Futuristic Methods for Treatment of HIV in the Nervous System
While many pathogens can seed the central nervous system (CNS) and cause severe morbidity and mortality, HIV presents a unique challenge. HIV is known to cross into the CNS early on in infection, and long-term infection leads to neurocognitive impairment. Antiretrovirals (ARVs) have decreased the complications related to HIV, and extended the lifespan for those living with the virus; however, they haven’t lowered the overall prevalence of neurocognitive disorders. One theory is due to compartmentalization of the virus in the CNS, leading to low level viremia and inflammation. ARVs have variable penetrance into the brain, which may explain the compartmentalization. Many new techniques are being used to tackle this problem such as nanotechnology. Nanotechnology offers a means of modifying existing ARVs and increasing their CNS penetration as well as sustaining CNS concentrations by conjugating them with liposomes, or ligands that can bind to receptors on the surface of the blood-brain barrier. Further, techniques such as machine learning can help in understanding the pathogenesis of cognitive disorders by using computer algorithms to sort through hundreds of variables and determine pathological HIV genes or proteins that can be used to develop medications in the future. While these applications are still in the early-stages, they offer hope in tackling a longstanding problem.
KeywordsHuman immunodeficiency virus Anti-retrovirals Central nervous system Blood-brain barrier Nanotechnology Machine learning
The authors would like to acknowledge the Neuro-AIDS Division at Icahn School of Medicine at Mount Sinai Hospital, including David Simpson MD and Susan Morgello MD for their support in this work.
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