title: Controversies in HIV-associated neurocognitive disorders.
abstract: Cross-sectional studies show that around half of individuals infected with HIV-1 have some degree of cognitive impairment despite the use of antiretroviral drugs. However, prevalence estimates vary depending on the population and methods used to assess cognitive impairment. Whether asymptomatic patients would benefit from routine screening for cognitive difficulties is unclear and the appropriate screening method and subsequent management is the subject of debate. In some patients, HIV-1 RNA can be found at higher concentrations in CSF than in blood, which potentially results from the poor distribution of antiretroviral drugs into the CNS. However, the clinical relevance of so-called CSF viral escape is not well understood. The extent to which antiretroviral drug distribution and toxicity in the CNS affect clinical decision making is also debated.
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. Electronic address: s.nightingale@liverpool.ac.uk.
authors.forename: Sam
authors.initials: S
authors.lastname: Nightingale
authors.affiliation: Division of Medicine, Imperial College London, St Mary's Campus, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Winston
authors.affiliation: University of California and HIV Neurobehavioral Research Center and Antiviral Research Center, San Diego, CA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Letendre
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; The Walton Centre Neurology and Neurosurgery NHS Foundation Trust, Liverpool, UK.
authors.forename: Benedict D
authors.initials: BD
authors.lastname: Michael
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
authors.affiliation: Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
authors.forename: Saye
authors.initials: S
authors.lastname: Khoo
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; The Walton Centre Neurology and Neurosurgery NHS Foundation Trust, Liverpool, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
mesh_terms: D015526:AIDS Dementia Complex / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D003072:Cognition Disorders / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D015497:HIV-1 / Q000378:metabolism*; D006801:Humans; D012367:RNA, Viral / Q000097:blood*
chemical_list: D012367:RNA, Viral