Jacqueline Ellero1, Michal Lubomski1,2, Bruce Brew3,4,5,6. 1. Department of Neurology, St Vincent's Hospital, Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia. 2. School of Medicine, Sydney, The University of Notre Dame Australia, Sydney, 160 Oxford St, Darlinghurst, NSW, 2010, Australia. 3. School of Medicine, Sydney, The University of Notre Dame Australia, Sydney, 160 Oxford St, Darlinghurst, NSW, 2010, Australia. B.Brew@UNSW.edu.au. 4. Departments of Neurology and Immunology, St Vincent's Hospital, Sydney, Level 4 Xavier Building. 390 Victoria St, Darlinghurst, NSW, 2010, Australia. B.Brew@UNSW.edu.au. 5. Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Darlinghurst, NSW, 2010, Australia. B.Brew@UNSW.edu.au. 6. School of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia. B.Brew@UNSW.edu.au.
Abstract
PURPOSE OF REVIEW: This study aimed to evaluate current barriers to HIV cure strategies and interventions for neurocognitive dysfunction with a particular focus on recent advancements over the last 3 years. RECENT FINDINGS: Optimal anti-retroviral therapy (ART) poses challenges to minimise neurotoxicity, whilst ensuring blood-brain barrier penetration and minimising the risk of cerebrovascular disease. CSF biomarkers, BCL11B and neurofilament light chain may be implicated with a neuroinflammatory cascade leading to cognitive impairment. Diagnostic imaging with diffusion tensor imaging and resting-state fMRI show promise in future diagnosis and monitoring of HAND. The introduction of ART has resulted in a dramatic decline in HIV-associated dementia. Despite this reduction, milder forms of HIV-associated neurocognitive disorder (HAND) are still prevalent and are clinically significant. The central nervous system (CNS) has been recognised as a probable reservoir and sanctuary for HIV, representing a significant barrier to management interventions.
PURPOSE OF REVIEW: This study aimed to evaluate current barriers to HIV cure strategies and interventions for neurocognitive dysfunction with a particular focus on recent advancements over the last 3 years. RECENT FINDINGS: Optimal anti-retroviral therapy (ART) poses challenges to minimise neurotoxicity, whilst ensuring blood-brain barrier penetration and minimising the risk of cerebrovascular disease. CSF biomarkers, BCL11B and neurofilament light chain may be implicated with a neuroinflammatory cascade leading to cognitive impairment. Diagnostic imaging with diffusion tensor imaging and resting-state fMRI show promise in future diagnosis and monitoring of HAND. The introduction of ART has resulted in a dramatic decline in HIV-associated dementia. Despite this reduction, milder forms of HIV-associated neurocognitive disorder (HAND) are still prevalent and are clinically significant. The central nervous system (CNS) has been recognised as a probable reservoir and sanctuary for HIV, representing a significant barrier to management interventions.
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