It is well-known that persistence of HIV in reservoir (sanctuary) sites is a major barrier to viral eradication despite treatment with antiretroviral therapy (ART). A study published in the Journal of Clinical Investigation reaffirms this challenge and also brings attention to the problem of neurocognitive impairment in some patients on long-term ART.
The authors find that cerebrospinal fluid (CSF) can offer a window into the neuropathogenesis of HIV in living patients, although HIV-infected cells in CSF does not necessarily cause neurocognitive impairment. Overall, the investigators from the University of North Carolina, the University of Pittsburgh, and Yale University find that examining CSF cells revealed a higher prevalence of persistent HIV in the central nervous system (CNS). The CNS and persistent HIV in CSF cells despite years of viral suppression due to ART may be a significant barrier to optimal neurocognitive function and finding a cure for HIV.
HIV-associated neurocognitive disorder (HAND) is indicated with patients perform below expectations for age and ability on formal neurocognitive tests. Cross sectional studies demonstrate that approximately half of all treated HIV patients have cognitive impairment. Co-morbidity and lifestyle behaviors are known to contribute to impairment, but are insufficient to explain the frequency of impairment that currently exists in patients with HIV.
The CSF study consisted of sixty-nine participants (97% male, median age 50 years, CDF 696 cells/mm3, plasma HIV RNA <100 copies/mL) enrolled in the AIDS Clinical Trials Group (ACTG) HIV Reservoirs Cohort Study (A5321). The observational study was supported by the National Institutes of Health (NIAID and NIMH). To read this article, visit the JCI website.