Fig. 1
From: Relevance of retrovirus quantification in cerebrospinal fluid for neurologic diagnosis
Mechanism of HIV-acquired drug resistance with the central nervous system as reservoir. a Initial phase of HIV infection: HIV is replicating in blood and access the CNS. b cART is initiated and controls the viremia. However, depending on the drug regimen, the drug access to the CNS is poor, and HIV can efficiently replicate in this reservoir. As replication occurs, a mutated virus can be formed (compartmentalization). c Mutated HIV enters the bloodstream. The mutated virus is able to replicate more efficiently in the cART poor environment (CNS) and could get into the bloodstream. d The mutant drug-resistant virus replicates efficiently even with cART therapy. In such cases, the medication has to be changed. The higher replication rate in the CNS is associated with the high proviral load in the CNS despite the proviral load in blood and is associated with neurologic abnormalities in HIV-infected patients