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Early ART Treatment Key to Halting HIV-Related Brain Damage

Brain damage caused by HIV can begin soon after infection, according to new research, but initiating antiretroviral therapy drugs can halt the damage.

Antiretroviral therapy (ART) drugs are key to suppressing HIV symptoms and reducing morbidity and mortality related to infection, and now, in a new study, an international team of researchers found that ART can also stop the progression of HIV-related brain damage.

HIV infection has become a highly manageable disease with longer life expectancies, thanks to the development of ART medications. While these drugs do not kill the virus or offer patients a cure, ART drugs suppress the growth of the virus and slow its progress, while also lowering the chance of transmitting the virus to others. ART drugs are typically taken in combinations of 3 or more, and when taken as recommended can help patients achieve an undetectable viral load.

Among the symptoms of HIV, neurological complications can occur with infection as a result of central nervous system damage. HIV causes inflammation that can damage the brain, leading to problems such as headaches, forgetfulness, issues with balance and coordination, changes in vision, behavioral changes, and seizures. Patients with advanced HIV/AIDS infections may experience HIV-associated dementia with symptoms including cognitive function impairment and trouble thinking, remembering, and understanding. ART medications can reduce the risk of these complications.

In a new study published in the journal Clinical Infectious Diseases, researchers found that such brain damage can occur even in the initial stages of HIV infection, emphasizing the need for early treatment with combination ART. The researchers examined 65 study participants in the primary stages of HIV infection, 30 of whom began treatment with combination ART during follow-up. The study also included 16 participants with chronic HIV and 19 HIV-negative participants for comparison. Participants underwent longitudinal MRA and researchers estimated brain volume and cortical thickness tensor-based morphometry and cortical modeling.

In their findings, the researchers noted that the longer patients’ HIV went untreated, the more brain damage they observed. This included volume loss in the thalamus, caudate, and cerebellum, and cortical thinning in the frontal and temporal lobes, and cingulate cortex. When patients began treatment with combination ART drugs, volume changes stopped and researchers observed cortical thickening in the front and temporal lobes.

“We knew HIV could cause neurological damage, but we did not know it happened so early in the infection,” said co-senior author and Yale professor of neurology Serena Spudich, MD, MA, in a recent statement. “The findings emphasize the importance of identifying infected people early and treating them so we can halt its progression.”

“It also helps focus the search for possible mechanisms of brain injury in this condition, pointing towards injury that occurs principally during untreated infection,” added first author and PhD candidate Ryan Sanford, in a separate statement, noting that this has been one of the few longitudinal structural neuroimaging studies conducted in early HIV infection. “This opens the door to novel treatments focused on potentially reversing these observed structural changes.”