HIV may persist in the central nervous system (CNS) despite treatment with antiretroviral therapy (ART), which could lead to cognitive impairment, according to a new study published in the Journal of Clinical Investigation. 

Most HIV research has focused on blood CD4+ memory T cells as the major viral reservoir; however, HIV persists in other sites, such as mucosal lymphoid tissue, bone marrow, and the brain, where infection can lead to CNS manifestations. 

According to the study authors, large studies of cerebrospinal fluid (CSF) cells in participants on ART who have suppressed plasma HIV RNA levels have not been previously performed. 

For the study, the researchers assessed HIV persistence in CSF and the associations with inflammation and cognitive performance during long-term ART. The study included mostly men aged 45 to 66 years who have had their infections controlled with ART for an average of 9 years. To assess HIV persistence, the researchers analyzed each individual’s CSF for HIV DNA and then compared the data to each of their results from standard neurocognitive evaluations. 

Overall, approximately half of the study participants had viral DNA in cells in the CSF, suggesting the presence of latent virus. However, only 4% of participants had detectable HIV RNA in cell-free CSF fluid, according to the findings. Additionally, 30% of those with persistent HIV DNA in the CSF experienced clinical neurocognitive impairment compared with 11% of individuals whose CSF did not contain viral DNA. The researchers did not correlate CSF inflammatory biomarkers with HIV persistence. 

“The striking observation that almost half of participants harbored HIV-infected cells in the CSF demonstrates that the CNS compartment is a site of viral persistence despite many years of viremia suppression on ART,” the authors wrote in the study. 

Although the findings indicate that persistent HIV-infected cells in the CNS may contribute to neurocognitive impairment, the authors noted that the overall frequency of cognitive impairment in this group was relatively low. Still, the study demonstrated a higher-than-expected prevalence of persistent HIV in the CNS, pointing to continued obstacles in the complete eradication of HIV from the body. 

“Our study indicates that examination of CSF cells is important in assessing residual HIV in compartments during ART,” the researchers wrote. 

Furthermore, sensitive methods of HIV detection combined with more research of CSF cells can help provide more insight into the CNS reservoir of HIV, the authors concluded. 

The post Persistent HIV in Cerebrospinal Fluid Associated with Cognitive Impairment appeared first on MyMedicPlus.

TUESDAY, July 16, 2019—(HealthDay News) Even with long-term treatment, HIV can still be found in the cerebrospinal fluid of some people with the AIDS-causing virus, a new study reports.

And these patients are at increased risk of having thinking problems, the researchers say.

“It is difficult to target infections that lurk in the brain, and HIV is probably not an exception to the rule,” said study senior author Dr. John Mellors, chief of infectious diseases at the University of Pittsburgh.

“We have our work cut out for us in the quest for an HIV cure, but knowing is half the battle, so I’m cautiously optimistic,” he said in a university news release.

Researchers analyzed cerebrospinal fluid from 69 people with HIV who had been on anti-HIV therapy for an average of nine years. The study found that nearly half the participants had cellsharboring HIV.

Of those who had HIV-harboring cells in their cerebrospinal fluid, 30% met criteria for thinking problems (cognitive impairment), compared with 11% of those without HIV-harboring cells in their cerebrospinal fluid.

The findings may help explain why people with well-controlled HIV can have memory and concentration problems and difficulty completing complex tasks, according to the researchers.

They also said that the results show that the brain is an important reservoir for HIV, a challenge that needs to be considered in clinical trials of potential cures.

“I don’t know of a single infectious disease that is easier to treat when it’s in the brain than when it’s elsewhere in the body,” Mellors said.

The researchers noted that the study does not prove that the presence of HIV-harboring cells in spinal fluid causes cognitive impairment. There could be several explanations for the findings, they noted.

For example, it’s possible that the level of original HIV infection in the nervous system was higher in patients with HIV-harboring cells, or that the mental problems may have started early in the HIV infection, before the start of anti-HIV therapy.

However, knowing about a possible link between even well-controlled HIV infection and thinking issues can help doctors track patients who may need additional monitoring, Mellors said.

The post HIV lurking in spinal fluid linked to thinking problems appeared first on MyMedicPlus.