Interventions for Neurocognitive Dysfunction.

Area of Science:

• Neuroscience
• Infectious Diseases
• Neurology

Background:

• The central nervous system (CNS) is a sanctuary for HIV, complicating eradication efforts.
• While antiretroviral therapy (ART) reduced HIV-associated dementia, milder forms of HIV-Associated Neurocognitive Disorder (HAND) remain prevalent and significant.
• Neurotoxicity and cerebrovascular risks associated with ART require careful management.

Purpose of the Study:

• To review current barriers to HIV cure strategies.
• To evaluate interventions for neurocognitive dysfunction in the context of HIV.
• To highlight recent advancements in the last three years.

Main Methods:

• Review of recent literature on HIV cure strategies and neurocognitive dysfunction.
• Analysis of advancements in diagnostic imaging (diffusion tensor imaging, resting-state fMRI).
• Evaluation of emerging biomarkers (BCL11B, neurofilament light chain) and their role in neuroinflammation.

Main Results:

• Optimal ART regimens face challenges in balancing neurotoxicity, blood-brain barrier penetration, and cerebrovascular risk.
• CSF biomarkers like BCL11B and neurofilament light chain may indicate neuroinflammation contributing to cognitive impairment.
• Advanced imaging techniques show potential for diagnosing and monitoring HAND.
• Despite ART's success against dementia, HAND persists as a clinical challenge.

Conclusions:

• The CNS reservoir remains a major barrier to HIV cure.
• Understanding neuroinflammation and utilizing advanced diagnostics are crucial for managing HAND.
• Continued research into ART optimization and novel therapeutic targets is essential for improving outcomes in individuals with HIV.