There is always this issue of unintended consequences of interventions.

-- Scott Letendre, M.D.

In an interview on behalf of IFARA at CROI 2017, Andy Kaytes spoke with three neurologists about neurological issues related to HIV. The effect of even well-controlled HIV on the brain is not receiving enough attention. Now that people living with HIV no longer need to focus only on survival, quality-of-life issues must be addressed. One of the foremost is depression, which may affect up to 30% of people living with HIV. However, it is difficult to tease out the biological foundations of this problem from the psychosocial stresses this population experiences.

A subgroup of people living with HIV may require four antiretrovirals to control the virus in their brain or lymph nodes. Caution must be exercised, though, since the ensuing rapid increase in a person's CD4 count could heighten their immune response to such an extent that it causes "bystander damage."

Antiretroviral medications may also need to be optimized to target the brain's white matter, where the burden of infection appears to be shifting once a person is virally suppressed.

On a positive note, the brief treatment interruptions needed in HIV cure research do not appear to cause the increase in brain inflammation seen in earlier studies.

Watch the video to learn more:

About the panelists:

  • Andy Kaytes, moderator
  • Bruce Brew, M.B.B.S., M.D., FRACP, Department of Neurology, St. Vincent's Hospital, Sydney, Australia.
  • Serena Spudich, M.D., M.A., Neurological Infections & Global Neurology, Yale School of Medicine, New Haven, Conn.
  • Scott Letendre, M.D., Division of Infectious Diseases, University of California, San Diego.

The video above has been posted on with permission from our partners at the International Foundation for Alternative Research in AIDS (IFARA). Visit IFARA's website or YouTube channel to watch more video interviews from the conference, as well as earlier meetings.