Abstract

HIV causes neurodegeneration and dementia in AIDS patients, but its function in milder cognitive impairments in virologically suppressed patients on antiretroviral therapy is unknown. Such patients are immunocompetent, have low peripheral and brain HIV burdens, and show minimal brain neuropathology. Using the model of HIV-related memory impairment in EcoHIV-infected conventional mice, we investigated the neurobiological and cognitive consequences of efficient EcoHIV expression in the mouse brain after intracerebral infection. HIV integrated and persisted in an expressed state in brain tissue, was detectable in brain monocytic cells, and caused neuroinflammatory responses and lasting spatial, working, and associative memory impairment. Systemic antiretroviral treatment prevented direct brain infection and memory dysfunction indicating the requirement for HIV expression in the brain for disease. Similarly inoculated murine leukemia virus used as a control replicated in mouse brain but not in monocytic cells and was cognitively benign, linking the disease to HIV-specific functions. Memory impairment correlated in real time with hippocampal dysfunction shown by defective long-term potentiation in hippocampal slices ex vivo and with diffuse synaptodendritic injury in the hippocampus reflected in significant reduction in microtubule-associated protein 2 and synapsin II staining. In contrast, there was no evidence of overt neuronal loss in this region as determined by neuron-specific nuclear protein quantification, TUNEL assay, and histological observations. Our results reveal a novel capacity of HIV to induce neuronal dysfunction and memory impairment independent of neurotoxicity, distinct from the neurotoxicity of HIV infection in dementia.IMPORTANCE HIV neuropathogenesis has been attributed in large measure to neurotoxicity of viral proteins and inflammatory factors produced by infected monocytic cells in the brain. We show here that HIV expression in mouse brain causes lasting memory impairment by a mechanism involving injury to hippocampal synaptodendritic arbors and neuronal function but not overt neuronal loss in the region. Our results mirror the observation of minimal neurodegeneration in cognitively impaired HIV patients on antiretroviral therapy and demonstrate that HIV is nonneurotoxic in certain brain abnormalities that it causes. If neurons comprising the cognition-related networks survive HIV insult, at least for some time, there is a window of opportunity for disease treatment.

Highlights

  • IMPORTANCE HIV neuropathogenesis has been attributed in large measure to neurotoxicity of viral proteins and inflammatory factors produced by infected monocytic cells in the brain

  • HIV infection causes brain abnormalities known as HIV-associated neurocognitive disorders (HAND) that include HIV-associated dementia (HAD) and two non-HAD neurocognitive impairments (NCI), asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND) [1]

  • NCI was described in AIDS patients independent of dementia [13, 14], the failure of antiretroviral therapy (ART) to prevent NCI [2, 3] suggests routes of HIV neuropathogenesis unlinked to virus burden and immunodeficiency and different from HAD/HIV encephalitis (HIVE) [15, 16]

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Summary

Introduction

IMPORTANCE HIV neuropathogenesis has been attributed in large measure to neurotoxicity of viral proteins and inflammatory factors produced by infected monocytic cells in the brain. NCI was described in AIDS patients independent of dementia [13, 14], the failure of ART to prevent NCI [2, 3] suggests routes of HIV neuropathogenesis unlinked to virus burden and immunodeficiency and different from HAD/HIVE [15, 16]. Neuronal dysfunction independent of neuronal loss is considered the major pathobiological feature distinguishing NCI from HAD [6] These findings suggest that HIV may act differently in causing NCI and HAD. Given that ART suppresses HIV replication, part of this difference could be quantitative, but the demonstration of mild NCI in AIDS patients with high virus burdens [13, 18] speaks against it. We used intracerebral (i.c.) virus delivery for efficient EcoHIV infection in immunocompetent mouse brain [24, 27] to directly evaluate the neurobiological and cognitive effects of HIV expression in the mouse brain

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