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Brain Sci. 2018, 8(10), 190; https://doi.org/10.3390/brainsci8100190

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?

1
Division of Infection and Immunity, University College London, London WC1E 6BT, UK
2
Africa Health Research Institute, KwaZulu-Natal Durban 4001, South Africa
3
Institute for Global Health, University College London, London WC1E 6BT, UK
4
RK Khan Hospital, KwaZulu-Natal Durban 4092, South Africa
5
Department of Infectious Diseases, University of KwaZulu-Natal, Durban 4041, South Africa
6
Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK
*
Author to whom correspondence should be addressed.
Received: 28 September 2018 / Revised: 16 October 2018 / Accepted: 17 October 2018 / Published: 20 October 2018
(This article belongs to the Special Issue Update on HIV-Associated Neurocognitive Disorders (HAND))
Full-Text   |   PDF [261 KB, uploaded 20 October 2018]   |   Review Reports

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. View Full-Text
Keywords: HIV; central nervous system; escape; discordance; independent replication; resistance HIV; central nervous system; escape; discordance; independent replication; resistance
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Collier, D.A.; Haddow, L.; Brijkumar, J.; Moosa, M.-Y.S.; Benjamin, L.; Gupta, R.K. 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? Brain Sci. 2018, 8, 190.

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