HIV-associated neurocognitive disorders

HIV infection in the central nervous system (CNS) is responsible for a spectrum of neurocognitive and behavioral disorders. The wide use of appropriate combination antiretroviral therapy (cART) has decreased the severity of cognitive dysfunction. Viral loads are reduced and CD4+ T cell counts are increased. In addition, patients are living longer with improved quality of life. However, cART does not completely eliminate CNS dysfunction in HIV infected patients. There is an increase in milder forms of HIV-associated neurocognitive disorders (HAND), which are the result of a complex interplay between many factors including: aging, vascular disease, Alzheimer’s disease, and psychiatric disease. The underlying biochemical and molecular changes that underlie these changes and the underlying mechanisms of HAND pathogenesis continue to be an area of ongoing research. New advances in imaging and biomarker discovery will continue to advance clinical diagnosis and management. Treatments that can perturb the viral reservoirs and decrease chronic inflammatory response, in addition to continuing cART, may give the clinician additional tools to prevent HAND.