIV-associated neurocognitive disorders.



Source: Eurekalert