Studying the neuropsychological sequelae of SARS-CoV-2: lessons learned from 35 years of neuroHIV research
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REVIEW
Studying the neuropsychological sequelae of SARS-CoV-2: lessons learned from 35 years of neuroHIV research Andrew Levine 1
&
Ned Sacktor 2 & James T. Becker 3
Received: 15 June 2020 / Revised: 11 August 2020 / Accepted: 18 August 2020 # Journal of NeuroVirology, Inc. 2020
Abstract 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. Keywords Neuropsychology . COVID-19 . SARS-CoV-2 . NeuroHIV . HIV-associated neurocognitive disorders
COVID-19: neurological symptoms and outcomes Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and the associated syndrome, coronavirus disease 2019 (COVID-19), first gained attention in December of 2019 in the city of Wuhan, China (World Health Organization: Naming the coronavirus disease (COVID-19) and the virus that causes it 2020). Transmission to humans was zoonotic, apparently originating in bats (Zhou et al.
* Andrew Levine [email protected] 1
Department of Neurology David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
2
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
3
Departments of Psychiatry, Neurology, and Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
2020), possibly via pangolins (Lam et al. 2020) and/or snakes (Ji et al. 2020). Herein, we use the terms SARS-CoV-2 and COVID-19 to describe the virus and its associated clinical syndrome, respectively. All studies of neurological outcomes have occurred in individuals diagnosed with COVID-19 and have consisted of case reports and case series. There are, as of yet, no studies of the neuropsychological se
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