title: Cognitive Impairment and Persistent CNS Injury in Treated HIV.
abstract: The implementation of combination antiretroviral therapy (cART) has changed HIV infection into a chronic illness, conveying extensive benefits, including greater longevity and advantages for the central nervous system (CNS). However, studies increasingly confirm that the CNS gains are incomplete, with reports of persistent immune activation affecting the CNS despite suppression of plasma HIV RNA. The rate of cognitive impairment is unchanged, although severity is generally milder than in the pre-cART era. In this review, we discuss cognitive outcomes from recently published clinical HIV studies, review observations on HIV biomarkers for cognitive change, and emphasize longitudinal imaging findings. Additionally, we summarize recent studies on CNS viral invasion, CD8 encephalitis, and how CNS involvement during the earliest stages of infection may set the stage for later cognitive manifestations.
authors.affiliation: SEARCH-Thailand, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Phillip
authors.initials: P
authors.lastname: Chan
authors.affiliation: Memory and Aging Center, MC: 1207, Sandler Neurosciences Building, 675 Nelson Rising Lane, Room 192C, Department of Neurology, University of California San Francisco, San Francisco, CA, 94143-1207, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Hellmuth
authors.affiliation: Department of Neurology, Yale University, New Haven, CT, USA.
authors.forename: Serena
authors.initials: S
authors.lastname: Spudich
authors.affiliation: Memory and Aging Center, MC: 1207, Sandler Neurosciences Building, 675 Nelson Rising Lane, Room 192C, Department of Neurology, University of California San Francisco, San Francisco, CA, 94143-1207, USA. vvalcour@memory.ucsf.edu.
authors.forename: Victor
authors.initials: V
authors.lastname: Valcour
mesh_terms: D015526:AIDS Dementia Complex / Q000150:complications / Q000188:drug therapy*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D002490:Central Nervous System / Q000187:drug effects / Q000378:metabolism; D060825:Cognitive Dysfunction / Q000150:complications* / Q000503:physiopathology; D004660:Encephalitis / Q000188:drug therapy* / Q000473:pathology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D015497:HIV-1; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: CNS injury; CaRT; Central nervous system; Clinical HIV studies; Cognitive impairment; Combination antiretroviral therapy; Complications of HIV and ART; HIV infection; Review