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2014 ; 11
(ä): 13
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Viral and cellular factors underlying neuropathogenesis in HIV associated
neurocognitive disorders (HAND)
#MMPMID24894206
Rao VR
; Ruiz AP
; Prasad VR
AIDS Res Ther
2014[]; 11
(ä): 13
PMID24894206
show ga
As the HIV-1 epidemic enters its fourth decade, HIV-1 associated neurological
disorders (HAND) continue to be a major concern in the infected population,
despite the widespread use of anti-retroviral therapy. Advancing age and
increased life expectancy of the HIV-1 infected population have been shown to
increase the risk of cognitive dysfunction. Over the past 10 years, there has
been a significant progress in our understanding of the mechanisms and the risk
factors involved in the development of HAND. Key events that lead up to neuronal
damage in HIV-1 infected individuals can be categorized based on the interaction
of HIV-1 with the various cell types, including but not limited to macrophages,
brain endothelial cells, microglia, astrocytes and the neurons. This review
attempts to decipher these interactions, beginning with HIV-1 infection of
macrophages and ultimately resulting in the release of neurotoxic viral and host
products. These include: interaction with endothelial cells, resulting in the
impairment of the blood brain barrier; interaction with the astrocytes, leading
to metabolic and neurotransmitter imbalance; interactions with resident immune
cells in the brain, leading to release of toxic cytokines and chemokines. We also
review the mechanisms underlying neuronal damage caused by the factors mentioned
above. We have attempted to bring together recent findings in these areas to help
appreciate the viral and host factors that bring about neurological dysfunction.
In addition, we review host factors and viral genotypic differences that affect
phenotypic pathological outcomes, as well as recent advances in treatment options
to specifically address the neurotoxic mechanisms in play.