Back to Journals » Neurobehavioral HIV Medicine » Volume 4

Management issues in HIV-associated neurocognitive disorders

Authors Cysique LA, Bain MP, Lane TA, Brew BJ

Received 1 February 2012

Accepted for publication 24 April 2012

Published 11 July 2012 Volume 2012:4 Pages 63—73

DOI https://doi.org/10.2147/NBHIV.S30466

Review by Single-blind

Peer reviewer comments 7

Lucette A Cysique,1,3,4 Margaret P Bain,1 Tammy A Lane,2 Bruce J Brew1,4

1Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, Australia; 2AIDS Dementia and HIV Psychiatry Service (ADAHPTS) Sydney Hospital and Sydney Eye Hospital, Sydney, Australia; 3St Vincent's Hospital Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia; 4St Vincent's Applied Medical Research Centre, Sydney, Australia

Abstract: The incidence of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) decreased with the introduction of combined antiretroviral therapy (cART), but there is now evidence that HAND is persisting and developing despite effective HIV suppression and the absence of other confounds. HAND in the cART era is different. The main issues are: (1) HIV disease is now a chronic disorder spanning decades. While acute and subacute presentations of HAND still occur, there is mounting evidence that it is based on cumulative brain damage. Furthermore, the pathogenetic significance of continuing HIV replication as the main factor in such brain damage is still unclear. (2) As HIV disease is a chronic disorder with increased life expectancy, the effects of aging are now becoming important. Their impact and significance on the pathogenesis of HAND are only beginning to be grasped. (3) In addition to aging, there is the increased risk of the effects of comorbid conditions (eg, cardiovascular and kidney diseases). The optimal treatment of HAND in the context of cART has not yet been established with any certainty. As a general principle, systemic HIV disease must be well controlled. There is increasing evidence that central nervous system disease should also be well controlled and may require specific antiretroviral drugs that have the ability to effectively penetrate the central nervous system. The role of adjunctive therapies remains hypothetical. Research to date has shown that all adjunctive therapies have thus far failed to show any significant benefit. In this paper, we provide an updated review of the clinical presentation and neuropsychological profile in the cART era. We also review the current HAND diagnostic nomenclature in respect to both its recommendations and limitations. This is followed by discussion of the main management issues for persisting HAND, including screening algorithms and optimal therapeutic options. Finally, we explore the use of everyday life assessment methods and recommendations.

Keywords: HIV/AIDS, antiretroviral treatment, neurological complications, neuropsychological functions, HIV-associated dementia, aging

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 

 

Readers of this article also read:

Emerging and future therapies for hemophilia

Carr ME, Tortella BJ

Journal of Blood Medicine 2015, 6:245-255

Published Date: 3 September 2015

A new recombinant factor VIII: from genetics to clinical use

Santagostino E

Drug Design, Development and Therapy 2014, 8:2507-2515

Published Date: 12 December 2014

A novel preparation method for silicone oil nanoemulsions and its application for coating hair with silicone

Hu Z, Liao M, Chen Y, Cai Y, Meng L, Liu Y, Lv N, Liu Z, Yuan W

International Journal of Nanomedicine 2012, 7:5719-5724

Published Date: 12 November 2012

Cross-linked acrylic hydrogel for the controlled delivery of hydrophobic drugs in cancer therapy

Deepa G, Thulasidasan AK, Anto RJ, Pillai JJ, Kumar GS

International Journal of Nanomedicine 2012, 7:4077-4088

Published Date: 27 July 2012

Crystallization after intravitreal ganciclovir injection

Pitipol Choopong, Nattaporn Tesavibul, Nattawut Rodanant

Clinical Ophthalmology 2010, 4:709-711

Published Date: 14 July 2010