About My Health Careers Internship MedBlogs Contact us

Uncovering the Neurocognitive Impairment of HIV Patients on Antiretroviral Therapy

by Anjali Aryamvally on December 9, 2017 at 1:23 PM
Font : A-A+

Uncovering the Neurocognitive Impairment of HIV Patients on Antiretroviral Therapy

While combination antiretroviral therapy (cART) has made significant contributions in improving the survival and quality of life of HIV patients, almost half of cART-treated HIV patients experience some degree of neurocognitive impairment (neuroHIV). In the search for the underlying pathology, scientists analyzed the brains of monkeys infected with simian immunodeficiency virus (SIV) then treated with cART. In the study reported in the American Journal of Pathology, the majority of the SIV-infected macaque brains showed signs of unusual lymphocyte-dominant inflammation, suggesting that persistent neuroinflammation may underlie cognitive problems in cART-treated HIV patients.

"In our well-characterized model of neuroHIV, most untreated SIV-infected animals develop classic HIV-associated encephalitis rich in macrophages and multinucleate giant cells bearing replicating SIV. Using this model, we expanded our research to study neuroHIV in the context of current therapy by treating these animals with cART," explained lead investigator Joseph L. Mankowski, DVM, PhD, of the Department of Molecular and Comparative Pathobiology at Johns Hopkins University (Baltimore, MD).


Within a group of 30 SIV-infected macaques treated with cART, researchers found that 17 of the animals developed lymphocyte-dominant inflammation around blood vessels in the brain or meninges that was clearly different from what is typically seen with severe SIV and HIV infection of the central nervous system (CNS). The high prevalence of lesions and lack of overt neurologic symptoms among these macaques support the premise that robust or dysregulated adaptive immune responses in the CNS may impact treated HIV patients at a subclinical level and may contribute to the continued high prevalence of HIV-associated neurocognitive disorders.

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

News A-Z
News Category
What's New on Medindia
Cochlear Implants may Consequently Drive Hearing Loss
E-cigarettes Use Linked to Erectile Dysfunction
Memory Loss - Can it be Recovered?
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Oral Health And AIDS AIDS/HIV AIDS/HIV - Epidemiology AIDS/HIV - Clinical Features AIDS/HIV - Health Education AIDS/HIV - Prevention And Transmission AIDS / HIV - Treatment AIDS/HIV- Lab Tests and Faqs Reiki and Pranic Healing Prostitution: Fresh Stakes in the Oldest Trade 

Recommended Reading
Antiretroviral Therapy Cocktails Suppress HIV Infections
There is no AIDS cure or vaccine. ART cocktails suppress the virus, enabling people to live long, .....
HIV Patients Adhere to Antiretroviral Therapy Longer
Adherence to medications for many chronic conditions is poor. Easy availability of antiretroviral .....
Smartphone App may Improve Adherence to Antiretroviral Therapy for HIV Patients
People living with HIV felt comfortable reporting their adherence to antiretroviral therapy using a ...
Antiretroviral Therapy Repairs Gut Inflammation in HIV+ Individuals
Combination antiretroviral therapy (cART) suppresses HIV replication and significantly slows the ......
AIDS / HIV - Treatment
Encyclopedia section of medindia explains in brief about the treatment for AIDS/HIV...
"AIDS is an epidemic disease, a potentially preventable, deadly infection for which there is no cure...
AIDS/HIV - Clinical Features
Encyclopedia section of medindia gives general info about HIV Clinical Features...
AIDS/HIV - Epidemiology
AIDS or HIV is an epidemic disease, a potentially deadly infection that can be prevented with preca...
AIDS/HIV - Health Education
Encyclopedia section of medindia gives general info about AIDS information and health education....
AIDS/HIV - Prevention And Transmission
Encyclopedia section of medindia explains in brief about the prevention for AIDS/HIV...
Oral Health And AIDS
AIDS has taken on massive proportions in modern times. It is estimated that over 15 million people a...
Prostitution: Fresh Stakes in the Oldest Trade
Prostitution has broadened its base to include street prostitution, massage brothels, gigolo outcall...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use