Central nervous system and neuropsychiatric disturbances in people living with HIV

CNS/NP disturbances are common in PLWH and still represent one of the major concerns in the modern HIV era. With an increasingly aging population, the spectrum of these manifestations depends on several factors, such as HIV direct activity in the CNS, the type of antiretroviral therapy, comorbidities and age-associated decline in neurocognition. When selecting an appropriate ARV regimen for PLWH, it is important to discuss the perception and impact of CNS/NP disturbances in the patient's quality of life. The rapidly evolving progress in antiretroviral development encourages the possibility of having minimally toxic molecules with even better CNS tolerability profiles in the future. Different studies have shown how in both ARV-naive and virologically suppressed adults, BIC-based regimen is associated with significantly lower bothersome CNS/NP symptoms when compared to DTG-based regimen. In conclusion, BIC-based regimen is an interesting option for all types of PLWH, especially among ARV-experienced patients with previous exposure to either EFV or DTG (or both) that may suffer from bothersome CNS/NP disturbances associated with antiretroviral therapy.