Neurologic complications of HIV infection: Highlights from the 2013 conference on retroviruses and opportunistic infections

Thirty years into the HIV epidemic, the management and investigation of neurologic complications of HIV disease have evolved from a struggle to understand and treat inexorable disorders to an optimistic effort to address more subtle but often complex conditions in patients surviving long-term with a chronic disease. Although severe forms of HIV encephalitis and HIV-associated dementia, myelopathy, opportunistic infections, and neuropathy are still frequently encountered entities where access to HIV treatment is limited, in settings with sufficient resources, they are predominantly seen in those who present late to care or are unable to maintain consistent antiretroviral adherence. In 2013, practitioners, patients, and investigators can realistically aim for an outstanding quality of life for those living with HIV infection and seek to reduce morbidity associated with milder forms of HIV-associated neurocognitive disorder (HAND). Neurologic presentations at the 20th Conference on Retroviruses and Opportunistic Infections (CROI) reflected this now well-established paradigm shift, focusing on treatment strategies to optimize neurologic and cognitive function, the pathogenesis of HAND in the current era, imaging biomarkers of HAND, the confluence of HIV infection and aging, and characterization of central nervous system HIV reservoirs of infection.