Models of neuronal injury in AIDS: another role for the NMDA receptor?

As many as two-thirds of patients with acquired immunodeficiency syndrome (AIDS) eventually suffer from neurological manifestations, including dysfunction of cognition, movement and sensation. How can human immunodeficiency virus type 1 (HIV-1) result in neuronal damage if neurons themselves are not infected by the virus? In this article Stuart Lipton reviews a series of experiments from several different laboratories that offer related hypotheses accounting for neurotoxicity in the brains of AIDS patients. There is growing support for the existence of HIV- or immune-related toxins that directly or indirectly lead to the injury or demise of neurons via a potentially complex web of interactions between macrophages (or microglia), astrocytes and neurons. However, a final common pathway for neuronal susceptibility appears to be operative, similar to that observed after stroke, trauma and epilepsy. This mechanism involves voltage-dependent Ca2+ channels and NMDA receptor-operated channels, and therefore offers hope for future pharmacological intervention.