PURPOSE OF REVIEW: The present review discusses current concepts of HIV-associated neurocognitive disorders (HAND) in the era of antiretroviral therapy (ART). As the HIV epidemic enters its fourth decade (the second decade of ART), research must address evolving factors in HAND pathogenesis. These include persistent systemic and central nervous system (CNS) inflammation, aging in the HIV-infected brain, HIV subtype (clade) distribution, concomitant use of drugs of abuse, and potential neurotoxicity of ART drugs. RECENT FINDINGS: Although the severest form of HAND, HIV-associated dementia (HAD), is now rare due to ART, the persistence of milder, functionally important HAND forms persist in up to half of HIV-infected individuals. HAND prevalence may be higher in areas of Africa where different HIV subtypes predominate, and ART regimens that are more effective in suppressing CNS HIV replication can improve neurological outcomes. HAND are correlated with persistent systemic and CNS inflammation, and enhanced neuronal injury due to stimulant abuse (cocaine and methamphetamine), aging, and possibly ART drugs themselves. SUMMARY: Prevention and treatment of HAND requires strategies aimed at suppressing CNS HIV replication and effects of systemic and CNS inflammation in aging and substance-abusing HIV populations. Use of improved CNS-penetrating ART must be accompanied by evaluation of potential ART neurotoxicity.
PURPOSE OF REVIEW: The present review discusses current concepts of HIV-associated neurocognitive disorders (HAND) in the era of antiretroviral therapy (ART). As the HIV epidemic enters its fourth decade (the second decade of ART), research must address evolving factors in HAND pathogenesis. These include persistent systemic and central nervous system (CNS) inflammation, aging in the HIV-infected brain, HIV subtype (clade) distribution, concomitant use of drugs of abuse, and potential neurotoxicity of ART drugs. RECENT FINDINGS: Although the severest form of HAND, HIV-associated dementia (HAD), is now rare due to ART, the persistence of milder, functionally important HAND forms persist in up to half of HIV-infected individuals. HAND prevalence may be higher in areas of Africa where different HIV subtypes predominate, and ART regimens that are more effective in suppressing CNS HIV replication can improve neurological outcomes. HAND are correlated with persistent systemic and CNS inflammation, and enhanced neuronal injury due to stimulant abuse (cocaine and methamphetamine), aging, and possibly ART drugs themselves. SUMMARY: Prevention and treatment of HAND requires strategies aimed at suppressing CNS HIV replication and effects of systemic and CNS inflammation in aging and substance-abusing HIV populations. Use of improved CNS-penetrating ART must be accompanied by evaluation of potential ARTneurotoxicity.
Authors: B J Brew; R B Bhalla; M Paul; J J Sidtis; J J Keilp; A E Sadler; H Gallardo; J C McArthur; M K Schwartz; R W Price Journal: AIDS Date: 1992-05 Impact factor: 4.177
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Authors: H A Gelbard; H S Nottet; S Swindells; M Jett; K A Dzenko; P Genis; R White; L Wang; Y B Choi; D Zhang Journal: J Virol Date: 1994-07 Impact factor: 5.103
Authors: J C McArthur; T E Nance-Sproson; D E Griffin; D Hoover; O A Selnes; E N Miller; J B Margolick; B A Cohen; H Farzadegan; A Saah Journal: Neurology Date: 1992-09 Impact factor: 9.910
Authors: M P Heyes; B J Brew; A Martin; R W Price; A M Salazar; J J Sidtis; J A Yergey; M M Mouradian; A E Sadler; J Keilp Journal: Ann Neurol Date: 1991-02 Impact factor: 10.422
Authors: P Genis; M Jett; E W Bernton; T Boyle; H A Gelbard; K Dzenko; R W Keane; L Resnick; Y Mizrachi; D J Volsky Journal: J Exp Med Date: 1992-12-01 Impact factor: 14.307
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