Changing clinical phenotypes of HIV-associated neurocognitive disorders

Area of Science:

• Neuroscience
• Infectious Diseases
• Neurology

Background:

• HIV-associated neurocognitive disorder (HAND) affects 15-55% of HIV+ individuals, even during combination antiretroviral therapy (CART).
• CART has reduced the prevalence of severe HIV-associated dementia, leading to milder forms like asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND).
• MND can still cause significant functional impairment in daily activities.

Purpose of the Study:

• To describe the evolving clinical features and persistent challenges of HAND in the CART era.
• To highlight the impact of aging and comorbidities on cognitive impairment in HIV+ patients on CART.
• To emphasize the need for novel research into HAND pathogenesis and treatment.

Main Methods:

• Review of clinical features and epidemiological data of HAND in the CART era.
• Analysis of changes in HAND presentation, including cognitive deficits and neurological signs.
• Consideration of factors like viral load suppression, aging, and comorbidities.

Main Results:

• HAND predominantly presents as milder forms (ANI, MND) in the CART era, with reduced dementia prevalence and increased survival.
• Patients on CART with suppressed viral load often show stable HAND, though some deteriorate.
• Executive functioning and working memory deficits are common, alongside persistent central nervous system abnormalities.
• Cerebrovascular risk factors are increasingly implicated in cognitive impairment among aging HIV+ individuals on CART.

Conclusions:

• HAND remains a significant neurological condition in the CART era, characterized by milder but persistent cognitive and neurological deficits.
• The aging HIV+ population faces compounded risks from comorbidities like hypertension and diabetes, exacerbating cognitive impairment.
• Development of new animal models is crucial for understanding HAND pathogenesis and devising effective therapeutic strategies.