Dr. Feinberg,

Previously, a woman had posted a question regarding the cleansing of hiv from the blood, and you said that hiv is not only in the blood, but also the brain. Does this mean that it could be assumed everyone who is positive, has at least some hiv in their brain, or only those with high viral loads and low tcell counts, or just a portion of people with hiv have it in their brains for unknown reasons?

thanks

It is thought that when people are first infected with HIV, the virus gets access to the entire body through the bloodstream. The virus is able to live in certain cells of the body besides CD4 lymphocytes, inlcuding a certain type of cell in the brain. The HIV in brain may not cause problems if the circulating HIV is well controlled-- for example, we are seeing fewer patients with HIV dementia now that powerful combination therapy has become available. There is still much to be learned, though, about HIV in other body compartments besdies the bloodstream.