Neurocognitive impairment is common in people living with HIV and AIDS. Prior to highly active antiretroviral therapy (HAART), cognitive impairment primarily affected patients with advanced disease, and was a more rapidly progressive illness. With the use of HAART, cognitive impairment improved, along with the overall health of HIV-positive patients. However, it is still a prevalent problem, even in patients with desirable CD4+ count and undetectable plasma viral load. In this review, we address the nature of HIV-related neurocognitive impairment in the HAART era, including its etiology, pathology, appropriate diagnostic tools for clinical practice and research, and rational treatment approaches.
"The widespread availability and use of combination antiretroviral therapy (CART) over the past decade has resulted in dramatic reductions in mortality (Yeni, 2006) and improved cognitive status among many HIV-infected individuals (Cohen et al., 2001; Robinson-Papp et al., 2009). Yet, cognitive impairments remain prevalent affecting up to 50% of HIV-infected individuals in the United States (Heaton et al., 2011; Schouten et al., 2011), even among those with good HIV control on CART (Cysique and Brew, 2011; Garvey et al., 2011). "
[Show abstract][Hide abstract] ABSTRACT: Chronic systemic immune activation and inflammatory processes have been linked to brain dysfunction in medically stable HIV-infected people. We investigated the association between verbal memory performance and plasma concentrations of 13 cytokines measured using multiplexed bead array immunoassay in 74 HIV-seropositive individuals and 50 HIV-seronegative controls. Memory performance was positively related to levels of IL-8 and IFN-γ, and negatively related to IL-10 and IL-18 and to hepatitis C infection. Memory performance was not significantly related to HIV disease markers. The results indicate the importance of systemic immune and inflammatory markers to neurocognitive function in chronic and stable HIV disease.
Journal of neuroimmunology 09/2013; 265(1-2). DOI:10.1016/j.jneuroim.2013.09.005 · 2.47 Impact Factor
"ARV treatment has dramatically changed the life expectancy of HIV-infected patients, and ADC is these days a rare diagnosis if patients are adherent to treatment . However, a number of reports have described an apparent increase in prevalence of HIV-associated neurocognitive impairment [2,4]. The clinical definitions of the various HIV-associated conditions affecting the central nervous system are not clear and potential pathogenic mechanisms are not well understood . "
[Show abstract][Hide abstract] ABSTRACT: The long-term neurological consequences of HIV infection and treatment are not yet completely understood. In this study we examined the prevalence of cerebral metabolic abnormalities among a cohort of neurologically intact HIV patients with fully suppressed HIV viral loads. Concomitant analyses of circulating brain derived neurotrophic factor (BDNF) were performed to correlate these abnormalities with potential signs of neuro-regenerating/protective activity, and concomitant analyses of circulating tumour necrosis factor (TNF) alpha, interleukin (IL) 6, and soluble urokinase plasminogen activator receptor (suPAR) were performed to correlate these abnormalities with potential signs of neurodegenerative processes.
The study population consisted of HIV-positive patients known to be infected for more than 5 years and on antiretroviral (ARV) treatment for a minimum of three years with no history of virological failure, a CD4 count above 200 x 106 cells/l and no other co-morbidities. The distribution of the regional cerebral metabolic rate of glucose metabolism was measured using fluorine-18-flourodeoxyglucose positron emission tomography (FDG-PET) scanning. The PET scans were evaluated for individual pathology using Neurostat software and for group pathology using statistical parametric mapping (SPM). Circulating levels of BDNF, TNF alpha, IL-6 and suPAR were measured by ELISA techniques.
More than half (55%) of the patients exhibited varying severities of mesial frontal reduction in the relative metabolic rate of glucose. Compared to healthy subjects, the patients with abnormal FDG-PET scanning results had a shorter history of known HIV infection, fewer years on antiretroviral therapy and higher levels of circulating TNF alpha and IL-6 (p = 0.08).
A large proportion of optimally treated HIV patients exhibit cerebral FDG-PET scanning abnormalities and elevated TNF alpha and IL-6 levels, which may indicate imminent neuronal damage. The neuroprotective effect of early ARV treatment should be considered in future prospective follow-up studies.
Journal of Neuroinflammation 02/2010; 7(1):13. DOI:10.1186/1742-2094-7-13 · 5.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors investigated the relationship between antiretroviral adherence and HIV-associated verbal memory impairment. HIV-positive participants demonstrated poorer verbal memory than HIV-negative participants. Both good (≥90%) and poor (<90%) adherers displayed encoding deficits as compared with controls, but only poor adherers exhibited retrieval deficits. Encoding deficits primarily accounted for reduced delayed recall in good adherers, but both encoding and retrieval deficits accounted for reduced delayed recall in poor adherers. The retrieval difference between the adherence groups might be explained by a neuroprotective effect of good antiretroviral adherence or preexisting HIV-related retrieval deficits that result in poorer adherence.
The Journal of neuropsychiatry and clinical neurosciences 09/2011; 23(3):324-31. DOI:10.1176/appi.neuropsych.23.3.324 · 2.82 Impact Factor
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