The Persistence of HIV-Associated Neurocognitive Disorder (HAND) in the Era of Combined Antiretroviral Therapy (cART)
| Autor: | Natasha Nemanim, Elyse J. Singer |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Cart Chemokine Microglia biology business.industry Neurotoxicity virus diseases Inflammation medicine.disease HIV-associated neurocognitive disorder 03 medical and health sciences 030104 developmental biology 0302 clinical medicine medicine.anatomical_structure Immune system Immunology medicine Coinfection biology.protein medicine.symptom business 030217 neurology & neurosurgery Clinical psychology |
| Zdroj: | Global Virology II-HIV and NeuroAIDS ISBN: 9781493972883 |
| DOI: | 10.1007/978-1-4939-7290-6_16 |
| Popis: | HIV invades the CNS compartment very early in infection and infects monocytes, microglia, macrophages, and astrocytes. These cells comprise the CNS viral reservoir. Neuroinvasion can continue throughout the infected individual’s lifetime due to the migration of HIV-infected monocytes across the blood-brain barrier (BBB). Infection of the CNS stimulates the activation of both infected and uninfected cells, the production of neurotoxic viral proteins, the expression of chemokines which attract additional infected monocytes, and a persistent CNS inflammation that causes neuronal dysfunction and death. These events are responsible for the neurocognitive, motor, and behavioral deficits collectively known as HIV-associated neurocognitive disorder (HAND). Treatment with combined antiretroviral therapy (cART) reduces the pool of replicating virus and may also reduce inflammation; however, current cART cannot eradicate the CNS viral reservoir nor persistent CNS inflammation, as HIV has molecular mechanisms of evading the immune system and may also be protected from therapeutic levels of cART within the CNS. Thus, cART attenuates rather than cures the brain pathology underlying HAND. In addition, comorbid processes such as aging, cART neurotoxicity, drug use, HCV coinfection, and vascular risk factors may contribute to brain injury and exacerbate the manifestations of HAND. |
| Databáze: | OpenAIRE |
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