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2013 ; 73
(9
): 893-905
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HIV-associated neurocognitive disorders: perspective on management strategies
#MMPMID23733447
Nabha L
; Duong L
; Timpone J
Drugs
2013[Jun]; 73
(9
): 893-905
PMID23733447
show ga
Potent combination antiretroviral therapy (ART) has resulted in dramatic
improvements in AIDS-associated morbidity and mortality. Although combination ART
has resulted in a significant reduction in HIV-associated dementia, the most
severe of the HIV-associated neurocognitive disorders (HAND), the overall
prevalence of HAND among this population is estimated at 40%. It has been
recognized that the central nervous system (CNS) serves as a reservoir for HIV,
and neuronal damage begins at the time of acute infection and persists due to
chronic infection of microglial and perivascular macrophages. Although
combination ART has resulted in virologic control in the plasma compartment,
virologic breakthrough can potentially ensue within the CNS compartment due to
limited ART drug exposure. The purpose of this review is to discuss the
definition, clinical spectrum, and risk factors associated with HAND, review the
pathogenesis of HAND, and address the pharmacologic challenges associated with
ART drug exposure in the CNS compartment.