Highlights of the 15th Conference on Retroviruses and Opportunistic Infections. Neurologic complications of HIV disease and their treatment.

New data were presented at the 15th Conference on Retroviruses and Opportunistic Infections that further support the importance of considering the neuroeffectiveness of antiretroviral drugs when designing treatment regimens. Two studies linked antiretroviral therapy that had estimates of better neuroeffectiveness with better global neuropsychologic outcomes in life. A third study linked estimates of better antiretroviral therapy neuroeffectiveness, particularly nonnucleoside analogue reverse transcriptase inhibitors, with a lower prevalence of HIV-associated brain pathology at death. Additional findings presented at the conference focused on the correlates of HIV-associated neurocognitive disorders (HAND) and peripheral neuropathy. Supporting the concept that viral factors influence the pathogenesis of HAND, high frequencies of HAND were identified in people infected with HIV subtype D and in people infected with subtype B and having brain-specific mutations in V3 of gp160. Supporting the importance of host correlates of HAND, important data from a macaque study identified a strong link between a major histocompatibility complex class I allele, Mane-A*10, and simian immunodeficiency virus encephalitis. Supporting the importance of comorbidities in determining risk for HAND, high levels of lipopolysaccharide in blood, likely derived from the HIV-injured intestine and bacterial translocation, were linked to HAND. Coinfections with JC virus or Treponema pallidum were topics of other presentations, identifying a prognostic marker for PML (better CD8+ cytotoxic T-lymphocyte responses were associated with survival) and a diagnostic one for neurosyphilis (CXCL13 levels in CSF).