Studying the neuropsychological sequelae of SARS-CoV-2: lessons learned from 35 years of neuroHIV research

• Published in: Journal of neurovirology 2020-12, Vol.26 (6), p.809-823
• Main Authors: Levine, Andrew, Sacktor, Ned, Becker, James T.
• Format: Article
• Language: English
• Subjects: AIDS Dementia Complex - virology; Biomedical and Life Sciences; Biomedicine; COVID-19 - complications; COVID-19 - virology; Humans; Immunology; Infectious Diseases; Nervous System Diseases - virology; Neurology; Neurosciences; Review; SARS-CoV-2; Virology
• ISSN: 1355-0284; 1538-2443; 1538-2443
• DOI: 10.1007/s13365-020-00897-2

The virology of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the human immune response to the virus are under vigorous investigation. There are now several reports describing neurological symptoms in individuals who develop coronavirus disease 2019 (COVID-19), the syndrome associated with SARS-CoV-2 infection. The prevalence, incidence, and clinical course of these symptoms will become clearer in the coming months and years through epidemiological studies. However, the long-term neurological and cognitive consequence of SARS-CoV-2 infection will remain conjectural for some time and will likely require the creation of cohort studies that include uninfected individuals. Considering the early evidence for neurological involvement in COVID-19 it may prove helpful to compare SARS-CoV-2 with another endemic and neurovirulent virus, human immunodeficiency virus-1 (HIV-1), when designing such cohort studies and when making predictions about neuropsychological outcomes. In this paper, similarities and differences between SARS-CoV-2 and HIV-1 are reviewed, including routes of neuroinvasion, putative mechanisms of neurovirulence, and factors involved in possible long-term neuropsychological sequelae. Application of the knowledge gained from over three decades of neuroHIV research is discussed, with a focus on alerting researchers and clinicians to the challenges in determining the cause of neurocognitive deficits among long-term survivors.