HIV transcripts cause brain injury despite antiretroviral therapy

What is it about?

Brain injury in HIV infection is common, even when there is viral suppression, no comorbidity, and no opportunistic infection. The cause is unclear with possibilities including a legacy effect from pre therapy damage, antiretroviral drug neurotoxicity, and continued production of viral components rather than whole virus. It is often forgotten that antiretroviral drugs only stop production of whole virus; they have limited effect on neurotoxic viral components such as tat, nef, gp120. Using a novel highly sensitive assay we explored whether HIV transcripts, as a measure of such viral components, in blood and spinal fluid would be linked to brain injury as determined by proton MR spectroscopy.

Featured Image

Why is it important?

Our results point to the pathogenetic significance of HIV transcripts causing brain injury despite effective antiretroviral therapy and do not support other putative causal mechanisms such as a legacy effect or drug toxicity. Additionally, the transcript load in monocytes was vastly less than that in CD4 T cells, calling in to question the currently held concept that the monocyte is the Trojan Horse delivering HIV to the brain. Lastly and most importantly, the data underline the urgent need to develop drugs that inhibit HIV transcription.

Perspectives