Article

HIV-1 infection and cognitive impairment in the cART era: a review

aDepartment of Neurology, The Netherlands bInternal Medicine, Division of Infectious Diseases, Tropical Medicine & Aids, Academic Medical Center, Amsterdam, The Netherlands cCenter for Poverty-related Communicable Diseases, Academic Medical Center and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands dDepartment of Neurology, OLVG Hospital, Amsterdam, The Netherlands eDepartment of Infectious Diseases, San Rafaele Scientific Institute, Milan, Italy fDepartment of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden.
AIDS (London, England) (Impact Factor: 6.56). 12/2010; 25(5):561-75. DOI: 10.1097/QAD.0b013e3283437f9a
Source: PubMed

ABSTRACT With the introduction of combination antiretroviral therapy AIDS dementia complex or HIV-associated dementia, as it was termed later, largely disappeared in clinical practice. However, in the past few years, patients, long-term infected and treated, including those with systemically well controlled infection, started to complain about milder memory problems and slowness, difficulties in concentration, planning, and multitasking. Neuropsychological studies have confirmed that cognitive impairment occurs in a substantial (15-50%) proportion of patients. Among HIV-1-infected patients cognitive impairment was and is one of the most feared complications of HIV-1 infection. In addition, neurocognitive impairment may affect adherence to treatment and ultimately result in increased morbidity for systemic disease. So what may be going on in the CNS after so many years of apparently controlled HIV-1 infection is an urgent and important challenge in the field of HIV medicine. In this review we summarize the key currently available data. We describe the clinical neurological and neuropsychological findings, the preferred diagnostic approach with new imaging techniques and cerebrospinal fluid analysis. We try to integrate data on pathogenesis and finally discuss possible therapeutic interventions.

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Available from: Paola Cinque, Nov 23, 2014
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