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HIV Cerebrospinal Fluid Escape and Neurocognitive Pathology in the Era of Combined Antiretroviral Therapy: What Lies Beneath the Tip of the Iceberg in Sub-Saharan Africa?

Published version
Peer-reviewed

Type

Article

Change log

Authors

Collier, Dami Aderonke  ORCID logo  https://orcid.org/0000-0001-5446-4423
Haddow, Lewis 
Brijkumar, Jay 
Moosa, Mahomed-Yunus S  ORCID logo  https://orcid.org/0000-0001-6191-4023

Abstract

Neurocognitive impairment remains an important HIV-associated comorbidity despite combination antiretroviral therapy (ART). Since the advent of ART, the spectrum of HIV-associated neurocognitive disorder (HAND) has shifted from the most severe form to milder forms. Independent replication of HIV in the central nervous system despite ART, so-called cerebrospinal fluid (CSF) escape is now recognised in the context of individuals with a reconstituted immune system. This review describes the global prevalence and clinical spectrum of CSF escape, it role in the pathogenesis of HAND and current advances in the diagnosis and management. It highlights gaps in knowledge in sub-Saharan Africa where the HIV burden is greatest and discusses the implications for this region in the context of the global HIV treatment scale up.

Description

Keywords

HIV, central nervous system, discordance, escape, independent replication, resistance

Journal Title

Brain Sci

Conference Name

Journal ISSN

2076-3425
2076-3425

Volume Title

8

Publisher

MDPI AG