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Chapter 10 : Neurovirological Aspects of HIV Infection in the HAART Era
Category: Viruses and Viral Pathogenesis
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The National Institute of Mental Health (NIMH) of the U.S. National Institutes of Health (NIH) organized a meeting to discuss clinical and basic research priorities on CNS-related comorbidities and complications in HIV-1-infected older populations. Of interest is a study in which it was demonstrated that HIV-1 RNA in cerebrospinal fl uid (CSF) is produced both from the peripheral blood and from the brain parenchyma in infected individuals. This study supports the notion that the remission of HAART-associated neurological disorders might be relevant to the decrease in peripheral viral load. The study involved comparison of viral env and pol gene sequences from viral genomic DNA isolated either directly from tissues or coculturing methodology for retrieval of viral quasispecies. Other important findings of this study were that during antiretroviral therapy the virus present in the CSF declined rapidly, with an estimated half-life of 1 to 3 days. Viral genome dynamics also play an important role in immune evasion as well as emergence of drug-resistant quasispecies. Changes in the expression of various genes might provide an environment conducive to viral persistence in the brain. Technological strategies used in this study provide a paradigm to isolate HIV-1 from individual cell types and its characterization. Several studies in the past and long-term experience with HAART suggest that the HIV-1-associated severe neurological disorder, HIV-1-associated dementia (HAD), has been significantly reduced in countries where the health care infrastructure could afford this costly treatment.
Effects of HAART on HAD and associated neurological disorders