title: Neurocognitive dysfunction in the highly active antiretroviral therapy era.
abstract: OBJECTIVE
  The aim is to review the recent confirmation of the continued high prevalence of HIV-associated neurocognitive disorders (HAND) despite highly active antiretroviral therapy (HAART) in a large cohort study and to review the recent studies that have begun to address the potential reasons for such persistence.
  
  
  RESULTS
  HAND remains prevalent, despite effective viral suppression in cerebrospinal fluid and plasma. Several studies have shown the benefit of a central nervous system (CNS) penetrating HAART regimen (neuro-HAART) in improving neurocognitive outcomes. New evidence supports the early initiation of HAART. There are recent data to suggest that HAART may be CNS toxic, but evidence is still limited. Ageing does not currently explain the persistence of HAND. A recent study has also shown a correlation between cardiovascular risk factors and HAND.
  
  
  CONCLUSIONS
  The prevalence of HAND remains high in the HAART era. Most studies point towards the benefit of neuro-HAART in the prevention and treatment of HAND. The possible neurotoxicity of HAART needs to be further evaluated. It may be too early to detect a combined ageing and HIV effect and long-term studies are required. The link between cardiovascular disease and neurocognitive decline in HIV needs further exploration. Effective screening in clinical practice is paramount in prevention of the morbidity and mortality associated with HAND.
authors.affiliation: Department of Neurology and HIV Medicine, St. Vincent's Hospital, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, New South Wales, Australia.
authors.forename: Nomvuyo Z
authors.initials: NZ
authors.lastname: Mothobi
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Brew
mesh_terms: D015526:AIDS Dementia Complex / Q000453:epidemiology* / Q000517:prevention & control*; D000375:Aging / Q000187:drug effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015995:Prevalence; D012307:Risk Factors