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Global HIV neurology

a comprehensive review

Thakur, Kiran T.a; Boubour, Alexandrab; Saylor, Deannac; Das, Mitasheed; Bearden, David R.e; Birbeck, Gretchen L.f,g

doi: 10.1097/QAD.0000000000001796

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:

Received 31 August, 2017

Revised 18 February, 2018

Accepted 21 February, 2018

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