Neuro-AIDS: Current Status and Challenges to Antiretroviral Drug Therapy (ART) for Its Treatment

Abstract

Introduction: The infiltration of HIV into the brain alters the functions of the nervous system known as NeuroAIDS. It leads to neuronal defects clinically manifested by motor and cognitive dysfunctions. Materials/Methods: Current antiretroviral therapy can prevent viral replication but cannot cure the disease completely. HAART-Highly active antiretroviral therapy used for the treatment of HIV infection. Challenges in neuro-AIDS therapy are as shown in the graphical abstract. One of the challenges is latent viral reservoirs like the brain; which acts as a sanctuary site for viruses. Nearly ~50% of HIV patients show neuropathological signs. Nervous system related disorders including AIDS dementia, sensory neuropathy, and myelopathy have a 25% of prevalence in patients having access to a highly active combination antiretroviral therapy. Results/Conclusions: Brain is one of the viral sanctuary sites for HIV. The current need of neuro-AIDS therapy is to target the brain as a viral reservoir. Drugs should cross or bypass the blood-brain barrier to reach the brain with effective concentrations. Current research on novel drug delivery approaches may prove helpful to treat neuro-AIDS and related disorders effectively.

Nose to brain delivery of nanosuspensions with first line antiviral agents is alternative treatment option to Neuro-AIDS treatment

“…The FTIR spectrum of drugs, polymer, and surfactants were recorded by FTIR spectrophotometer (Carry 630 FTIR, Agilent Tech.) In an FTIR spectrophotometer, all samples were scanned between wave numbers 500 and 4000 cm -1 [ 18 ]. FTIR was performed to analyze the inactivation or loss of the drug due to its conversion to a less therapeutically efficacious physical or chemical form.…”

Sirtuins as Interesting Players in the Course of HIV Infection and Comorbidities

“…Current treatment regimens have good CNS penetration, and rapid implementation of cART effectively prevents more severe forms of HAND [139]. As a result of the introduction of cART, the incidence of diseases such as AIDS dementia (AD), myelopathy or sensory neuropathy has significantly decreased [140]. However, about 50% of HIV-infected patients suffer from one of the milder forms of HAND, the most common being asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND) [132].…”

Nose to brain delivery of Efavirenz nanosuspension for effective neuro AIDS therapy: in-vitro, in-vivo and pharmacokinetic assessment

“…Nose to brain drug delivery via trigeminal and olfactory pathway is a success for migraine therapy and vaccine delivery, which may prove a better alternative for ARV to reach the brain with an effective drug level. The design of promising drug delivery approaches for life-threatening HIV infection may save the brain from Neuro-AIDS and help to enhance the socio-economic life of HIV patients [ 8 ]. Intranasal nanoformulations enhances drug bioavailability to the CNS as this route protects the drug from chemical and biological degradation, it prevents P-gp efflux proteins associated extracellular transport of drug, nano size of drug facilitates transcellular transport via neuronal pathway [ 9 ].…”