Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
aDivision of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Medical Center
bBarnard College, Columbia University, New York, New York, USA
cDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
dPrinceton University, Princeton, New Jersey
eDepartment of Neurology, Division of Child Neurology, University of Rochester, Rochester, New York
fDepartment of Neurology, Epilepsy Division, University of Rochester, Rochester, New York, USA
gChikankata Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.
Correspondence to Kiran T. Thakur, MD, Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, NY 10032, USA. Tel: +1 212 305 7236; fax: +1 212 305 2792; e-mail: firstname.lastname@example.org
Received 31 August, 2017
Revised 18 February, 2018
Accepted 21 February, 2018
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