In recent years, the early initiation of antiretroviral therapy and the use of new drug combinations, particularly integrase inhibitors, have led to improved HIV treatment effectiveness, safety, and adherence. Despite systemic control of the infection and good therapy outcomes, central nervous system infection can play a key role in this important battle. Indeed, chronic infection of certain central nervous system cells requires new and different control strategies.
According to recent studies, explains Professor Andrea Antinori, an infectious disease specialist and director of the infectious diseases department at the IIRCCS INMI Lazzaro Spallanzani in Rome, one in four people living with HIV shows cognitive deficits. Of these, 25%, two out of three are asymptomatic and can only be detected through special tests. Therefore, we are talking about an impairment of certain functions, such as motor skills, memory, and performance; however, in most cases, it does not significantly affect daily life. Only 2-3% of HIV patients with cognitive impairment develop more serious pathologies, known as dementia, which corresponds to the most advanced stage of the disease.
“ The central nervous system is also a natural reservoir of the virus, because some cells in the central nervous system, such as macrophages and microglia, can harbor the virus . With persistent infection, HIV replicates more slowly and differently than in peripheral blood and other compartments. Combatting the virus, which is hidden in the brain, is the major new challenge for so-called ‘functional cure’ strategies, which aim to achieve control of viral replication even in the absence of therapy.”
HIV, by its very nature, can take refuge in the central nervous system and cause illness. This is because a "sequestration" zone develops in the nervous system where the virus can continue to function undisturbed, leading to mild to moderate cognitive impairment. Most often, these impairments affect attention and memory, as well as executive functions and fine motor skills.
The eighth edition of Neuro HIV, an international conference on HIV infection of the central nervous system, was held in Rome at the NH Collection Vittorio Veneto. Organized by the San Raffaele Hospital in Milan and the Spallanzani Institute in Rome, the event brought together leading basic and clinical researchers from the Italian and international scientific communities.
Italian specialists assert that in Italy, almost all patients have controlled viremia: 90-95% of those undergoing treatment are in a state of viral suppression. However, some problems persist. First, there are the undisclosed cases, meaning those who are unaware that they are HIV-positive: according to recent estimates, there are approximately 15,000 people who are unaware of their status, which can lead to an advanced stage of the disease and the infection of others. Furthermore, preventive action is crucial: more than half of new diagnoses occur during an immunodeficiency phase, and one in five new diagnoses occurs during the stage of manifest disease (AIDS). Therefore, early treatment offers significant advantages in terms of health, safety, and efficacy.
“Several key takeaways emerged from this symposium ,” explains Professor Paola Cinque, an Infectious Disease Specialist at San Raffaele Hospital in Milan . “Firstly, it turned out that severe neurological problems in treated individuals are now almost nonexistent, and are only found in HIV-positive people who are not on therapy. Instead, there is a significant problem related to cognitive impairment, which could also be due to other neurological issues and age. The link between the virus and cognitive problems, in fact, needs to be definitively established: the interpretation of this data is not straightforward. However, from a broader perspective, it is essential to bear in mind that the persistence of the virus in the nervous system represents a potential obstacle to the ambitious goal of eradicating the infection.”
From: http://www.meteoweb.eu/2019/10/hiv-provoca-disturbi-cognitivo-asintomatico/1329059/