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Viral Dynamics 

Viral Dynamics
Chapter:
Viral Dynamics
Author(s):

Davey M. Smith

and Ronald J. Ellis

DOI:
10.1093/med/9780195399349.003.0060
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date: 17 June 2019

The central nervous system (CNS) possesses specific physiologic and anatomic characteristics that can contribute to the genetic evolution of HIV both in the CNS and systemically. The CNS can function as a reservoir, a compartment, and a drug sanctuary. A viral "reservoir" harbors replication-competent virus, making it possible for the virus to re-emerge after a period of suppression. A viral "compartment" refers to a situation wherein viral movement is restricted between anatomic sites or tissues, such as between the brain and blood. In the CNS, this restricted movement can ultimately lead to a divergence of genetic sequences between compartments. A "drug sanctuary" refers to a restriction of access of medication. As a drug sanctuary, the CNS can create an environment that facilitates additional genetic divergence between the viral populations in blood and CNS. These divergences can have clinical consequences in terms of the selection for antiretroviral resistance. This chapter reviews the evidence and clinical consequences of HIV-1 evolution and dynamics associated with the specialized tissues of the CNS.

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