Abstract
HIV-associated neurocognitive disorders (HAND) are increasingly prevalent despite the use of antiretroviral therapies. Previous research suggests that individual host factors play an important role in determining susceptibility to HAND. In this review, we propose that childhood trauma (CT) and HAND share several common aetiological mechanisms, namely hypothalamic-pituitary-adrenal axis dysregulation, neuroinflammation and oxidative stress. These convergent and consequent mechanisms may translate into an increased risk of developing HAND in individuals who have experienced early life stress. We provide an overview of basic and clinical research relating to these pathophysiological mechanisms and suggest that further research examine brain-derived neurotrophic factor and telomere length as common mediating factors and potential therapeutic targets for HAND and CT.
Both childhood trauma and HIV-associated neurocognitive disorders are associated with HPA axis dysregulation, inflammation and oxidative stress
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This work is supported by the South African Research Chair in post-traumatic stress disorder hosted by Stellenbosch University, funded by the South African Department of Science and Technology and administered by South African National Research Foundation, and the Faculty of Medicine and Health Sciences, Stellenbosch University.
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Key messages
• Despite improvements in antiretroviral medication, persisting minor and major HAND remain a serious concern.
• There is growing evidence that CT in HIV-infected individuals may increase the risk of developing HAND.
• The aforementioned increased risk may be due to shared and overlapping pathophysiological mechanisms of HPA axis dysfunction, inflammation and oxidative stress.
• Longitudinal studies are needed to elaborate on the interactions of these aetiologic factors in HAND pathology in the context of CT.
• Future work should further examine the role of BDNF and telomere length in CT/HAND and investigate the potential of BDNF and telomere length as corrective therapeutic targets, either as standalone agents or as adjuncts to other drugs.
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Womersley, J.S., Seedat, S. & Hemmings, S.M.J. Childhood maltreatment and HIV-associated neurocognitive disorders share similar pathophysiology: a potential sensitisation mechanism?. Metab Brain Dis 32, 1717–1733 (2017). https://doi.org/10.1007/s11011-017-0062-9
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DOI: https://doi.org/10.1007/s11011-017-0062-9