Brain health in HIV: pathogenesis, classification, and treatment

An update on brain health and cognitive function in persons living with HIV, with a focus on pathogenesis, classification and treatment.

Criteria for HIV-associated neurocognitive disorders overestimate prevalence of cognitive impairment and should no longer be used. Instead, HIV-associated brain injury should be considered as one cause of cognitive impairment in persons living with HIV, along with other non-HIV factors. The most widely used cardiovascular risk calculators and stroke categorization tools are not based on data including persons with HIV and appear to underestimate cardiovascular risk. A statin should be considered in all persons living with HIV over the age of 40 and assists in preventing cerebrovascular disease.

HIV is a neurotropic virus which penetrates the central nervous system (CNS) within days of infection, establishing a reservoir. Cerebrospinal fluid (CSF) HIV RNA escape can cause progressive neurologic symptoms and is treatable by targeting the CSF HIV genotypic resistance profile. As the population of persons living with HIV ages, it is important to address noncommunicable sequelae such as multifactorial causes of cognitive impairment and cerebrovascular disease. Strategies for HIV cure need to address barriers and risks posed by the CNS HIV reservoir.