HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment

Abstract

The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus–brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.

Is the History of Substance Abuse Correlated with Neuropsychiatric Disorders and Co-morbid HIV Infection? An Urban Population Study

“…Studies have shown that different brain regions that interact to promote cognitive functions show less-coordinated activation with aging, suggesting a vast loss of integrative function, related in part, to disruption of neuronal connections in different cortical regions [15,16]. There was a very high percentage of drug users in our cohort.…”

Selective peroxisome proliferator‐activated receptor‐gamma modulator, INT131 exhibits anti‐inflammatory effects in an EcoHIV mouse model

“…Reports have demonstrated that high viral burden and abnormal pathology are present within this brain region. 65,66 Herein, we decided to infect animals for a longer period of time (12 days) to more closely mimic the chronic nature of the disease. We investigated the same markers as the in vitro work and a significant increase in the inflammatory markers: TNFα, IL-1β, IFNγ, CCL2, CCL3, and C3 was evident after 12 days of infection ( Figure 3).…”

Diagnostic accuracy of new and old cognitive screening tools for HIV‐associated neurocognitive disorders

“… may be explained by the different CDT interpretation model and gold standard battery we used. The observed poor performance may also be attributable to cortical imprinting , which makes CDT less effective in revealing subcortical deficits, which are still more common in HAND patients .…”

“…The discordance between our results and those reported by Levy et al [22] may be explained by the different CDT interpretation model and gold standard battery we used. The observed poor performance may also be attributable to cortical imprinting [34], which makes CDT less effective in revealing subcortical deficits, which are still more common in HAND patients [35,36]. 3QT, which is based on symptom reporting, has been proposed as an easy-to-use screening tool for HAND by Simioni et al [11].…”