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Viral genetic differences are possible key to HIV dementia

equences from subjects with little or no cognitive deficit. "In other words," says Pillai, "there appears to be a particular HIV mutation that is associated with dementia." He cautions that this result is "suggestive, not conclusive," because of the study's small sample size.

This information "may be clinically relevant in terms of treatment," Pillai explains. "If we identify the quintessential neurotoxic variant of HIV, could we use that as a predictor of HIV dementia?" He says that such knowledge could also help care providers make "guided therapeutic decisions ?for example, the detection of particular viral genotypes may lead physicians to select for antiretroviral regimens that cross the blood-brain barrier into the CNS most efficiently." Or, he speculates, "we might actually try to design a drug to target these genetic variants that are responsible for the neurological damage."

Pillai notes that the issue of HIV dementia is particularly important in regions outside North America and Europe where state-of-the-art antiretroviral medications are not widely available and HIV infection frequently leads to dementia.

SFVAMC staff physician Joseph K. Wong, MD, associate professor of medicine at UCSF and senior author of the study, adds, "In addition to the implications of this new knowledge for the 40 million people infected with HIV, this study may also contribute to our general understanding of viral encephalitis," or brain inflammation caused by other viruses. "These results suggest that specific features of viral components themselves, and not just the immune response to viral infection, may be responsible for direct damage to the nervous system."

Pillai says that even though the study included almost 500 gene sequences, it is still exploratory: "We are now in the process of expanding this to a survey of 100 to 150 individuals."

The study's co-authors were Sergei L. Kosakovsky Pond, PhD, of UC San Diego; Yang Liu, P
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Source:University of California - San Francisco


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