CAB38; HIV and the brain

Friday 15 April 2011

At the MRC Clinical Trials Unit, 222 Euston Road, London, NW1

Programme

09:30-09:50 Registration, refreshments and expenses
09:50-10:00 Welcome, introductions, UKCAB updates
10:00-11:00 HIV and brain function – Dr Tristan Barber
11:10-11.30 Pre-Meeting for Abbott – Ben Cromarty
11:30-11:45 Break
11:45-12:45 HIV, antiretroviral therapy and the brain – Dr Sam Nightingale
12:40-14:00 Lunch
14:00-15:30 Company meeting: Abbott
15.30-15.35 Break
15:35-16:00 Changes to HIV prescribing in London and what implications this could have for the rest of the UK, UKCAB AOB
16.00 Close

Introduction:

The meeting will be looking at how HIV affects the brain.

This is an area where there are lots of questions and so far very few answers.

HIV causes inflammation in other organs, so perhaps also in the brain. How much virus gets to the brain in the cerebrospinal fluid (CSF)?   Is this important? Can it be measured? Is the choice of treatment likely to be important for everyone? Or just some people?

HAART has changed the treatment of HIV so that many of us can now lead long and productive lives. However the brain is a very sensitive organ and the body keeps it protected from substances it does not recognise. As a result HIV drugs have difficultly entering the brain and are often pumped back out if they do enter. This means that the level of drugs in brain fluid can be as little as 1% of that in blood. Lots of studies show that for different reasons these low levels may be enough – but do we need this from one, two or all three drugs.

In some people HIV can be found in the brain despite it being undetectable in blood. Sometimes the reverse is true. Does this matter?

Other studies looking a symptoms have shown that up to half of HIV positive people can have minor problems with thinking and memory, despite treatment.

We hope to discuss questions such as:

  • What tests can I have for brain impairment?
  • What can and can’t the doctor measure in the brain?
  • Are there any tools to improve brain impairment?
  • What drugs best penetrate the CSF?
  • What studies are being done on HIV and the brain?

Background reading:

HIV and the BrainThe Body

Covers a variety of issues from brain impairment to the role of HAART. You can easily jump to the areas of interest using the hyperlinks. A long but easy to read document.

Controlling HIV in the BrainamFAR AIDS Research

Steve Deeks’ work on elite controllers is interesting, the article looks at comparisons of brain inflammation of the elite controllers with three groups – HIV negative, HIV positive with detectable, HIV positive with undetectable viral load.

HIV infection in the brain: a long-term limitation of HAART?HTB, i-Base

This article focuses on neurological brain function while on HAART.  Looks at CSF viral load and drug penetration into the brain. Needs to be read a few times to be understood as it is quite technical.

Studies confirm that drugs that penetrate brain control HIV better and improve symptoms of brain impairmentAidsmap

Article reports on studies about whether HAART improves brain impairment. It is fairly easy to read and to understand and not lengthy.

HIV detectable in CSF of 10% of patients taking successful antiretroviral treatmentAidsmap

Report on studies looking at how much virus escapes into the brain through the CSF, participants were all on HAART with undetectable viral loads. 10% had detectable viral loads in their CSF, which was associated with increased inflammation the brain.

Financial support

The UK-CAB receives unrestricted funding from some pharmaceutical companies towards the direct costs of holding four meetings each year. This funding supports the travel and accommodation costs for members to attend from outside London, plus the cost of catering.

The content, programme and agenda for meetings is decided by the UK-CAB steering group in consultation with the wider membership. Funding is unconnected to meeting content.

We believe that manufacturers who currently develop and market medicines have a responsibility to actively engage with advocacy organisations and that HIV positive people and their advocates should be able to directly question manufacturers about the safety and efficacy of their products and proposals for future research.

For a list of companies that support the UK-CAB please see the “about us” page.

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Published: April 19, 2011
Last edited: August 13, 2013