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Neurocognitive dysfunction in the highly active antiretroviral therapy era
Nomvuyo Z Mothobi1, Bruce J Brew
1Department of Neurology and HIV Medicine, St. Vincent's Hospital, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, New South Wales, Australia.
Current Opinion in Infectious Diseases
|December 14, 2011
Summary
HIV-associated neurocognitive disorders (HAND) remain prevalent despite treatment. Central nervous system-penetrating antiretroviral therapy (neuro-HAART) shows promise, but further research on HAART neurotoxicity and cardiovascular links is needed.
Area of Science:
- Neuroscience
- Infectious Diseases
- Public Health
Background:
- HIV-associated neurocognitive disorders (HAND) persist despite advances in highly active antiretroviral therapy (HAART).
- Understanding the reasons for HAND persistence is crucial for improving patient outcomes.
- Recent large cohort studies confirm the continued high prevalence of HAND.
Purpose of the Study:
- To review the ongoing high prevalence of HAND in the HAART era.
- To examine recent studies investigating the causes of HAND persistence.
- To synthesize current evidence on prevention and treatment strategies for HAND.
Main Methods:
- Review of recent large cohort studies on HAND prevalence.
- Analysis of recent research on potential factors contributing to HAND persistence.
- Synthesis of findings from studies evaluating neuro-HAART efficacy and HAART neurotoxicity.
Main Results:
- HAND remains prevalent, even with effective viral suppression.
- Central nervous system-penetrating HAART (neuro-HAART) shows benefits for neurocognitive outcomes.
- Early HAART initiation is supported by new evidence; potential HAART neurotoxicity requires further study.
- Ageing does not fully explain HAND persistence; cardiovascular risk factors correlate with HAND.
Conclusions:
- HAND prevalence remains high, underscoring the need for effective management strategies.
- Neuro-HAART appears beneficial for HAND prevention and treatment.
- Further investigation into HAART neurotoxicity, combined ageing and HIV effects, and the cardiovascular disease-HAND link is warranted.
- Clinical screening for HAND is essential to reduce associated morbidity and mortality.
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