Cognitive function in treated HIV patients

Abstract

Although highly active antiretroviral therapy (HAART) has reduced the incidence of HIV-associated dementia, the overall prevalence of HIV-associated neurocognitive disorders (HAND) has increased. Since treatment and prevention of HAND are becoming an increasing concern, management strategies for cognitive impairment in patients living with HIV are expected to play an important role in the near future. This review summarizes the existing literature on studies investigating cognitive functions in patients receiving antiretroviral (ARV) treatment.Most studies indicate that HAART use results in improvement of neurocognitive functions, yet milder forms of HAND are not only prevalent, but also incident in patients with persistently undetectable plasma HIV RNA. We performed a systematic review on all studies performed in patients receiving ARV treatment that included neurocognitive evaluations as study end points. Thirty-six studies were examined. Study methodology varied from cross-sectional to doubleblind, randomized, controlled designs. Aside from historic zidovudine monotherapy trials, in most studies, ARV schemes varied considerably, and in some cases, ARV regimens were not reported in detail. Only a few articles included virological studies on cerebrospinal fluid. Study duration was ,2 years in most cases. Differences in study design and presence of study limitations may account for difficulties in understanding the impact of HAART on cognition and in evaluating the effect of an individual agent or ARV regimen on cognitive functioning. The aim of the present article is to provide HIV clinicians with a comprehensive review of recent achievements and future prospects for ARV treatment and prevention of cognitive dysfunctions in HIV-infected patients.

Assessment, Diagnosis, and Treatment of HIV-Associated Neurocognitive Disorder: A Consensus Report of the Mind Exchange Program

“…It is not possible from existing data to conclude whether patients with successful treatment (ie, plasma HIV RNA <50 copies/ mL) are at risk of progression and there are no systematic studies addressing the extent to which neurocognitive deficit may be permanent or reversible. Data show that cART for approximately 1 year is associated with modest benefits in NP functioning, particularly attention, processing speed, and executive performance (CEBM 1a) [73][74][75][76][77]. The degree of improvement correlates with changes in CD4 + T-cell counts (CEBM 1a) [42,[78][79][80][81][82].…”

Effects of highly active antiretroviral therapy on cognitive functions in severely immune-compromised HIV-seropositive patients

“…This implies the presence of a non-reversible component of neural injury and possibly some neural injury continues in some patients regardless of the benefits of anti-retroviral therapy [46]. Notwithstanding, the evidence in support of HAART-related cognitive improvements in HIV infection is convincing enough to advocate its use in the management of HAND.…”

HIV-associated Neurocognitive Disorders

“…In 1995, saquinavir, the first protease inhibitor, was shown to increase the CD4 cell count and decrease the plasma viral load. 24 Further studies of cognitive function under HAART confirmed these early findings (for a review, see Tozzi et al 25 ). 22 However, resistance to each previously discovered drug developed, leading to clinical trials of 3-drug combination therapy.…”