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HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy
The most severe HAND diagnosis (HAD) was rare, but milder forms of impairment remained common, even among those receiving CART who had minimal comorbidities.
HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors
High rates of mild NCI persist at all stages of HIV infection, despite improved viral suppression and immune reconstitution with CART, and the consistent association of NCI with nadir CD4 across eras suggests that earlier treatment to prevent severe immunosuppression may also help prevent HAND.
Validation of the CNS Penetration-Effectiveness rank for quantifying antiretroviral penetration into the central nervous system.
Poorer penetration of ARV drugs into the CNS appears to allow continued HIV replication in the CNS as indicated by higher CSF HIV viral loads, which is probably critical in treating patients who have HIV-associated neurocognitive disorders.
Neurologic complications of HIV disease and their treatment.
- S. Letendre, R. Ellis, B. Ances, J. McCutchan
- Medicine, BiologyTopics in HIV medicine : a publication of the…
- 1 April 2010
New data on common coinfections in people with HIV identified that a specific strain of Treponema pallidum may be more neurovirulent than other strains, that hepatitis C virus Core protein may be neurotoxic, and that hepatitis B virus may replicate in the nervous system.
Soluble CD163 made by monocyte/macrophages is a novel marker of HIV activity in early and chronic infection prior to and after anti-retroviral therapy.
The utility of monocyte- and macrophage-derived sCD163 as a marker of HIV activity that links viral replication with monocyte andmacrophage activation is pointed to, underscore the significance of monocytes and Macrophage immune responses with HIV pathogenesis.
Changing Patterns in the Neuropathogenesis of HIV During the HAART Era
Despite the initial success of combined anti‐retroviral therapy, more severe forms of HIV encephalitis appear to be emerging as the epidemic matures, and factors that may contribute to this worsening include the prolonged survival of HIV‐infected patients, thereby prolonging the brain's use of increasingly toxic combinations of poorly penetrating drugs in highly antiretroviral‐experienced AIDS patients.
Central nervous system complications in HIV disease: HIV-associated neurocognitive disorder.
- S. Letendre
- Psychology, MedicineTopics in antiviral medicine
- 1 November 2011
Available data indicate that regimens with higher CPE scores are associated with lower HIV RNA levels in CSF and improvement in neurocognitive functioning, and increasing data on pharmacokinetics of antiretrovirals in cerebrospinal fluid has permitted formulation of central nervous system penetration-effectiveness rankings for single drugs and combinations.
Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance
In this study, antiretroviral regimens with good CNS penetration were associated with poorer neurocognitive performance, and a larger controlled trial is required before any conclusions regarding the influence of specific antireTrovirals on neuroc cognitive performance should be made.
CD4 nadir is a predictor of HIV neurocognitive impairment in the era of combination antiretroviral therapy
It is suggested that initiation of CART as early as possible might reduce the risk of developing HAND, the most common source of NPI among HIV-infected individuals.