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Chronic Inflammation and the Role for Cofactors (Hepatitis C, Drug Abuse, Antiretroviral Drug Toxicity, Aging) in HAND Persistence

  • Central Nervous System and Cognition (I Grant, Section Editor)
  • Published:
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Abstract

HIV-associated neurocognitive disorders (HAND) is a group of syndromes of varying degrees of cognitive impairment affecting up to 50 % of HIV-infected individuals. The neuropathogenesis of HAND is thought to be driven by HIV invasion and productive replication within brain perivascular macrophages and endogenous microglia, and to some degree by restricted infection of astrocytes. The persistence of HAND in individuals experiencing suppression of systemic HIV viral load with antiretroviral therapy (ART) is incompletely explained, and suggested factors include chronic inflammation, persistent HIV replication in brain macrophages, effects of aging on brain vulnerability, and co-morbid conditions including hepatitis C (HCV) co-infection, substance abuse, and CNS toxicity of ART, among other factors. This review discusses several of these conditions: chronic inflammation, co-infection with HCV, drugs of abuse, aging, and antiretroviral drug effects. Effectively managing these co-morbid conditions in individuals with and without HAND is critical for improving neurocognitive outcomes and decreasing HIV-associated morbidity.

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Alexander J. Gill and Dennis L. Kolson declare that they have no conflict of interest.

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  1. Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 415 Curie Boulevard 280C Clinical Research Building, Philadelphia, PA, 19104, USA

    Alexander J. Gill & Dennis L. Kolson

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  2. Dennis L. Kolson
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Correspondence to Dennis L. Kolson.

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Gill, A.J., Kolson, D.L. Chronic Inflammation and the Role for Cofactors (Hepatitis C, Drug Abuse, Antiretroviral Drug Toxicity, Aging) in HAND Persistence. Curr HIV/AIDS Rep 11, 325–335 (2014). https://doi.org/10.1007/s11904-014-0210-3

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