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Evolving clinical phenotypes in HIV-associated neurocognitive disorders
1aDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland bDepartment of Neurology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
Current Opinion in HIV and AIDS
|September 10, 2014
Summary
The presentation of HIV-associated neurocognitive disorders (HAND) has shifted. While severe dementia decreased with combination antiretroviral therapy (cART), milder forms like asymptomatic neurocognitive impairment (ANI) increased, requiring early recognition and treatment.
Area of Science:
- Neuroscience
- Infectious Diseases
- Neurology
Background:
- HIV-associated neurocognitive disorders (HAND) remain a significant concern for individuals living with HIV.
- The advent of combination antiretroviral therapy (cART) has profoundly impacted HIV management and associated neurological complications.
Purpose of the Study:
- To compare the clinical presentation and progression of HAND in the pre-cART era versus the current cART era.
- To understand the evolving landscape of neurocognitive impairment in individuals with HIV.
Main Methods:
- Review of existing literature and clinical data comparing HAND presentation before and after cART implementation.
- Analysis of changes in the frequency and characteristics of different HAND stages.
Main Results:
- A decrease in the incidence of severe HIV-associated dementia (HAD) has been observed with cART.
- An increase in milder forms of HAND, including asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder, is noted.
- Neuropsychological deficits may have shifted from motor and processing speed issues to challenges in learning, memory, and executive functions.
Conclusions:
- HAND continues to be a relevant neurological complication in individuals with HIV, regardless of cART status.
- Asymptomatic neurocognitive impairment (ANI) is a critical precursor to symptomatic HAND, emphasizing the need for early detection and intervention.
- Long-term central nervous system (CNS) injury may persist despite viral suppression with cART.
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