HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors

  title={HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors},
  author={Robert K Heaton and Donald R. Franklin and Ronald J. Ellis and John Allen McCutchan and Scott L. Letendre and Shannon LeBlanc and Stephanie Corkran and Nichole A. Duarte and David B. Clifford and Steven Paul Woods and Ann C Collier and Christina M. Marra and Susan Morgello and Monica Rivera Mindt and Michael J. Taylor and Thomas D Marcotte and Joseph Hampton Atkinson and Tanya J Wolfson and Benjamin B. Gelman and Justin C McArthur and David M. Simpson and Ian Abramson and Anthony Collins Gamst and Christine Fennema-Notestine and Terry L. Jernigan and Joseph K. Wong and Igor Grant},
  journal={Journal of Neurovirology},
  pages={3 - 16}
Combination antiretroviral therapy (CART) has greatly reduced medical morbidity and mortality with HIV infection, but high rates of HIV-associated neurocognitive disorders (HAND) continue to be reported. Because large HIV-infected (HIV+) and uninfected (HIV−) groups have not been studied with similar methods in the pre-CART and CART eras, it is unclear whether CART has changed the prevalence, nature, and clinical correlates of HAND. We used comparable methods of subject screening and… 
Changing clinical phenotypes of HIV-associated neurocognitive disorders
  • N. Sacktor
  • Medicine, Psychology
    Journal of NeuroVirology
  • 2017
HIV-associated neurocognitive disorder (HAND) remains a common cause of cognitive impairment and persists in 15–55% of HIV+ individuals in the combination antiretroviral therapy (CART) era, but it is effective in only a subset of patients.
Neurocognitive impairment in the cART era in a Romanian cohort of young adults with chronic HIV infection.
A moderate rate of mild neurocognitive impairment is still present in young adults with chronic HIV infection acquired in early childhood despite successful cART, without any association with classic markers of HIV infection.
Low prevalence of neurocognitive impairment in early diagnosed and managed HIV-infected persons
HIV+ patients diagnosed and managed early during the course of HIV infection had a low prevalence of NCI, comparable to matched HIV-uninfected persons, and may be important in limiting neurocognitive impairment.
Evolving clinical phenotypes in HIV-associated neurocognitive disorders
HAND continues to be an important neurological manifestation in both HIV+ individuals naïve to cART and on cART, and ANI has recently been shown to lead to a two-fold to five-fold increased progression to symptomatic HAND.
HIV Associated Neurocognitive Disorders in the Modern Antiviral Treatment Era: Prevalence, Characteristics, Biomarkers, and Effects of Treatment
How cART interacts with HAND in terms of clinical characteristics and biomarkers is discussed and the outcomes of recent clinical studies focused on the CNS penetrating antiretroviral regimens and some novel therapeutic approaches are reviewed.
Factors related to HIV-associated neurocognitive impairment differ with age
Here, features are identified, routinely collected in primary care settings, that provide more accurate diagnostic value than a neurocognitive screening measure among younger and older HIV individuals.
Neurocognitive Impairment in Well-Controlled HIV-Infected Patients: A Cross-Sectional Study.
Prevalence of NCI is high in otherwise healthy adults with HIV-infection and high IL-6 levels are associated with NCI, and delayed recall ND is worse in patients with subclinical atherosclerosis.
Neurocognitive profile of HIV-positive adults on combined antiretroviral therapy: A single-centre study in Serbia
The findings suggest that even with the absence of a subjective experience of cognitive deficits and with a good basic control of the illness, a certain degree of cognitive deficit can be observed in the tested group.
An initial screening for HIV-associated neurocognitive disorders of HIV-1 infected patients in China
The present data suggest that CD4 count and viral load cannot predict the severity of HAND, although the prevalence of Handed is similar to previous report in these patients.
Risk Factors Leading to Most Severe Forms of HAND in Adults on cART who Present Suppressed Plasma HIV-1 viral load
It is concluded that these individuals present cognitive disorders (eg, memory deficits and/or depression on cART, thereby impairing the activities of daily life, due in part to risk factors emphasized in this study.


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 cognitive impairment before and after the advent of combination therapy
Even though HAART has reduced the incidence of HIV dementia, HIV-associated cognitive impairment continues to be a major clinical problem among individuals with advanced infection.
Neurocognitive impairment and survival in a cohort of HIV-infected patients treated with HAART.
The results of this prospective study highlight the clinical relevance of HIV-related central nervous system (CNS) involvement in the HAART era, and raise concerns regarding theclinical relevance of CNS involvement as potent antiretroviral therapies become less effective.
The prevalence and incidence of neurocognitive impairment in the HAART era
The association of previous advanced immunosuppression with prevalent and sustained impairment suggests that there is a non-reversible component of neural injury that tracks with a history of disease progression, and suggests that restoring immunocompetence increases the likelihood of neurocognitive recovery.
Dynamics of cognitive change in impaired HIV-positive patients initiating antiretroviral therapy
Clinically meaningful neuropsychological improvement seemed to peak around 24–36 weeks after combination antiretroviral therapy initiation and was prolonged over the 1-year study period, providing new evidence that benefit may be maximized by choosing antireficiency medications that reach therapeutic concentrations in the CNS.
Highly active antiretroviral treatment in HIV infection: benefits for neuropsychological function
Findings suggest that HAART benefits neuropsychological function through the reduction of viral load, and those without neuropsychologically impairment had significantly lower mean viral load levels and were more likely to have undetectable viral load than those with impairment.
Cognitive dysfunction in HIV patients despite long-standing suppression of viremia
The prevalence of HANDs without functional repercussion in daily life (asymptomatic neurocognitive impairment) is the most frequent subtype observed in this population, and the HIV dementia scale with a cutoff of 14 points or less seems to provide a useful tool to screen for the presence of Handeds.
Does highly active antiretroviral therapy improve neurocognitive function? A systematic review
The results show that although HAART does improve cognition, it does not appear to fully eradicate impairments and studies examining the long-term effects of HAART on HIV-associated neurocognitive disorders (HANDs) using uniform methods of data collection are needed, together with clear reporting ofHAART regimens.
Nadir CD4 cell count predicts neurocognitive impairment in HIV-infected patients.
Differences in neurocognitive functioning in relation to nadir CD4 count in HIV-infected patients are found and attention should be given to this value in the management of neuroc cognitive protection in HIV infection.
Enhancing antiretroviral therapy for human immunodeficiency virus cognitive disorders
Using CSF‐penetrating drugs in the ART regimen and monitoring CSF viral load may be indicated for individuals with HIV‐associated cognitive impairment, and significant, independent predictors of GDS reduction were CSF HIV RNA suppression, baseline antiretroviral history, and their interaction.