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HIV-associated neurocognitive disorders: recent advances in pathogenesis,
biomarkers, and treatment
#MMPMID28413625
Carroll A
; Brew B
F1000Res
2017[]; 6
(?): 312
PMID28413625
show ga
HIV-associated neurocognitive disorders (HAND) remain prevalent despite plasma
viral suppression by antiretroviral agents. In fact, the prevalence of milder
subtypes of cognitive impairment is increasing. Neuropsychologic testing remains
the "gold standard" of diagnosis; however, this is time consuming and costly in a
resource-poor environment. Recently developed screening tools, such as CogState
and the revised HIV dementia scale, have very good sensitivity and specificity in
the more severe stages of HAND. However, questions remain regarding the utility
of, optimal population for, and insensitivity of tests in mild HAND. Recognition
of ongoing viral persistence and the inflammatory milieu in the central nervous
system (CNS) has advanced our understanding of the pathogenesis of HAND and
facilitated the development of biomarkers of CNS disease. The importance of the
monocyte-macrophage lineage cell and the astrocyte as viral reservoirs, HIV viral
proteins, self-perpetuating CNS inflammation, and CCR5 chemokine receptor
neurotropism has been identified. Whilst biomarkers demonstrate monocyte
activation, inflammation, and neuronal injury, they remain limited in their
clinical utility. The improved understanding of pathogenic mechanisms has led to
novel approaches to the treatment of HAND; however, despite these advances, the
optimal management is still undefined.
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