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HIV, as well as infecting the blood, can invade the brain causing anything from a mild neurocognitive disorder to more severe HIV-associated dementia.
This can mean memory loss, the inability to walk or carry out normal day-to-day functions – life-altering conditions which are difficult enough to manage without the effects of HIV as well.
“Neurological complications remain a significant and debilitating clinical issue for HIV-infected patients, whether or not they have access to treatment,” Burnet’s Associate Professor Melissa Churchill said.
Here is a short excerpt of the feature story that appeared in the Summer edition of IMPACT.
Since the introduction of antiretroviral therapy, the incidence and severity of HIV-associated dementia and HIV-associated neurocognitive disorders (HAND) have reduced, but the prevalence has risen.
Before the availability of antiretrovirals and in countries where the therapy isn’t available, 40 per cent of HIV-infected patients suffered from dementia or HAND.
A recent University of California study showed that 52 per cent of HIV patients on treatment had neuropsychological impairment, 33 per cent had asymptomatic neurocognitive impairment and 14 per cent had more severe dementia or HAND.
Associate Professor Churchill said even the comparatively milder form of these neurological disorders predict an increased death rate, loss of employment, poor medication adherence and eventual progression to more severe neurological impairment.
“These patients can become confused, forgetful, their behaviour can change, they may experience headaches, trouble with movement and sometimes pain due to nerve damage in the central nervous system (CNS),” she said.
Associate Professor Churchill and her team, Dr Lachlan Gray and Wan Jung Chen, along with collaborators Professor Paul Gorry and Professor Steve Wesselingh, are determining the way in which HIV enters, replicates and persists in the brain.
Understanding these mechanisms will inform strategies aimed at preventing and treating central nervous system infection and improving patients’ long-term outcomes.
The Churchill Laboratory has shown that the way the virus infects the central nervous system is distinctly different from how it infects the blood, which suggests the regulation of replication and virus production will also be different in the central nervous system.
“In a study funded by the NHMRC, we found that the regulatory systems that control HIV in the brain differ substantially to those controlling replication in the lymphoid and other tissues,” Associate Professor Churchill said.
“This finding has important implications for strategies designed at controlling and eliminating HIV infection in the CNS.”
The central nervous system represents a significant potential reservoir of HIV because the infection can be extensive and hidden. Little is known about the penetration of antiretrovirals and why the immune system doesn’t play a significant role in the brain like in the rest of the body.
“As the well-justified optimism surrounding the possibility of a cure grows around the world, the impact of HIV infection in the CNS on eradication strategies is becoming more and more significant,” she said.
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