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Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update
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Abstract
Purpose of Review
Perinatally acquired HIV infection (PHIV) can confer neurodevelopmental risk. As children with PHIV increasingly survive through adolescence and into adulthood, understanding its long-term central nervous system (CNS) impacts is critical for maximizing adult outcomes and quality of life.
Recent Findings
Recently published neurocognitive and neuroimaging findings show impacts on the CNS associated with early HIV disease progression that endure into adolescence and young adulthood. Although developmental trajectories in adolescence largely appear stable, further research on maturational processes is indicated.
Summary
Although early antiretroviral therapy in infancy appears to be protective, it is not universally available and current youth largely developed without its benefit. The neurocognitive effects of HIV and the multiple other risks to neurodevelopment experienced by youth with PHIV call for further longitudinal research and a multifaceted approach to prevention and intervention.
That HIV can have significant neurologic and neurocognitive effects has been well known since the early years of the epidemic, and prior to the introduction of ART, particularly combination ART (cART) in 1995, perinatal acquisition was associated with a high risk for poor brain development, encephalopathy and other neurologic sequelae [5]. Since then, the picture of CNS complications of PHIV has evolved as therapies have been refined, availability has increased, albeit at different rates in various regions of the world, and guidelines regarding treatment initiation have changed. At the same time, studies conducted largely in adults have described ongoing impacts of HIV on the CNS despite ART and clarified many aspects of neuropathogenesis; these include early HIV entry into the CNS, ongoing effects through immune activation and inflammation despite viral suppression, maintenance of a viral reservoir in the CNS compartment, and varying neurotoxicity of ART regimens [6, 7]. In both youth and adults, critical issues include HIV’s evolving and often subtle functional effects, disentangling them from other influences on CNS functioning, impact on everyday functioning, and development of preventive and rehabilitative therapies.
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