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Mechanisms of Viral and Cell Entry into the Central Nervous System 

Mechanisms of Viral and Cell Entry into the Central Nervous System
Mechanisms of Viral and Cell Entry into the Central Nervous System

Eliseo A. Eugenin

and Joan W. Berman

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date: 07 July 2020

This chapter focuses on four mechanisms that have been proposed to explain how HIV crosses the blood-brain barrier (BBB) and gains access to the central nervous system (CNS): (1) Trojan Horse model: infected monocytes and perhaps CD4+ lymphocytes act as vehicles to transport the virus from the blood to the CNS and, subsequently, to recruit more inflammatory cells into the CNS. (2) Direct infection of BBB endothelial cells and astrocytes: these infected BBB cells either infect CNS parenchymal cells or release free virus into the CNS. (3) Transcytosis model: internalization of HIV virus by endothelial cells or astrocytic foot processes, with subsequent transfer of the virus to CNS cells. (4) Viral entry due to BBB disruption: this theory is non-specific and forms an element of the other three theories, in that entry of HIV into the brain ultimately depends on the loss of BBB integrity due to any cause, including causes associated with the other theories. Explanation of these theories is followed by a discussion of how current antiviral regimens influence the BBB in HIV-infected patients.

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