Central nervous system complications of human immunodeficiency virus infection

Despite the success of active antiretroviral therapy (ART) in reducing human immunodeficiency virus (HIV) comorbidities and mortality, people living with HIV (PLWH) continue to exhibit central nervous system (CNS) disease. Latently infected CNS immune cells, secondary ART toxicities, rebound viruses, low blood brain barrier ART penetration, opportunistic infections, substance abuse disorders, nutritional deficiencies, and sustained neuroinflammation are considered several of the factors that drive HIV neuropathogenesis. Common disease signs and symptoms include mild cognitive and motor impairments with neuropsychiatric complications of depression and social withdrawal. Research continues in its quest to identify brain homeostatic targets to sustain neural homeostasis, control neuroinflammation, protect against viral and cell-associated neuronal damage, and discover neuroprotective therapeutic agents. All serve to enable the restitution of cognitive dysfunction. The complexities of what is now considered a multifactorial disease provide new avenues for biomarker discovery and newer treatments. Each serves to improve the quality of life for PLWH. The emergence of new technologies to halt viral transmission and protect the brain in disease, in tandem, serves as guides for newer therapeutic approaches to improve disease outcomes.