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Where does HIV hide? A focus on the central nervous system

Churchill, Melissaa,b; Nath, Avindrac

Current Opinion in HIV and AIDS: May 2013 - Volume 8 - Issue 3 - p 165–169
doi: 10.1097/COH.0b013e32835fc601
STATE OF HIV CURE: Edited by Françoise Barré-Sinoussi and Michael M. Lederman

Purpose of review To review the literature on infection and evolution of HIV within the brain in the context for understanding the nature of the brain reservoir and its consequences.

Recent findings HIV-1 in the brain can evolve in separate compartments within macrophage/microglia and astrocytes. The virus adapts to the brain environment to infect these cells and brain-specific mutations can be found in nearly all genes of the virus. The virus evolves to become more neurovirulent.

Summary The brain is an ideal reservoir for the HIV. The brain is a relatively immune privileged site and the blood–brain barrier prevents easy access to antiretroviral drugs. Further, the virus infects resident macrophages and astrocytes which are long-lived cells and causes minimal cytopathology in these cells. Hence as we move towards developing strategies for eradication of the virus from the peripheral reservoirs, it is critical that we pay close attention to the virus in the brain and develop strategies for maintaining it in a latent state failure of which could result in dire consequences.

aCentre for Virology, Burnet Institute, Melbourne, Australia

bDepartments of Microbiology and Medicine, Monash University, Clayton, Victoria, Australia

cSection of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institute of Health, Bethesda, Maryland, USA

Correspondence to Melissa Churchill, PhD, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia. Tel: +61 3 92822175; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.