Neurocognitive disorders in HIV infected patients

Abstract

The initiation of Highly Active Antiretroviral Therapy (HAART) in the management of HIV infection has led
to an increase in survival and altered the spectrum of HIV-associated neurocognitive disorders (HAND).
Although HAART reduced the incidence of HIV-associated dementia, HAND now typically presents in more
subtle forms of cognitive impairment, even among patients with viral suppression. Depending on the severity
of symptoms, cognitive deficits can be classified into three conditions: 1) asymptomatic neurocognitive
impairment (ANI), 2) HIV-associated mild neurocognitive disorder (MND), and 3) HIV-associated dementia
(HAD). Risk factors for HIV- associated neurocognitive disorders include HIV disease factors, coinfection
with hepatitis C virus, and host genetic factors. The clinical symptoms of these patients are characterized by
memory and psychomotor speed impairment, movement disorders and depressive symptoms. The diagnosis
is made by the clinical detection of cognitive impairment with the exclusion of other possible causes that
could cause such impairment. The differential diagnosis includes other conditions that cause cognitive
impairment in the context of HIV infection such as, CNS infections, malignancies, neurodegenerative
diseases, nutritional deficiencies, endocrine disorders and substance use, all of which are common in HIV
infected patients. Treatment of HIV neurocognitive disorders is based on novel antiretroviral regimens
which seem to have an optimized central nervous system penetration effectiveness degree.