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2015 ; 5
(3
): 224-231
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HIV-associated neurocognitive disorders: Five new things
#MMPMID26124979
Rumbaugh JA
; Tyor W
Neurol Clin Pract
2015[Jun]; 5
(3
): 224-231
PMID26124979
show ga
HIV-associated neurocognitive disorders (HAND) remain an important cause of
cognitive dysfunction. Current nomenclature for HAND includes HIV-associated
dementia and milder forms known as asymptomatic neurocognitive impairment (ANI)
and mild neurocognitive disorder (MND). ANI and MND remain highly prevalent
despite combined antiretroviral therapy (cART). These mild forms of HAND must be
diagnosed through neuropsychological testing. If a patient has HAND, it remains
unclear whether using a cART regimen with theoretically superior CNS penetration
improves the prognosis. Nevertheless, a CNS penetration effectiveness score for
antiretrovirals is available. Other factors to consider when diagnosing and
treating HIV infection and HAND include the HIV clade or subtype. Data suggest
that HAND occurs more often in association with certain clades, and higher
vigilance for cognitive dysfunction may be recommended. Finally, comorbidities,
such as diseases associated with advanced age, other infections, and drug abuse,
need to be considered as cofactors for cognitive dysfunction and treated
accordingly.