The Neuropathology of HIV Infection in the Era of Highly Active AntiRetroviral Therapy (HAART)

Gray, Françoise; Keohane, Catherine

doi:10.1111/j.1750-3639.2003.tb00008.x

Cited by 23 publications

(12 citation statements)

References 38 publications

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“…[ 11 C](R)-PK11195 PET retention in the brain did not differ between HIV infected patients on retroviral drugs with and without neurological deficits (Hammoud et al, 2005. These findings may be in part due to decreased brain inflammation seen in neurologically impaired HIV infected subjects on antiretroviral therapy (ART) without frank dementia (Gray et al, 2003b, Gray et al, 2003a. It is also possible that [ 11 C](R)-PK11195 shows low sensitivity of in detecting milder forms of neuroinflammation.…”

Section: Introductionmentioning

confidence: 90%

The high affinity peripheral benzodiazepine receptor ligand DAA1106 binds to activated and infected brain macrophages in areas of synaptic degeneration: Implications for PET imaging of neuroinflammation in lentiviral encephalitis

Venneti

Wang

Wiley

2008

Neurobiology of Disease

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Section: Introductionmentioning

confidence: 90%

The high affinity peripheral benzodiazepine receptor ligand DAA1106 binds to activated and infected brain macrophages in areas of synaptic degeneration: Implications for PET imaging of neuroinflammation in lentiviral encephalitis

Venneti

Wang

Wiley

2008

Neurobiology of Disease

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“…However, several studies have been published and it appears that the spectrum of CNS disease is now different (Langford et al 2003). Burnt-out forms of HIVE and opportunistic conditions have been described, and persistent cognitive impairment in HAART-treated individuals has been attributed to extensive neural damage predating HAART therapy (Gray and Keohane 2003). Cases have been described of immune reconstitution syndrome, in which the CNS displays very significant lymphocytic infiltration and associated severe white matter damage (Langford et al 2002).…”

Section: The Post-haart Eramentioning

confidence: 98%

Neurobiology of Multiple Insults: HIV-1-Associated Brain Disorders in Those Who Use Illicit Drugs

Bell

Arango

Anthony

2006

Jrnl NeuroImmune Pharm

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Despite two decades of research, certain aspects of HIV-related central nervous system (CNS) disease remain poorly understood. HIV targets microglia and macrophages within the CNS and enters the brain compartment early. However, HIV is there held in check apparently until the onset of significant immune compromise, when viral replication, microglial activation, neuronal damage, and cognitive impairment are likely to ensue. Illicit drug abuse continues to be a significant risk factor for HIV transmission worldwide. Whether HIV-related CNS disease is more prevalent or more severe in this risk group has long been debated. Drugs of abuse can of themselves cause immune suppression, blood-brain barrier breakdown, microglial activation, and neuronal injury. This review presents evidence that HIV associated CNS disorders are indeed accentuated in drug abusers. However, the advent of effective therapy has added a new dimension, which must be taken into consideration. Treated individuals are surviving much longer and HIV encephalitis and HIV-associated dementia have become much less common. However, more subtle forms of CNS damage are emerging. Examination of the brains of individuals who have been treated long term with highly active antiretroviral therapy (HAART) reveals a surprising degree of microglial activation, comparable at times to that seen formerly in milder cases of HIV encephalitis. In addition, these individuals show evidence of increased deposition of neurodegenerative proteins, particularly hyperphosphorylated tau. Similar observations have been made in young opiate abusers who are HIV negative. Taken together, these results suggest that neuroinflammation and neurodegeneration, which are clinically silent at present, may cause problems in the future in HAART-treated subjects.

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“…However, systematic studies of autopsy series from HIV-positive patients evaluating the neuropathological findings are infrequent and most have evaluated the pre-HAART period [4, 5, 7, 9, 15–18] and even scarcer are post-HAART studies [2, 3, 19–23], perhaps because there was an important reduction in the number of autopsies from HIV-positive patients [3, 19, 21, 22]. However, they remain important even after HAART, as changes occurred after that therapy, such as a decrease in opportunistic infections and the increase of HIV encephalitis [24], at least in developed countries, although in the rest of the world, in over 90% of AIDS cases, patients do not survive long enough to present HIV neurological complications [25]. However, these autopsy studies are even rarer in developing countries, which makes it difficult to establish the true prevalence of the neuropathological lesions [26].…”

Section: Introductionmentioning

confidence: 99%

Neuropathology of AIDS: An Autopsy Review of 284 Cases from Brazil Comparing the Findings Pre- and Post-HAART (Highly Active Antiretroviral Therapy) and Pre- and Postmortem Correlation

Silva

Rodrigues

Micheletti

et al. 2012

AIDS Research and Treatment

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A retrospective study of central nervous system (CNS) in 284 autopsy AIDS cases in Brazil (1989–2008) divided into 3 groups: A (without antiretroviral treatment: 163 cases); B (other antiretroviral therapies: 76 cases); C (HAART for 3 months or more: 45 cases). In 165 (58.1%) cases, relevant lesions were found, predominantly infections (54.2%); the most frequent was toxoplasmosis (29.9%) followed by cryptococcosis (15.8%), purulent bacterial infections (3.9%), and HIV encephalitis (2.8%); non-Hodgkin lymphomas occurred in 1.4% and vascular lesions in 1.1%. There was no difference when compared the frequency of lesion among the groups; however, toxoplasmosis was less common while HIV encephalitis was more frequent in group C related to A. CNS lesions remain a frequent cause of death in AIDS; however, the mean survival time was four times greater in group C than in A. In 91 (55.1%) of 165 cases with relevant brain lesions (or 32% of the total 284 cases), there was discordance between pre- and postmortem diagnosis; disagreement type 1 (important disease that if diagnosed in life could change the patient prognosis) occurred in 49 (53.8%) of 91 discordant cases (17.6% of the total 284) indicating the autopsy importance, even with HAART and advanced diagnostics technologies.

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The Neuropathology of HIV Infection in the Era of Highly Active AntiRetroviral Therapy (HAART)

Cited by 23 publications

References 38 publications

The high affinity peripheral benzodiazepine receptor ligand DAA1106 binds to activated and infected brain macrophages in areas of synaptic degeneration: Implications for PET imaging of neuroinflammation in lentiviral encephalitis

The high affinity peripheral benzodiazepine receptor ligand DAA1106 binds to activated and infected brain macrophages in areas of synaptic degeneration: Implications for PET imaging of neuroinflammation in lentiviral encephalitis

Neurobiology of Multiple Insults: HIV-1-Associated Brain Disorders in Those Who Use Illicit Drugs

Neuropathology of AIDS: An Autopsy Review of 284 Cases from Brazil Comparing the Findings Pre- and Post-HAART (Highly Active Antiretroviral Therapy) and Pre- and Postmortem Correlation

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