HIV Can Spread Early And Evolve In Patients' Brains

HIV Can Spread Early And Evolve In Patients' Brains
This photo shows HIV (yellow), infecting a human immune cell.
(Credit: Seth Pincus, Elizabeth Fischer and Austin Athman,
National Institute of Allergy and Infectious Diseases,
National Institutes of Health.)
The HIV virus can genetically evolve and independently replicate in patients' brains early in the illness process, researchers have discovered. An analysis of cerebral spinal fluid (CSF), a window into brain chemical activity, revealed that for a subset of patients HIV had started replicating within the brain within the first four months of infection. CSF in 30 percent of HIV-infected patients tracked showed at least transient signs of inflammation - suggesting an active infectious process - or viral replication within the first two years of infection. There was also evidence that the mutating virus can evolve a genome in the central nervous system that is distinct from that in the periphery. The findings are published in the journal PLoS Pathogens.
Prior to the study, it was known that HIV readily penetrates the brain and can trigger neurological problems and eventually cause dementia over the course of the infection. Yet there was little evidence about how quickly it can take hold and thrive there. Nor was it clear to what extent the brain serves as a hard-to-reach hideout from which the virus might re-infect the body - even if it is eliminated from peripheral blood and lymph node tissue by treatment.
To learn more, the researchers compared evidence of HIV activity in CSF versus blood from 72 untreated HIV-infected patients over the first two years of their infection. Overall, 10-22 percent of the patients showed evidence of HIV replication or inflammation in the brain at the different time points analyzed within the first two years - and the signs persisted over time in about 16 percent of the participants.
The evidence suggests that in most patients peripheral forms of the virus infect immune cells that spread to the brain via blood. Yet in some patients, genetic versions of the virus not found in blood evolve in the brain environment. So it could become an independent, compartmentalized viral reservoir, capable of generating treatment-resistant mutant forms that could break out and re-infect the rest of the body after seemingly successful treatment.
These results underscore the importance of early diagnosis and treatment with antiretroviral therapy. Any delay runs the risk that the virus could find refuge and cause damage in the brain, where some medications are less effective - potentially enabling it to re-emerge, even after it is suppressed in the periphery.
Based on material originally posted by NIH/National Institute of Mental Health.