HIV DNA persists in cerebrospinal fluid despite treatment, related to cognitive impairment

New study found that many people living with the human immunodeficiency virus (HIV) and using antiretroviral therapy (ART) may still have cells that protect it in the cerebrospinal fluid concealed in the cerebrospinal fluid

A team of researchers from the University of Pittsburgh (Yale) and the University of Carolina wanted to investigate why people with well-controlled HIV who had been on long-term treatment were still experiencing cognitive impairment.

"I do not know of any infectious diseases that are easier to treat when it's in the brain than when it's elsewhere in the body," said Dr. John Mellors, MD, lead author and chief of the Infectious Diseases Division of the University of Pittsburgh. "It's hard to target hidden infections in the brain, and HIV is probably no exception – we've got work to do in the quest for a cure for HIV, but knowing that Is half the battle, so I'm cautiously optimistic, "he added.

Antiretroviral therapy (ART) is a combination of drugs used to treat HIV infection. It is recommended that all people infected with HIV receive antiretroviral therapy as soon as they know they have the virus. Although antiretroviral therapy does not cure HIV, medications can help infected people live longer and healthier lives.

The main goal of antiretroviral therapy is to reduce the patient's viral load to undetectable levels. When a patient reaches an undetectable viral load, it means that the level of virus in the blood is too low to be detected by the test.

Illustration of the HIV virus in the blood. Credit: RAJ CREATIONZS / Shutterstock

HIV DNA can thrive in cerebrospinal fluid cells

In this new study, published in the Journal of Clinical Investigation, the researchers found that HIV-positive people on treatment were more likely to have memory and concentration problems than those without HIV-positive cells.

With funding from the National Institutes of Health's AIDS Clinical Trials Group, the team badyzed the cerebrospinal fluid of 69 patients on long-term antiretroviral therapy. Patients aged 45 to 56 years had their drug-controlled infections for an average of nine years.

The researchers badyzed the HIV DNA of each patient's cerebrospinal fluid and compared this information to the standard results of their neurocognitive badessment. They found that half of the participants had viral DNA cells in the cerebrospinal fluid, suggesting the presence of the latent virus. This despite tests showing that their HIV RNA viral load in the HIV-free CSF fluid was positive in only 4% of patients.

Of these, 30% of patients with HIV DNA in the cerebrospinal fluid had clinical neurocognitive problems compared to the 11% whose cerebrospinal fluid had not detected viral DNA.

The presence of HIV-infected cells can trigger a recurrence of active infection

"HIV-infected cells persist in CSF in nearly half of people on long-term ART and their detection is badociated with lower neurocognitive performance," the researchers concluded.

As some patients still have HIV DNA thriving in some blood cells, once treatment is stopped, the presence of this vital genetic material can trigger a recurrence of active infection. The researchers pointed out, however, that they did not establish a causal relationship between the presence of cells and cognitive impairment. They explained that the results could have many explanations, including the fact that the level of infection of the origin in the central nervous system was higher in the group harboring the cells containing the HIV DNA .

Human immunodeficiency virus (HIV) in figures

Cases of infection with the human immunodeficiency virus (HIV) increase every minute. In fact, the World Health Organization (WHO) says that more than 70 million people have been infected with HIV since the beginning of the epidemic. Of these individuals, 35 million died.

According to estimates, about 40 million people worldwide live with the virus, with Africa still being the most affected. In this country, about one in 25 adults live with the disease, which is about two-thirds of all people living with HIV in the world.

In the United States, an estimated 1.1 million people are living with HIV and about 15% of them still do not know that they are infected. About 38,700 people in the country contracted a new infection in 2016 alone.

In 2017, a total of 940,000 people died of HIV-related illnesses around the world.

However, progression to Acquired Immunodeficiency Syndrome (AIDS), a fatal complication of HIV, can be prevented by antiretroviral therapy (ART).