Controversies in HIV-associated neurocognitive disorders
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 pati...
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| Published in | Lancet neurology Vol. 13; no. 11; pp. 1139 - 1151 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.11.2014
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
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| Abstract | 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. |
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| AbstractList | 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.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. Summary 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. 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. |
| Author | McArthur, Justin C Letendre, Scott Winston, Alan Nightingale, Sam Michael, Benedict D Khoo, Saye Solomon, Tom |
| Author_xml | – sequence: 1 givenname: Sam surname: Nightingale fullname: Nightingale, Sam email: s.nightingale@liverpool.ac.uk organization: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK – sequence: 2 givenname: Alan surname: Winston fullname: Winston, Alan organization: Division of Medicine, Imperial College London, St Mary's Campus, London, UK – sequence: 3 givenname: Scott surname: Letendre fullname: Letendre, Scott organization: University of California and HIV Neurobehavioral Research Center and Antiviral Research Center, San Diego, CA, USA – sequence: 4 givenname: Benedict D surname: Michael fullname: Michael, Benedict D organization: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK – sequence: 5 givenname: Justin C surname: McArthur fullname: McArthur, Justin C organization: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 6 givenname: Saye surname: Khoo fullname: Khoo, Saye organization: Institute of Translational Medicine, University of Liverpool, Liverpool, UK – sequence: 7 givenname: Tom surname: Solomon fullname: Solomon, Tom organization: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25316020$$D View this record in MEDLINE/PubMed |
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| Copyright | 2014 Elsevier Ltd Elsevier Ltd Copyright © 2014 Elsevier Ltd. All rights reserved. Copyright Elsevier Limited Nov 2014 |
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| Snippet | Cross-sectional studies show that around half of individuals infected with HIV-1 have some degree of cognitive impairment despite the use of antiretroviral... Summary Cross-sectional studies show that around half of individuals infected with HIV-1 have some degree of cognitive impairment despite the use of... |
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| SubjectTerms | 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 |
| Title | Controversies in HIV-associated neurocognitive disorders |
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