Casper Rokx

After HIV acquisition, the virus disseminates to the central nervous system where it affects brain tissue. This session encompassed studies on changes in brain structure, clinical and functional outcomes both in the developing brains of children and the brains of adults during various stages of their HIV infection.

Two substudies of the CHER study evaluated changes in the developing brains of HIV-infected children compared to uninfected peers. The investigators showed that despite suppressive antiretroviral therapy initiated before 18 months of age, persistent white matter abnormalities on magnetic resonance imaging in various brain regions were apparent at 9 years of age. There was evidence of ongoing brain damage especially associated with treatment interruptions. In adults, antiretroviral treatment initiation improved neurocognitive functioning in 400 Ugandan patients, one study reported. However, another study of Ugandan patients found that elevated immune-activation markers (soluble CD14 and kynurenine/tryptophan-ratio) were associated with depression, in the first 2 years of antiretroviral treatment. Data from a Taiwanese cohort suggested an increased stroke risk during the same period. The session closed with 2 conflicting reports on dolutegravir’s neuropsychiatric adverse events with an increased risk observed in a French cohort but not in pooled data from dolutegravir’s phase-III trials.

Once again, the combined data in this session show the detrimental effect of HIV on the brains of children and adults. This effect is unfortunately only partly reversed by antiretroviral therapy. No adjunctive intervention has yet been effective in treating HIV-associated neuro-psychiatric comorbidities. Evidence for these comorbidities are consistently apparent across structural, biochemical, and functional measurements. Investigation of the consequences of the structural brain defects in HIV infected children on functional development is a research priority, as is a more prolonged follow up of children and adults in light of potential for accelerated age-related neuro-psychiatric deficits.