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HIV in the brain: new tools and treatment to keep your mind beautiful
Theo Smart, 2016-02-25 19:30:00

In the future, HIV-associated neurocognitive disorder (HAND) may become less common because of the earlier use of antiretroviral therapy (ART), but neurological disease – caused by a number of different factors – will remain an important issue as people with HIV live longer, according to several presentations in a symposium called “A beautiful mind, keeping It”, held at the annual Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston.

In the emerging scenario, management of neurological complications in people living with HIV will increasingly be guided by the use of biomarkers, including measures of HIV and inflammation in the cerebrospinal fluid (CSF), new biomarkers of neurological damage that can be measured in the blood instead of CSF and a number of different brain imaging technologies. Together, these biomarkers could help clinicians differentiate between the various causes of neurocognitive impairment and help them tailor treatments that will work better for specific individuals.

Some therapeutic choices should be the same for all people with HIV, according to Andrea Calcagno from the University of Torino in Italy.

“I think we should try to reduce cardiovascular risk [which is independently associated with neurocognitive impairment] in all our patients; and we must control plasma and CSF HIV RNA by using genetic resistance testing based-ART, but we might combine the biomarkers we have to select patients for different interventions,” he said, such as intensified ART regimens or anti-inflammatory agents to reduce chronic inflammation, or neuro- or CNS-targeted ART to address HIV replication in what appears to be a distinct reservoir of virus evolving within the brain tissue of some individuals.