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Related Experiment Video

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Quantification of Cerebral Vascular Architecture using Two-photon Microscopy in a Mouse Model of HIV-induced Neuroinflammation
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HIV-associated neurocognitive disorder.

David B Clifford1, Beau M Ances

  • 1Department of Neurology and Medicine, Washington University in St Louis, St Louis, MO, USA.

The Lancet. Infectious Diseases
|October 26, 2013
PubMed
Summary

Most people with HIV experience neurocognitive impairment despite effective treatment. New biomarkers and optimized therapies are needed to manage HIV-associated neurocognitive disorder and improve brain health.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Public Health

Background:

  • Neurological involvement is common in HIV, often leading to cognitive impairment.
  • While severe cases are rarer with antiretroviral therapy, most HIV patients still show cognitive deficits.
  • HIV-associated neurocognitive disorder (HAND) remains a significant global health concern.

Purpose of the Study:

  • To review HAND manifestations in the era of effective HIV therapy.
  • To outline current diagnosis and treatment recommendations for HAND.
  • To identify remaining research questions and future directions for managing HAND.

Main Methods:

  • Review of current literature on HIV-associated neurocognitive disorder.
  • Analysis of factors associated with cognitive impairment in treated HIV patients.

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  • Discussion of diagnostic and therapeutic strategies for HAND.

    • Main Results:

    • Most HIV patients on treatment exhibit neurocognitive impairment.
    • Traditional HIV markers (viral load, CD4 count) poorly predict ongoing impairment.
    • Cardiovascular and inflammatory markers are more strongly associated with HAND.
    • Comorbidities like hepatitis C or epilepsy do not fully explain the prevalence of impairment.

    Conclusions:

    • Effective HIV therapy has reduced severe HAND but not eliminated cognitive impairment.
    • Novel biomarkers (CSF, neuroimaging) are crucial for detecting and monitoring HAND.
    • Optimizing CNS penetration of HIV therapy and targeting neurotoxicity are key research areas.
    • Complete viral control in the brain is essential for HIV eradication efforts.