title: HIV, aging, and cognition: emerging issues.
abstract: The prevalence of HIV-associated neurocognitive disorder has not changed from the pre- to the potent antiretroviral therapy era, remaining at approximately 50%. In research settings, mild neurocognitive disorder (MND) and so-called asymptomatic neurocognitive impairment (ANI) are now more common than HIV-associated dementia. The diagnosis of ANI is misleading because functional deficits, when tested in a laboratory, and degree of neuropsychologic testing abnormalities are often comparable in patients with ANI and those with symptomatic MND. Age-related comorbidities increase the risk of cognitive impairment in HIV infection. In a cohort of patients aged 60 years or older with excellent antiretroviral therapy adherence, correlates to cognitive impairment were apolipoprotein (Apo) E4 genotype and a novel measure of the effectiveness of antiretroviral drugs in monocytes, the monocyte efficacy (ME) score, with trend associations for diabetes and nadir CD4+ cell count. Management of impairment includes ensuring that patients are on and adhere to antiretroviral therapy and addressing comorbidities. Switching from effective and well-tolerated antiretroviral therapy for patients with mild cognitive impairment is not routinely recommended, but this must still be addressed on a case-by-case basis. This article summarizes a presentation by Victor G. Valcour, MD, at the IAS-USA continuing education program held in Atlanta, Georgia, in April 2013.
authors: Department of Neurology, Division of Geriatric Medicine, University of California San Francisco, San Francisco, CA, USA.
authors: Victor G
authors: VG
authors: Valcour
mesh_terms: D015526:AIDS Dementia Complex / Q000453:epidemiology*; D000375:Aging; D003072:Cognition Disorders / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D012307:Risk Factors
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