Neuropsychological Functioning and Antiretroviral Treatment in HIV/AIDS: A Review

Abstract

This article presents a review of studies that have investigated the neuropsychological effects of antiretroviral treatment (ART) for HIV-1 infection. It provides a brief overview of the era of monotherapy, dual-therapy, and an extended overview of the current era of combination antiretroviral therapy (CART). This review highlights that while CART has had a dramatic effect on the incidence and the severity of HIV-associated neurocognitive disorders (HAND), HAND, in its mild form, still remains prevalent. New causes of this sustained prevalence are poor CNS penetration of some antiretroviral agents, drug resistance, poor adherence, potential neurotoxicity, co-morbidities such as the long-term CART side effects in relation to cardio-vascular disease, and chronic HIV brain infection that may facilitate the expression of new forms of neurodegenerative processes. The review emphasizes the need to address methodological limitations of published studies and the need for large and representative cross-disciplinary longitudinal investigations across the HIV illness span.

Abnormal MEG Oscillatory Activity during Visual Processing in the Prefrontal Cortices and Frontal Eye-Fields of the Aging HIV Brain

“…Cognitive impairments are a recognized complication observed in 35–70% of persons infected with human immunodeficiency virus type one (HIV-1), including those who are both treated and untreated [1]–[5]. While combination antiretroviral therapy (cART) has robustly decreased the prevalence of HIV-associated dementia (HAD), milder forms of HIV-associated neurocognitive disorders (HAND) remain prevalent [1]–[3], [5], [6].…”

“…While combination antiretroviral therapy (cART) has robustly decreased the prevalence of HIV-associated dementia (HAD), milder forms of HIV-associated neurocognitive disorders (HAND) remain prevalent [1]–[3], [5], [6]. Despite such high prevalence, a differential diagnosis can often be difficult, requiring neurocognitive testing and exclusion of opportunistic infections, psychiatric disorders, drug toxicities, brain tumors, and other factors to rule out other causes.…”

Neues bei HIV und Neuro-Aids

“…Shiramizu et al fanden eine gute Korrelation zwischen HAND und der Virus-DNA in infizierten Monozyten [19], therapieassoziierte Kofaktoren sind: niedrige Therapietreue, suboptimale Behandlung mit im Blut und/oder Liquor nachweisbarer Viruslast bzw. Therapieunterbrechungen [20], ein geringer "CNS-Penetration-Effectiveness"-Score [21] sowie die potenzielle Neurotoxizität der antiretroviralen Therapie [22]. Kandidatengene mit einer Korrelation zu neurokognitiven Defiziten sind das Mannose bindende Lectin-2 = MBL2 und APOE e4 [23], virale Gene mit Bezug zur Kognition sind die CD4 + -binding site des envelope-Gens, das Transaktivatorgen ("tat") und das "viral protein" (Vpr).…”

The neurobiology of HIV dementia: implications for practice in South Africa

“…[51][52][53] This type of antiretroviral neurotoxicity is independent of the phenomenon of neuroIRIS (immune reconstitution syndrome), which is thought to be rare but may result in worsening neurocognitive function despite HAART use. 54 NeuroIRIS may occur from between two and six weeks of HAART, and reflects an inflammatory response following cellular immune reactivation.…”