Controversies in HIV-associated neurocognitive disorders

• Published in: Lancet neurology Vol. 13; no. 11; pp. 1139 - 1151
• Main Authors: Nightingale, Sam, Winston, Alan, Letendre, Scott, Michael, Benedict D, McArthur, Justin C, Khoo, Saye, Solomon, Tom
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2014; Elsevier Limited
• Subjects: AIDS Dementia Complex - blood; AIDS Dementia Complex - diagnosis; AIDS Dementia Complex - therapy; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - methods; Cognition Disorders - blood; Cognition Disorders - diagnosis; Cognition Disorders - therapy; Cross-Sectional Studies; Drug resistance; Drug therapy; HIV; HIV Infections - blood; HIV Infections - diagnosis; HIV Infections - therapy; HIV-1 - metabolism; Human immunodeficiency virus; Humans; Neurology; RNA, Viral - blood
• ISSN: 1474-4422; 1474-4465; 1474-4465
• DOI: 10.1016/S1474-4422(14)70137-1

Cross-sectional studies show that around half of individuals infected with HIV-1 have some degree of cognitive impairment despite the use of antiretroviral drugs. However, prevalence estimates vary depending on the population and methods used to assess cognitive impairment. Whether asymptomatic patients would benefit from routine screening for cognitive difficulties is unclear and the appropriate screening method and subsequent management is the subject of debate. In some patients, HIV-1 RNA can be found at higher concentrations in CSF than in blood, which potentially results from the poor distribution of antiretroviral drugs into the CNS. However, the clinical relevance of so-called CSF viral escape is not well understood. The extent to which antiretroviral drug distribution and toxicity in the CNS affect clinical decision making is also debated.