Antiretroviral treatment of central nervous system HIV‐1 infection: a review

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Abstract
HIV‐1 infects the central nervous system (CNS) and it has been feared that the CNS may be a sanctuary site where HIV‐1 could hide and continue to replicate despite otherwise effective antiretroviral treatment. Neurological HIV‐1 related symptoms, cerebrospinal fluid (CSF) viral load, intrathecal immunoactivation and CSF drug concentration measurements are considered in this review of antiretroviral treatment effects on CNS HIV‐1 infection. We conclude that antiretroviral combination treatment regimens improve neurocognitive symptoms in HIV‐1 infection and substantially lower CSF viral load. The threat of an increasing number of patients with neurological symptoms and continued HIV‐1 replication in the brain despite otherwise effective antiretroviral therapy has not yet proved to be a problem. It is, however, important to keep this potential risk in mind, and more longitudinal prospective studies addressing the issue of antiretroviral treatment effects on CNS HIV‐1 infection are needed.