Central Nervous System Infection by HIV-1: Special Emphasis to NeuroAIDS in India

Advent of combinatorial antiretroviral therapy has widely declined the number of HIV related deaths. It has however resulted in an increase in number of people living with HIV, and their morbidity in terms of their compromised brain functions, thereby worsening the overall scenario in the form of HIV associated neurocognitive impairment that are studied under the umbrella of neuroAIDS. Productively infected macrophages “hijack” brain parenchyma, resulting in slow neurodegeneration especially in the basal ganglia, hippocampus, prefrontal cortex and white matter. Although not directly infected, neurons undergo apoptosis via different pathways as discussed in the review. In addition, more devastating is the condition when HIV synergizes with drugs of abuse and brings in oxidative stress, elevation of inflammatory cytokines and increased calcium waves ultimately leading to augmented excitotoxicity. Mother to child transmission has been another important risk factor in the field of HIV rendering the neonates afflicted with severe neurodevelopmental delays and reduced immune response. Increase in several cytokines and other molecules have been promising in early diagnosis of the syndrome, but search for a biomarker is still on. In this review, we have outlined the recent developments in the field, practical challenges in neuroAIDS research and possible future directions that may help in better management of the disease.