Main mechanisms of central nervous system damage with combined infection of HIV and SARS-COV-2: review

Abstract

OBJECTIVE: Assess the degree of elaboration regarding mechanisms of the nervous system damage in HIV infection to further evaluate SARS-CoV-2, as a possible contributing factor in emergence and worsening psycho-neurological pathology in HIV-infected patients. MATERIALS AND METHODS: The analytical review was conducted using the medical database PubMed. More than 20 domestic and 30 foreign publications were studied on the mechanisms of the nervous system damage in HIV infection and SARS-CoV-2 between 2019-2022.Some preliminary study was conducted. Outpatient charts data of 146 HIV-infected patients were analyzed; a confirmed diagnosis of COVID-19 mild or moderate form (between 2020-2022) appeared in 42 (25,8%) cases (1st group). The comparison group (2nd group) included 40 patients without HIV infection, but suffered COVID-19, who were surveyed after signing voluntary informed consent. The survey data provided insight into the frequency and severity of neuropsychiatric manifestations and their possible connection with COVID-19. RESULTS: The high neuroinvasive and neurotropic HIV potential was demonstrated and implemented in a variety of ways and mechanisms that manifests in clinical practice by the appearance of diverse neuropsychiatric symptomatology. The study proved the influence of HIV infection on ACE-2 receptor expression by neurovascular cells (NVC) and also revealed some other features, contributing to the potentiation of SARS-CoV-2 invasion in CNS. The results of the preliminary study showed that in the group with HIV-infected 9 patients (21,4% of recover from COVID-19) experienced long-term neuropsychiatric manifestations after coronavirus infection, while all patients had long-term suppressed HIV viral load against the backdrop of regular ARV therapy and satisfactory immune status (CD4+ T-lymphocytes count). In the group without HIV infection after COVID-19 22 (55%) patients experienced neuropsychiatric complications, estimated by them as “extremely strong”. DISCUSSION: Although the study did not reveal a clear link between the presence of immunodeficiency in HIV infection and manifestation of neuropsychiatric pathology after COVID-19, further research is needed to define mutual influence of HIV and SARS-CoV-2 on the emergence of neuropsychiatric pathology. CONCLUSION: Considering a lack of research, where the results obtained could reliably confirm increased risk of complications from the nervous system, caused by SARS-CoV-2 against the backdrop of the existing HIV infection, there is reason to believe that this problem remains relevant today. This dictates the need to examine closely neurological status in patients of this category and monitor neurological complications.