Introduction
PWH, neuronal injuries, neuronal injury, HAD, neurotoxicity, HAND, neuronal dysfunction, HIV (PWH, AD
VIRUS, NEURODEGENERATION, PATHOPHYSIOLOGY, PLAQUE, CHRONIC INFLAMMATION
Since the advent of antiretroviral therapy (ART), HIV management has improved dramatically, resulting in a decrease in early mortality in people with HIV (PWH) (Trickey et al. The high reported rates of ANI in PWH are, however, controversial. There is growing concern that relying solely on neuropsychological performance can lead to false positives of up to 20% (Gisslen et al. The pathophysiology of HAND is complex and multifactorial. The viral pathway involves neuronal dysfunction and irreversible neuronal injury, which often correlates with the level of virus circulating in the plasma (Marcotte et al. Preliminary results from observational and experimental studies suggest that this form of chronic neuronal injury may set off neurodegeneration. In addition, there has been a steady rise in the number of PWH living beyond the age of 50 years (Autenrieth et al. GSK-3-β is a serine protein kinase that promotes cellular apoptosis (Thornton et al. Various surrogate biomarkers can be analyzed from plasma and CSF to assess the effectiveness of treatments against HAND. Some of the biomarkers have been studied extensively in HAND and found to be highly sensitive and specific for neuronal injuries, such as the neurofilament light chains (NfL) (Gisslén et al. Because of similarities between AD and HAD, such as the chronic inflammatory state, research has been conducted on CSF amyloid and tau protein metabolism in patients with HAND. Aβ plaque synthesis may be triggered by chronic inflammation, microglial activation, and disruption of the blood–brain barrier (BBB) (Noe et al. Similarly, in a study by Gisslen et al. (Lithium confers neuroprotection by modulating neurotransmission and preventing neurotoxicity (Malhi et al. In this study, we aimed to determine whether lithium can halt or reverse the injury caused by HIV in patients diagnosed with moderate to severe HAND who are on stable ART treatment. This study is the first to use biomarkers across several pathways hypothesized to be involved in HAND and AD.