Chapter

Viral Dynamics

Davey M. Smith and Ronald J. Ellis

in The Neurology of AIDS

Third edition

Published on behalf of Oxford University Press

Published in print December 2011 | ISBN: 9780195399349
Published online September 2012 | e-ISBN: 9780199965199 | DOI: http://dx.doi.org/10.1093/med/9780195399349.003.0060
Viral Dynamics

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  • Disorders of the Nervous System
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The central nervous system (CNS) possesses specific physiologic and anatomic characteristics that can contribute to the genetic evolution of HIV both in the CNS and systemically. The CNS can function as a reservoir, a compartment, and a drug sanctuary. A viral "reservoir" harbors replication-competent virus, making it possible for the virus to re-emerge after a period of suppression. A viral "compartment" refers to a situation wherein viral movement is restricted between anatomic sites or tissues, such as between the brain and blood. In the CNS, this restricted movement can ultimately lead to a divergence of genetic sequences between compartments. A "drug sanctuary" refers to a restriction of access of medication. As a drug sanctuary, the CNS can create an environment that facilitates additional genetic divergence between the viral populations in blood and CNS. These divergences can have clinical consequences in terms of the selection for antiretroviral resistance. This chapter reviews the evidence and clinical consequences of HIV-1 evolution and dynamics associated with the specialized tissues of the CNS.

Chapter.  8375 words.  Illustrated.

Subjects: Disorders of the Nervous System ; Infectious Diseases

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