TY - JOUR
T1 - HIV-associated neurocognitive disorder
AU - Clifford, David B.
AU - Ances, Beau M.
N1 - Funding Information:
This work was supported by the National Institute of Mental Health grants 22005 ( The CNS HIV Antiretroviral Therapy Effects Research study—to DBC and BMA ), and K23MH081786 (to BMA); the National Institute for Nursing Research ( grants R01NR014449, R01NRO012657, and R01NR012907 to BMA ); and the National Institute of Allergy and Infectious Diseases ( grants AI069495 and NS077384 to DBC ).
Funding Information:
DBC has received financial support for research from Bavarian Nordic, Millennium Pharmaceuticals, Lilly, Roche, and Biogen Idec. He has acted as a consultant for Pfizer, Genzyme, Millennium Pharmaceuticals, Drinker, Biddle, Reath, Amgen, Quintiles, Arnold Todara and Welch, W Holt Smith Attorney, Biogen Idec, Cytheris, Genentech, GSK and BMS. He has received speaker support from Sun Pharmaceuticals and Biogen Idec. BMA declares no conflicts of interest.
PY - 2013/11
Y1 - 2013/11
N2 - Neurological involvement in HIV is often associated with cognitive impairment. Although severe and progressive neurocognitive impairment has become rare in HIV clinics in the era of potent antiretroviral therapy, most patients with HIV worldwide have poor outcomes on formal neurocognitive tests. In this Review, we describe the manifestations of HIV-associated neurocognitive disorder in the era of effective HIV therapy, outline diagnosis and treatment recommendations, and explore the research questions that remain. Although comorbid disorders, such as hepatitis C infection or epilepsy, might cause some impairment, their prevalence is insufficient to explain the frequency with which it is encountered. HIV disease markers, such as viral load and CD4 cell counts, are not strongly associated with ongoing impairment on treatment, whereas cardiovascular disease markers and inflammatory markers are. New cerebrospinal fluid and neuroimaging biomarkers are needed to detect and follow impairment. Ongoing research efforts to optimise HIV therapy within the CNS, and potentially to intervene in downstream mechanisms of neurotoxicity, remain important avenues for future investigation. Ultimately, the full control of virus in the brain is a necessary step in the goal of HIV eradication.
AB - Neurological involvement in HIV is often associated with cognitive impairment. Although severe and progressive neurocognitive impairment has become rare in HIV clinics in the era of potent antiretroviral therapy, most patients with HIV worldwide have poor outcomes on formal neurocognitive tests. In this Review, we describe the manifestations of HIV-associated neurocognitive disorder in the era of effective HIV therapy, outline diagnosis and treatment recommendations, and explore the research questions that remain. Although comorbid disorders, such as hepatitis C infection or epilepsy, might cause some impairment, their prevalence is insufficient to explain the frequency with which it is encountered. HIV disease markers, such as viral load and CD4 cell counts, are not strongly associated with ongoing impairment on treatment, whereas cardiovascular disease markers and inflammatory markers are. New cerebrospinal fluid and neuroimaging biomarkers are needed to detect and follow impairment. Ongoing research efforts to optimise HIV therapy within the CNS, and potentially to intervene in downstream mechanisms of neurotoxicity, remain important avenues for future investigation. Ultimately, the full control of virus in the brain is a necessary step in the goal of HIV eradication.
UR - http://www.scopus.com/inward/record.url?scp=84886917428&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(13)70269-X
DO - 10.1016/S1473-3099(13)70269-X
M3 - Review article
C2 - 2415689
AN - SCOPUS:84886917428
SN - 1473-3099
VL - 13
SP - 976
EP - 986
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 11
ER -