HIV-associated neurocognitive disease continues in the antiretroviral era

Despite the ability to suppress viral replication with antiretroviral therapy, HIV-associated neurocognitive disturbances can still be detected in nearly half of patients. Neurologic dysfunction before initiating or in the absence of antiretroviral treatment is primarily the result of neuronal dysfunction or loss from direct viral effects, whereas that in patients receiving antiretroviral therapy appears to be associated at least in part with inflammation driven by chronic low-level infection. Contributing factors may include genetic differences in HIV and human hosts and aging of patients. This article summarizes a presentation on HIV-associated neurocognitive disorder made by David B. Clifford, MD, at an International AIDS Society-USA Continuing Medical Education course in New York in October 2007.