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New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment

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Neurocognitive Complications of HIV-Infection

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 50))

Abstract

Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) affect approximately half of people living with HIV despite viral suppression with antiretroviral therapies and represent a major cause of morbidity. HAND affects activities of daily living including driving, using the Internet and, importantly, maintaining drug adherence. Whilst viral suppression with antiretroviral therapies (ART) has reduced the incidence of severe dementia, mild neurocognitive impairments continue to remain prevalent. The neuropathogenesis of HAND in the context of viral suppression remains ill-defined, but underlying neuroinflammation is likely central and driven by a combination of chronic intermittent low-level replication of whole virus or viral components, latent HIV infection, peripheral inflammation possibly from a disturbed gut microbiome or chronic cellular dysfunction in the central nervous system. HAND is optimally diagnosed by clinical assessment with imaging and neuropsychological testing, which can be difficult to perform in resource-limited settings. Thus, the identification of biomarkers of disease is a key focus of the field. In this chapter, recent advances in the pathogenesis of HAND and biomarkers that may aid its diagnosis and treatment will be discussed.

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Authors and Affiliations

  1. Chronic Infectious and Inflammatory Diseases Research, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia

    Thomas A. Angelovich & Melissa J. Churchill

  2. Burnet Institute, Melbourne, VIC, Australia

    Edwina J. Wright

  3. Life Sciences Discipline, Burnet Institute, Melbourne, VIC, Australia

    Thomas A. Angelovich & Melissa J. Churchill

  4. Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia

    Edwina J. Wright

  5. The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia

    Edwina J. Wright

  6. Applied Neurosciences Program, Peter Duncan Neurosciences Research Unit, St. Vincent’s Centre for Applied Medical Research, Sydney, NSW, Australia

    Bruce J. Brew

  7. Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, NSW, Australia

    Bruce J. Brew

  8. Departments of Neurology and Immunology, St. Vincent’s Hospital, Sydney, NSW, Australia

    Bruce J. Brew

  9. Department of Microbiology and Immunology, Monash University, Melbourne, VIC, Australia

    Melissa J. Churchill

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  1. Thomas A. Angelovich
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  2. Melissa J. Churchill
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  3. Edwina J. Wright
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  4. Bruce J. Brew
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Correspondence to Thomas A. Angelovich .

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Editors and Affiliations

  1. School of Psychology, The University of New South Wales, Sydney, NSW, Australia

    Lucette A. Cysique

  2. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute St. Michael’s Hospital and Unity Health Toronto, Toronto, ON, Canada

    Sean B. Rourke

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Angelovich, T.A., Churchill, M.J., Wright, E.J., Brew, B.J. (2020). New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. In: Cysique, L.A., Rourke, S.B. (eds) Neurocognitive Complications of HIV-Infection. Current Topics in Behavioral Neurosciences, vol 50. Springer, Cham. https://doi.org/10.1007/7854_2019_126

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