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HIV Compartmentalization in the CNS and Its Impact in Treatment Outcomes and Cure Strategies

  • HIV Pathogenesis and Treatment (AL Landay and NS Utay, Section Editors)
  • Published:
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Abstract

Purpose of Review

This review focuses on the cerebrospinal fluid (CSF) findings in connection to the central nervous system (CNS) reservoir in treatment-naïve and virally suppressed PLWH, followed by the findings in CSF HIV-1 escape and analytical treatment interruption studies.

Recent Findings

Compared to chronic infection, initiating antiretroviral therapy (ART) during acute HIV-1 infection results in more homogeneous longitudinal benefits in the CNS. Viral variants in CSF HIV-1 escape are independently linked to infected cells from the systemic reservoir and in the CNS, highlighting the phenomenon as a consequence of different mechanisms. HIV-infected cells persist in CSF in nearly half of the individuals on stable ART and are associated with worse neurocognitive performance.

Summary

Future studies should probe into the origin of the HIV-infected cells in the CSF. Examining the capacity for viral replication would provide new insight into the CNS reservoir and identify strategies to eradicate it or compensate for the insufficiency of ART.

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  1. SEARCH, Institute of HIV Research and Innovation, Bangkok, Thailand

    Phillip Chan

  2. Department of Neurology and Center for Neuroepidemiology and Clinical Neurological Research, Yale University, New Haven, CT, USA

    Serena Spudich

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Phillip Chan declares that he has no conflict of interest. Serena Spudich reports grants from NIH-NIMH, NINDS and NIDA, during the conduct of the study; non-financial support from ViiV Healthcare, Inc., outside the submitted work.

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Chan, P., Spudich, S. HIV Compartmentalization in the CNS and Its Impact in Treatment Outcomes and Cure Strategies. Curr HIV/AIDS Rep 19, 207–216 (2022). https://doi.org/10.1007/s11904-022-00605-1

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