title: HIV-associated neurocognitive disorders: perspective on management strategies.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Georgetown University Hospital, 3800 Reservoir Rd NW, 5PHC Building, Washington, DC 20007, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Nabha
authors.forename: Lan
authors.initials: L
authors.lastname: Duong
authors.forename: Joseph
authors.initials: J
authors.lastname: Timpone
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy* / Q000821:virology*; D000818:Animals; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents