Chapter 5 - Neuropharmacology

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With virologically suppressive antiretroviral therapy, immune system recovery is now achievable for persons living with HIV (PLWH). This immune recovery is associated with dramatic reductions in acquired immune deficiency syndrome (AIDS) defining illnesses including HIV dementia. However, milder form of cognitive disturbances are widely reported in PLWH despite effective antiretroviral therapy. The underlying pathogenic mechanisms of these cognitive disturbances remain elusive, with many potential pathogenic mechanisms including residual brain damage prior to the initiation of antiretroviral therapy and neuroinflammation and ongoing immune system disturbances despite antiretroviral therapy. Lifestyle factors and concomitant infections and medical problems are also likely to be major contributing factors. The penetration of antiretroviral agents into the central nervous system compartment resulting in a lack of suppression of HIV viremia in the brain has generated much interest as well as potential neuro-toxicities from antiretroviral agents themselves. This chapter reviews the clinical pharmacology, both the pharmacokinetic and pharmacodynamic effects, of antiretroviral therapy in the central nervous system compartment.