There have been an array of therapies developed since the rise of the HIV and AIDS epidemic in the 1980s and 1990s that have allowed HIV-positive individuals to enjoy a better quality of life and healthier living.
However, new research indicated that despite long-term treatment, some HIV-positive people are at an increased risk for developing cognitive problems. Simply put, HIV cells have been found in the cerebrospinal fluid.
For these people, it means a higher chance for cognitive defects. Researchers noted that despite the finding, it doesn’t mean people are having problems thinking. It does, though, indicate how serious HIV really is as a virus in that it can cause other health problems and diseases.
The study involved researchers from three universities – Yale University, University of North Carolina and the University of Pittsburg School of Medicine. According to Dr. John Mellors, the study’s lead author and University of Pittsburg School of Medicine Chief Division of Infectious Diseases the primary goal was to find out where HIV hides in the body even with potent treatments.
Mellors’ team analyzed the cerebrospinal fluid of about 70 people who had been treated for HIV for an average of nine years. The researchers found that half of the individuals had HIV cells in the spinal fluid.
Around 30 percent of them met the conditions used to define impaired cognition. Only 11 percent of them had no HIV cells in the region but still suffered from cognitive issues.
Mellors said the team didn’t believe it would discover the cells in the brain fluid half of the participants and he was just as surprised to see the cells linked to poor neurocognitive function.
NYU Langone Health Infectious Disease Specialist Dr. Mark Mulligan said the study is momentous and leads to further questions that must be answered if there is ever going to be a cure for HIV and AIDS.
Mulligan said it expands on the present understanding of HIV in the brain.
There is a huge demand in understanding HIV and all its complexities, as there are roughly 1.1 million people who have the disease with another one in seven who don’t know they have it.
Though gay and bisexual men are most at risk for the disease, it’s a condition that affects anyone regardless of their background or sex. Transgender people, women and people of color face both economic and social obstacles in getting treatment for the disease.
And, there’s been a tremendous amount of change since the height of the disease epidemic.
People who follow their treatments can have a viral load that’s virtually undetectable, which means they may not transmit the virus to their sexual partners who are not HIV positive. Still, a lot of work has to be done. Since HIV has no cure and, even with the best possible treatments, the virus remains in the body.
The brain is the one known place of persistence for HIV. Mulligan said cognitive ability could either be mildly or severely impaired – dementia, Alzheimer’s disease – when the person isn’t taking antiviral treatments. And, even with treatments, the changes in cognition is subtle.
According to Mulligan, this may be the result of several factors such as the virus directly affecting the brain cells or the indirect nature such as inflammation damaging the brain cells, a compromised immune system and other co-existing issues.
He said HIV cognition problems are significant but are not as frequent and severe in today’s form of treatments. Still, he said, more research on brain health is needed to improve the brain health of those infected with HIV.
Mulligan said research for a cure would need to involve total eradication of HIV in the body including the brain where it can hide even in individuals with s long-term treatment.
He said the biggest point people should take from the research is that HIV can lead to brain dysfunction even with the best treatments being used even though it’s not known how HIV in the spinal fluid is causing the problem. Mulligan said more work must be done to determine the cause and effect.
Mellors’ team is still looking at the kind of HIV cells that are in the fluid; if it’s infectious and tearing them apart to determine the relationship between the cognitive decline and infected cells.
Anyone with HIV or know someone with HIV should talk to their doctor and an HIV specialist about the possibility of cognitive decline. The doctor will need to take a thorough medical history, do a physical exam, send off for blood tests and order brain scan images. They may even suggest a spinal tap to see what the cerebrospinal fluid reveals.
Written by Mark Riegel, MD
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