Document Detail


Current understanding of HIV-associated neurocognitive disorders pathogenesis.
MedLine Citation:
PMID:  21467932     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Patrick Gannon; Muhammad Z Khan; Dennis L Kolson
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Current opinion in neurology     Volume:  24     ISSN:  1473-6551     ISO Abbreviation:  Curr. Opin. Neurol.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-02     Completed Date:  2011-08-15     Revised Date:  2014-04-14    
Medline Journal Info:
Nlm Unique ID:  9319162     Medline TA:  Curr Opin Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  275-83     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
AIDS Dementia Complex / drug therapy,  etiology,  pathology,  physiopathology*
Anti-HIV Agents / adverse effects,  therapeutic use
Central Nervous System / pathology,  virology
HIV Infections / drug therapy,  pathology,  physiopathology*
HIV-1 / immunology,  physiology
Humans
Inflammation / complications
Substance-Related Disorders / complications
Virus Replication
Grant Support
ID/Acronym/Agency:
NS-043994/NS/NINDS NIH HHS; NS27405/NS/NINDS NIH HHS; R01 MH095671/MH/NIMH NIH HHS; R01 NS043994/NS/NINDS NIH HHS; T32-GM008076/GM/NIGMS NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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